Talk:Epidemiology of autism/Archive 1

Genesis
Since other suggestions have been made about it, here is the true story of how this article arose.

Autism epidemic was not a good article. I rfa'd it. It survived after a typically rancourous discussion.

user:KimvdLinde suggested in the rfa, a couple of hours later that if one stripped out the extraneous garbage there might be an article there

"Delete if unaltered. Otherwise, major weeding out of junk, non-verifiable stuff,  speculation, POV etc could make it a basic article"

she said.

So I focussed on a definite topic - what is the incidence of autism and why is it difficult - and by stripping out anything not about it, and anything else that was junk, non-verifiable stuff, speculation, POV and other bad things found that indeed, there was something that looked quite like an article.

So then I put it up here for other people to edit further, and remarked upon it. Saying as is below ... 12:35, 7 April 2006 (UTC)

too long
This is still too long, with too much in it, but a page on what the incidence is and whether it is changing, but not why, has a chance of beng useful if only to other pages. Midgley 01:59, 6 April 2006 (UTC)

that graph
It was a problem - rather an advertising presentation graph - someone must have a graph of incidence by time for one or more countries that is available for use... Midgley 00:54, 7 April 2006 (UTC)

Russia, and landmark events might be ruled in
I'm not quite convinced that stripping out the remark in Russia "incidence ... since 1985 when Thimerosal was abandoned..." is necessary. COnsidering changes in incidence relative to a particular event/date/change is not unreasonable for an incidence article. I agree it is reasonable, and pure, and I personally would be inclined to oppose any amplification of thimerosal's discontinuation such as commonly gets repeated near the word (that is what links are for and that link might well be to Thimerosal controversy rather than Thimerosal (chemical), but perhaps concensus may grow to favour putting that one clause back in. Maybe.  I however shall not do it. Midgley 21:53, 7 April 2006 (UTC)
 * It is interpretation, and as such original research. No citation that links the change with the cause.KimvdLinde 21:57, 7 April 2006 (UTC)
 * Read with emotional tone absent: Hmmmm.  Those are two reasons to not do it, yes, or might they be seen as excuses to not do it.  One might consider whether it would be of assistance to the reader to be told why the date given is given, and the answer there is that I think it might well be of assistance.  I agree that a citation is essential, but I'd more require one that said that "In 1985 Russia abandoned Thimerosal" than a citation of the widespread rumour that Thimerosal is worthy of note for some reason.  I think the latter could actually be left as common knowledge, for two reasons: - firstly the references that might be cited almost all without exception simply suck; and secondly, few if any people will arrive here without having been alerted to the mentions of Thimerosal and autism in adjacent sharply indrawn breaths.  As I said, I will not add it myself, and nor will I press anyone else to do it, but like Hemingway, if we leave out an important plot point or character development we must know that we do so, and know that our readers will interpolate it themselves and not have their experience diminished thereby.  Midgley 22:34, 7 April 2006 (UTC)
 * I am in extreme verifiable mode with this article, just to get that kind of shit weeded out (you are going to regret that I am here ;-). If there is a good primary or secondary source providing evidence of the link with Thimerosal, fine. If not, it has to stay out, or we have to list all possible causes (Collapse of the USSR and subsequant worsening of the mediacal system? Changed diagnostic criteria? etc) So, without a source backing that specific link, it is original reseach. KimvdLinde 15:11, 8 April 2006 (UTC)
 * That is an entrirely reasonable view, and the material now presented in this article will not suffer from application of so pure a principle to it. I'm satisfied with that and feel the presence or absence of that clause has been discussed sufficiently.  It stays out, in teh knowledge tehat there is a reason for it being out.  Thanks.  Midgley 17:07, 8 April 2006 (UTC)

It needs ...
A picture to reach the GA standards. Midgley 09:31, 8 April 2006 (UTC)


 * If there is some verifyable data out there, I can make a good graph of that. KimvdLinde 15:02, 8 April 2006 (UTC)

And if there was anyone who knew anything about autism and New Jersey it would be useful if that paragraph acquired some citations. Even in Autism epidemic that would be useful. Midgley 09:31, 8 April 2006 (UTC)

Epidemiology
I don't think the new discription of epidemilogoy is relevant here. As I've wrote several times already in autism & Asperger talk, autism is not as disease. Therefore, it should not be here. Just as naming an article "autism epidemic" is POV and wrong, so is useing the word "disease" in this or any other autism-related article. --Rdos 13:43, 8 April 2006 (UTC)
 * I can agree with avoiding the word disease, what term woruld you use instead? Condition? KimvdLinde 15:02, 8 April 2006 (UTC)
 * Even though I don't like that term either, DSM uses disorder. Disorder at least does not say anything about the causes of autism, which disease implies. Condition is better, but it isn't used in DSM, so could be found POV by the other side? --Rdos 10:11, 9 April 2006 (UTC)
 * I think its relevance is entirely limited to distinguishing incidence from prevalence. There is no reason at all for the word disease to be in there, condition, variant, or event would be perfectly correct and I'd be pleased if someone picks one and changes it.
 * I think it is relevant though. The article is about incidence, and empirically there is a lot of confusion between incidence and prevalence in writing about the number of cases of {thing} that one sees or has.  I am firmly of the opinion that presenting that definition and distinction in the first piece of the article will reduce the maintenan ce load and assist subsequent editors in avoiding writing about something else.  (I'm not suggesting they shouldn't write about Autism (prevalence) or Autism (epidemiology), just that it is best not to do it in an article titled "Incidence".)  The second box, noting a difference between new cases and indcidence also addresses a confusion which I believe has added fluff and work.  Making a clear distinction within body text seems to me less easy and effective.  But then, I like boxouts. Midgley 10:58, 9 April 2006 (UTC)

