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This is part 1 of "Letters to the British Medical Journal Rapid Response Board",
click here for part 2.

Occasionally a topic comes up on the British Medical Journal Rapid Response board that draws the attention of a certain person on the autism spectrum, inciting her to write a "Rapid Response". Below here (in the yellow box) you will find part of a letter written by a Dr. Yazbak to the BMJ. He seems to be angry that they had printed an article repeating what the Mayo Clinic had announced - that there was no good evidence to indicate that there is an autism epidemic. (Tanne JH. Increase in autism due to change in definition, not MMR vaccine. BMJ 2005;330:112-d.) The numbers in parentheses direct one to footnotes. click here for a link to Dr. Yazbak's letter. I don't know how long the BMJ website keeps them available so I am including part of his long letter below. The first part of his letter misapplies the United States Department of Education's IDEA numbers. I have dealt with the abuse of these statistics here. Dr. Laidler has also exposed the real meaning of the numbers here. Yazbak then misuses the stats from the California DDS system. This is what I address in my letter to the BMJ which is in the next aqua colored box. - oddizm.

"<...> AUTISM; DEFINITION and DIAGNOSIS In the United States, (3) the definition and diagnosis of autism have been based since 1994 on the clear criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM IV). The diagnosis is usually made by trained physicians and reviewed by Special Education specialists in the different school districts, before services are provided. Because of the cost involved and the shrinking Special Ed budgets, it is unlikely that services would be provided to anyone who does not clearly fit the criteria. In 1994, there were 22,780 children diagnosed with autism and autistic spectral disorders (ASD) aged 6 to 21 in US schools according to the US Department of Education (DOE) reports to Congress. This number increased on average by 22% per year (18.28 - 26.48%/yr) to reach 140,972 in 2004. (3, 4) According to the same sources, the number of children with autism aged 6 to 21 attending Minnesota schools increased from 296 in school year 1992-1993 to 4,116 in 2002-2003, a 1300% increase in 10 years. The number of such affected students reached 5,076 in school year 2003-2004, a 23% increase in a single year. (4) In January 2004, HHS, CDC and AAP jointly issued an “Autism A.L.A.R.M.” warning that the prevalence of autism (autistic spectrum disorders) in the United States was 1 in 166 children. (5) According to recently released figures by the California Department of Developmental Services (6, 7), a record 807 NEW cases of Type I autism (aged 3 years or older and not including children with other ASD) were admitted into the system in the Fourth Quarter of 2004. This is the largest number of new cases for any October to December period in 36 years. It is 16% higher than the Fourth Quarter of 2003 (676 new cases) and 468% more than the last 3 months of 1994 (142 new cases). On average, California added 9 new children with type I autism DAILY to its system from October 1 to December 31, 2004. To put all this into perspective, while there were apparently 124 children with autism in Olmsted County, MN in 21 years, according to the Mayo Clinic study, California will register the same number of new cases in the next two weeks. In school year 2003-2004, there were 19,034 children with autism/ASD aged 6 to 21 in California and as mentioned earlier, 5,076 in Minnesota.(4) In 2003, the population of Minnesota was estimated at 5,059,375 (8) and that of California at 35,484,453 (9). The percentage of children with autism (ages 6 to 21) to the population was therefore 0.1 in MN and 0.05 in CA, a surprising and alarming finding indeed. The team from the Mayo Clinic can not tell parents that autism represents a small change in definition, when these parents are facing children who convulse, scream and bang their heads all day, or who have severe bloody diarrhea or severe constipation for two weeks at a time, or who meltdown in the supermarket and at church or who freak out when the garage door opens or when the neighbor starts his lawn mower, or who can never be left alone for a minute … and who were born normal and will certainly need help for the rest of their lives. One can only also imagine the outrage of school superintendents (who are responsible for the training and education of these children until they turn 21) or municipal and state legislators (who have to fund all the needed services), when informed that all the challenges they are facing now always existed but with a different name. The fact is that public authorities and school districts are overwhelmed by the recent rapid increase of their financial responsibilities. <...>"

Dr. Yazbak apparently hasn't read the latest quarterly report from the California Department of Developmental Services (1) as he makes the assumption that was made by Rick Rollens, a board of directors member of the University of California Davis, Medical Investigation of Neurodevelopmental Disorders institute (UC Davis MIND institute) (2) in a letter published in the online newsletter, "The Schafer Autism Report". That assumption is that the 807 new cases added to the rolls of the California DDS who are tallied as clients with "autism" are all toddlers. In fact, only 159 of them were 3, 4 or 5 years old when the data were collected. If I may re-emphasize, in 3 months time, in the whole State of California 159 new clients were added to the DDS rolls who were aged 3 to 5. They also added 131 youths 14 to 17 years old, 202 young ones 10 to 13 years old and 172 grade school kids, 6 to 9 years old. This totals 664 children under age 18. I also noted that they added 55 individuals aged 18 to 21, 49 people aged 22 to 31 and one person aged somewhere between 32 and 41. Further, there were 25 recently enrolled, middle-aged autistics between 42 and 51 years old, 11 new autistic clients aged between 52 and 61, and 3 autistics new to the State or to the diagnosis who were over 62 years of age. As for how "functional" these people on the autism spectrum are, it should be noted that doctors here in California have been known to give a diagnosis of autism to a child who might otherwise be diagnosed as having Aspergers syndrome just so that they can get the services they need from the DDS regional centers because they generally refuse to help kids with an Asperger's disorder diagnosis. It might be further noted that Dr. Peter Szatamri in a presentation at the MIND institute last year said that if doctors rigourously followed the DSM-IV (Diagnostic and Statistical Manual -fourth edition) guidelines there might be no one with a diagnosis of Asperger's syndrome (3). As I understand it, it is sometimes perfectly legitimate to diagnose a person who seems like an "Asperger's" person as an "autistic disorder" person. But letting the California DDS speak for itself, it's data show that 82.57% of all their autistic clients have no "severe behaviors" and about 62% have normal intelligence . If you add in the ones with "mild" or "moderate" retardation, you account for about 80% of the DDS clients. Interestingly, about 94% don't have any "Special Health Care Requirements", also 610 people or about 2% of these autistics are able to live "independently". As for Mr. Yazbak's misuse of the United States Department of Education numbers, I have addressed this before on the British Medical Journal's Rapid Response board in response to another autism related article. My points are also made in my analysis of these data in a letter that was published in the Schafer Autism Report (4). I also recommend a very good article by James Laidler M.D. on this subject (5). I would caution anyone to inspect carefully the sources of statistics that show shocking increases in the numbers of autistic children. When I have done so, I have found that the numbers do not measure what they are said to measure. (signature) References: 1)http://www.dds.ca.gov/FactsStats/quarterly.cfm 2)http://www.ucdmc.ucdavis.edu/mindinstitute/html/our_team/directors.html 3)http://www.ucdmc.ucdavis.edu/mindinstitute/html/events/index.htm 4)http://www.geocities.com/autistry/conspiracy.html 5)http://www.autism-watch.org/general/edu.shtml Competing interests: None declared