Autism: Why Diagnoses Are Growing; understand – 03/04/2023 – Equilibrium

Writer Renata Formoso confesses that she felt relief when she learned that her son Noah, who is now seven years old, is autistic.

“It’s obvious that I didn’t want him to have the disorder. But receiving confirmation of that fact worked like a flashlight. At that moment, I finally knew that I would have a light to help us walk this path”, he reports.

Renata lives in London, UK, and says that she had never noticed anything atypical in Noah’s behavior or in the way he interacts with the world.

“He was always a very talkative child and had no developmental delay. However, when Noah was three and a half years old, the daycare teacher came to talk to us and advised us to look for a neuropediatrician”, he says.

According to the teacher, the boy was having some difficulties in the classroom, especially when it came to interacting and socializing with his classmates.

But then came the Covid-19 pandemic, and plans to undergo a medical evaluation had to be postponed for almost two years.

“During this period, I began to read a lot about autism. I also began to notice several signs, such as the fact that my son sings a lot, as if every game needed a soundtrack”, he details.

At the age of five, the boy finally managed to see the neuropediatrician, who “officially” confirmed the diagnosis of autism and ensured that feeling of comfort mentioned by Renata.

“It was a great relief to understand that Noah has certain limits that need to be respected by us, as a mother and father, by his family and by the community. I noticed that everyone became more patient – ​​and that did not change the wonderful child he was in the least. was always.”

Although each patient is unique and has its own particularities, Noah’s story is far from unique: every day, several children are diagnosed with autism around the world.

And the numbers show that the detection of this developmental disorder, marked by communication difficulties, repetitive behaviors and restricted interests, is on the rise.

A newly published survey by the United States Center for Disease Control and Prevention (CDC) reveals that 1 in 36 American children under the age of 8 have autism.

This work, which is repeated every two years, reveals a solid upward trend in cases: in the previous edition of the survey, the rate was 1 case in every 44 boys and girls.

To give you an idea, in the year 2000, the prevalence was 1 in 150 – and in preliminary studies in the area, carried out in the 1960s, this number was estimated at 1 in every 2,500.

But, after all, why does the diagnosis of autism cases grow so much? While there are no definitive answers to this question, experts suspect that increased awareness of the topic is the main explanation for the phenomenon.

What does the research say?

The CDC article evaluates autism diagnoses in several health centers, spread across 11 US states.

The most recent data point to a prevalence of 27.6 cases of the disorder per thousand children aged up to eight years (which allows reaching a ratio of 1 to 36).

The work also shows that autism is 3.8 times more frequent in boys – about 4% of them have the condition.

However, the statistics are also rising among the female audience. This was the first year that the percentage of girls with autism surpassed 1%.

Another novelty observed in this year’s survey has to do with race: the prevalence of the disorder was lower in whites when compared to other groups, such as blacks and Hispanics, a reversal of the historical trend.

And this is not the only evidence that points to an increase in autism diagnoses: researchers from the University of Newcastle, in the United Kingdom, estimated that in 2021 that 1 in 57 British children will have the condition, a number that is significantly higher than that previously registered in the United Kingdom. country.

Unfortunately, there are no official statistics or epidemiological studies of the kind carried out in Brazil.

“Studies like the CDC’s are very important for us to think about specific public policies for these individuals”, analyzes neuropsychologist Joana Portolese, coordinator of the Autistic Spectrum Disorders Program at the Institute of Psychiatry (IPq) at the Hospital das Clínicas in São Paulo.

What causes autism?

Autism is in that group of diseases whose origin is complex and multifaceted.

Among specialists, there is no doubt that genetics has an influence on this condition.

“But there is not a single gene responsible for autism. There are alterations in different stretches of DNA that can lead to the development of the disorder”, points out Portolese.

But changes in the genome are not able to explain 100% of cases. That’s where environmental factors come in, especially those that happen during the nine months of pregnancy.

For example, children of older fathers or mothers, who are over 35 years of age at the time of conception, are at increased risk of developing the disorder.

“In addition, issues such as stress, overweight, gestational diabetes and hypertension during pregnancy are other risk factors”, adds the IPq specialist.

Portolese recalls that autism is not something that is acquired: the person is born with the disorder and, from the first months of life, presents patterns that can raise suspicion and the need for a medical evaluation.

