Why have autism rates ‘exploded’ in New Jersey?

Researchers at Rutgers University have revealed that pre-schoolers in New Jersey have the highest rates of autism ever recorded in the US. They report rates of autism have increased faster in children living in New Jersey than in other states.

The study, which was conducted in conjunction with the Centers for Disease Control and Prevention (CDC), states that up to three percent of children in the US live with autism spectrum disorder (ASD).

Autism cases have risen by 43% in the past decadeAlexander Lukatskiy | Shutterstock

As a spectrum condition, autism affects people in different ways, with different symptoms arising among those with the condition that manifest with varying levels of severity.

There are two main characteristics of autism. The first is a person showing difficulties with social interactions and communication, for instance joining conversations or reading social cues. The second main symptom is engaging in repetitive behaviors, routines, and activities.

Possible symptoms of autism in pre-school aged children include delayed speech development, rejecting physical gestures of affection, avoiding eye contact, showing little interest in interacting with other children, or preferring to play with toys in a repetitive manner over engaging with imaginative play.

Children who are diagnosed with autism by their fourth birthday are often diagnosed early because they present moderate to severe symptoms of autism and catch the attention of pediatricians and early-childhood educators. One in 35 children in New Jersey are diagnosed by this time.

The study analyzed data from the health and special education records of 129,354 children who turned 4 between 2010 and 2014, along with 128,655 children who were 8 years old during the same period.

Guidelines for ASD in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders-IV were used for the study’s primary findings.

The data for New Jersey was sourced from the Autism and Developmental Disabilities Monitoring Network (ADDM), a network that has monitored rates of autism diagnoses for almost 20 years.

Along with researchers in New Jersey, researchers in Arizona, Colorado, Missouri, North Carolina, Utah, and Wisconsin analyzed health records of almost 71,000 children.

Autism rates increased by 43% between 2010 and 2014

Walter Zahorodny, an associate professor at Rutgers New Jersey Medical School who was responsible for running the study in New Jersey, explained that among 4-year-olds, the rate of autism increased by 43 percent from 2010 to 2014, with 1 in 23 four year old boys being diagnosed with autism. He also said that the increasing rates of autism in children show no signs of slowing.

The explosive rate of autism is impossible to ignore. There’s no let-up. I really don’t understand why the rate is going up in this way.”

Dr. Walter Zahorodny

Risk factors associated with ASD incidence include advanced parental age, maternal illness during pregnancy, genetic mutations, and premature birth.

“These are true influences exerting an effect, but they are not enough to explain the high rate of autism prevalence,” Zahorodny said.

“There are still undefined environmental risks that contribute to this significant increase, factors that could affect a child in its development in utero or related to birth complications or to the new-born period. We need more research into non-genetic triggers for autism.”

The results were ‘startling’

Discussing the prevalence of ASD in children of 4 years of age, the estimated prevalence of ASD was “13.4 per 1,000 in 2010, 15.3 in 2012, and 17.0 in 2014.”

Disparities in ASD prevalence were also highlighted by the study, with the prevalence of ASD in 4-year-old white children standing at 7.7 per 1,000 children in Missouri (2014), but 29.3 in New Jersey (2014).

Data for black children in New Jersey showed a prevalence of 24.7 per 1,000 (2014), and prevalence in Hispanic children was 28.2 per 1,000 in New Jersey (2014).

It was found that across all the sites studied, ASD prevalence was higher in boys than in girls, ranging from 2.6 in Arizona and Wisconsin (2010) to 5.2 boys per one girl in Colorado (2014).

The study states “an absence or delay in ASD identification could adversely affect children by delaying interventions and initiation of special services.”

We must take swift and systematic action to increase access to and fund medically necessary treatment for every child with autism. Early identification is crucial to helping families access services for these pre-schoolers, who need intensive treatment to learn developmentally appropriate skills and maximize their potential.”

Suzanne Buchanan, Executive Director, Autism New Jersey

Zahorodny deemed the results to be “consistent, broad and startling,” believing that “It’s very likely that the next time we survey autism among children, the rate will be even higher.”

Limitations of the study were acknowledged, from the fact that the study was based on a record review and not clinical examinations to the possibility that some children with ASD may not have been included in the network because their records were incomplete.

Additionally, the specificity of the records may have been affected by early diagnoses being changed at a later date if clinicians have concluded a different diagnosis fits a child’s symptoms more accurately.

The earlier the diagnosis, the better

On the importance of early screening, Zahorodny said: “Children who are evaluated for autism early – around their second birthday – often respond better to treatment than those who are diagnosed later. However, it appears that only the most seriously affected children are being evaluated a crucial time, which can delay access to treatment and special services.”

It is concerning to see results showing that black and Hispanic children were slightly less likely to be diagnosed than white children and that the age of diagnosis did not change over a period of 15 years. An increase in demand for services and subsequent delay in care could account for this plateau.

According to Zahorodny, “The experience of our special education system and the number of developmental specialists in our region” meant that NJ’s data was more complete than other states.

Despite our greater awareness, we are not effective yet in early detection. Our goal should be systematic, universal screening that pediatricians and other health providers provide at regular visits starting at 18 months to identify autism as soon as possible.”

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