“The way the look is established, the understanding of the social world, understanding what the mother and the people around her are trying to say, the expression of feelings… All of this can be different”, he describes.

precious windows

Noticing these signs early, by the way, is strategic, point out the experts interviewed by BBC News Brasil.

“There are windows of neurological development that we can take advantage of. The first of them goes up to two years of age”, quotes psychiatrist Daniel Minahim, clinical director of Associação Vozes Atípicas (AVA).

“If the intervention takes place early, within these periods, the result is even more positive”, he adds.

Therefore, being aware of the symptoms and, if necessary, making an appointment with a specialist in early childhood is very important.

“In short, autism rests on a tripod of symptoms. First, communication and speech-related disorders. Second, repetitive behaviors. Third, restricted interests, in which the individual focuses a lot on just one or a few things well specific areas”, informs Minahim.

“Autistic people like other people, have feelings and want to interact”, clarifies Portolese.

“The big issue is that, precisely because of the difficulty of social communication, they are often focused on the things that interest them, because it is difficult to understand the subtleties of the subliminal”, she adds.

There are no specific tests to detect the disorder. Health professionals use some scientifically validated questionnaires. They also ask a series of questions to investigate the case in detail before reaching any conclusions.

Even the age at which the diagnosis occurs is something that needs to be improved: in the CDC survey, the disorder is usually discovered at 48 months (or four years of life).

The ideal, according to international guidelines, is that the conclusion that the child has autism happens a little earlier, from 36 months (or three years) – precisely to take advantage of such windows of opportunity for intervention in neurological development.

This, of course, does not mean that late diagnosis of autism is a waste: by discovering the disorder in any age group (even in adolescence or adulthood), the person can seek a better understanding of themselves and initiate treatments to alleviate specific symptoms. or difficulties that impair well-being and quality of life.

information and awareness

But after all, what explains this increase in diagnoses in recent decades?

“When we see ascending curves of cases, as in autism, we are always left with a flea behind our ear: is there any biological factor behind this?”, asks Minahim.

“But we need to be careful with conspiracy theories or false information. There is no environmental factor that has changed recently and that serves as an explanation for this increase”, continues the psychiatrist.

“What we see of change, in fact, is a greater awareness about autism, with the dissemination of more information both among health professionals and among the population”, he completes.

“These statistics possibly reflect improvements in screening, awareness and even access to health services by minority populations”, agrees Portolese.

That is: as people are more informed about the disorder, they become aware and seek help if they notice the symptoms in themselves or in close family members.

For pediatric neurologist Carlos Takeuchi, scientific advisor at Instituto Pensi – Research and Teaching in Child Health, in São Paulo, future research needs to better investigate this increase in diagnoses.

“It could be that there are genetic and environmental factors involved in this”, he opines.

Takeuchi, who is also coordinator of the Neurology Service at Sabará Hospital Infantil, in São Paulo, reinforces the need to start treatment as soon as possible – and always with the help of several professionals.

“The patient usually needs cognitive-behavioral therapy, with analyzes applied to the behaviors he presents”, he details.

“It may also be necessary to do speech therapy, occupational therapy, have school support…”, he adds.

In some cases, doctors even prescribe medications that help to better deal with specific symptoms (such as insomnia or difficulty concentrating, for example).

In other words, there is no single recipe or treatment that works for all autistic people. Depending on the degree of impairment and symptoms, the individual may need more than one therapy or another.

Lessons learned from practice

About two years after Noah’s diagnosis, Renata reflects on some things she would like to say to all families who receive similar news.

“Once, I heard a sentence that struck me: when you meet an autistic child, you only know an autistic child”, he says.

“The autism spectrum is very broad and each individual, each family, will have a different way of dealing with the world.”

Renata also gradually learned from other patients and through social networks to avoid certain terms, which can reinforce stigmas or annoy people with the disorder.

“There is no mild, moderate or severe autism. In Brazil, we have levels one, two and three of support, according to the need for intervention and support that the person needs”, he teaches.

“Phrases like ‘Wow, but he doesn’t look autistic’ or ‘He’s a blue angel’ don’t help either. Autism doesn’t have a face, and we can’t infantilize the struggle of people who just want to be included, go to school, find a job and do the daily activities”, highlights the writer.

Finally, Renata understands that acceptance of the diagnosis by families is always the best way.

“Accepting that your child has autism can open up a wonderful path for the child to finally be who they are.”

This text was published here