Drop in cases
Does anyone know the reason why the cases dropped in the US? Just another star in the night T 01:23, 13 April 2006 (UTC)


 * The short answer seems to be no. Indeed, there is still argument about whether the cases have dropped.  It seems accepted that case incidence rose, but when it all settles down and people are looking at it neutrally that may still turn out to have been an illusion (I don't think it will).    I wonder if we are stopping watching TV now - that seems to fit quite well.  Midgley 08:36, 13 April 2006 (UTC)


 * A possibly banal explanation, but nonetheless relevant. Diagnoses are subject to the "fad effect," just like many other things in society. The statistics are also influenced by this effect, and they will swing up and down in harmony with this phenomenon. One will always experience a steep increase in the statistics starting with the "discovery" of a disease, even if it has actually existed for the last million years. This attracts attention, diagnostic criteria are refined, more and more clinicians become better at recognizing and diagnosing the condition, the press gets involved, the internet gets involved, activist groups get involved, ...... you get the picture.


 * This creates a false picture of the real incidence, and the numbers go up, then yo-yo up and down a bit, and then fall slightly, only to stabilize once the big hub-bub is all over and the disease is accepted as a "so what" part of life. Only then (and it can take a number of years to reach that point!) can one get an accurate picture of the real incidence, and then measure if there is a real increase, decrease, or stable situation. My son is an Aspie, so this is also of personal interest to myself. It would be very tempting to play the blame game and join the activists, but I still retain some critical thinking abilities.....;-) As a skeptic I need good proof first. -- Fyslee 18:21, 13 April 2006 (UTC)

Stable article
By the (low) standards of the genre, this is a stable article. I propose we work toward good article (I think it is too specific to be FA) status, and make a stable version of it. Midgley 20:56, 13 May 2006 (UTC)
 * I agree. I might read over it this evening and see what I think. Kim van der Linde at venus 22:43, 13 May 2006 (UTC)
 * But ultimately, at the end of the day, a merger with frequency of autism would be necessary to avoid having two articles on the same topic. Andrew73 00:10, 14 May 2006 (UTC)
 * What is frequency of autism about though? It isn't prevalence, it isn't incidence, and it isn't settling down - it really continues to be an assertion that there is an epidemic. Midgley 01:26, 14 May 2006 (UTC)
 * I don't think the lay person would necessarily appreciate the difference between "frequency" and "incidence." In any event, a merger would serve to tone done the epidemic POV in the frequency of autism article.  Having two articles on the same topic seems a bit excessive, and risks orphaning the important points made in the autism (incidence) article.  Andrew73 01:47, 14 May 2006 (UTC)
 * Only this article was created by leaving behind everything of Autism epidemic that was referenced, and only then adding anything else. Merging it back in recreates the old article.  And there is a voice for not losing the old article, whatever it ends up being called.  I looked at pulling out an article on prevalence of Autism/PDD, but there isn't the material there.  Antivaccinationist might be warming up again ... they are all tied together still.  Midgley 02:05, 14 May 2006 (UTC)
 * The main problem is that it is nearly impossible to change something to NPOV in autism articles due to the continued soapboxing of some editors. But I would be very much in favour. Kim van der Linde at venus 03:46, 14 May 2006 (UTC)

Picture
What can we use as a picture, to illustrate it? Or would a graph do? 02:08, 14 May 2006 (UTC)

Merge
This article should be merged with Frequency of autism. — Reinyday, 23:00, 13 July 2006 (UTC)
 * Better, this article should replace it, that article is full of POV, and unreadable stuff. -- Kim van der Linde at venus 01:57, 14 July 2006 (UTC)
 * What actually is frequency of autism? I mean as a definition?  We can do "Incidence" because we know what that is.  We could do "prevalence",  but what would the scope fo frequency of autism be if someone wrote an article about it?  (Note that the article referred to was a sopaboxy effort arguing that there is an epidemic of autism.  Also note, if you wouldn't mind, that there is a description of the geenration of this article already in this page, and merging it seems wholly illogical - deleting it would be logical ...  Midgley 22:31, 14 July 2006 (UTC)

Level One Autism
There is no mention of the fact that the least ambiguous diagnostic category of autism, "level one", is the category least susceptible to false increase of incidence.

New Cases
There are a couple info boxes that use the term "New Cases" in this article. That metric is not a useful metric, the way it's calculated. To be an indication of incidence, "new cases" should be the number of persons diagnosed in that period of time (quarter or year). But this information is generally unavailable from administrative data. For example, when people speak of "new cases" in the California DDS, they are referring to the difference in caseload from one quarter to the next. But unfortunately, this is not the same as the number of new clients in the system. That's because some clients leave the system every quarter, and not a negligible number of clients at that. The number of clients who leave periodically obviously must depend on the total size of the population, confounding matters further. Neurodivergent 20:08, 19 October 2006 (UTC)
 * New cases is a difficult term - it appears in the literature, and the purpose of one of the boxes is to distinguish between "new cases" and "incidence", since they don't appear to be the same thing. In an older less focussed article they are not distingushed, with results that could confuse the reader.  Midgley 21:16, 9 March 2007 (UTC)

Proposal to redirect "Frequency of autism" to "Autism (incidence)"
Please see Talk:Frequency of autism. aLii 01:55, 14 February 2007 (UTC)

Totally disputed
This article barely reads like an article. Opinions are stated as facts, speculations are presented as conclusions, etc., and numerous questions are omitted. --Leifern 02:02, 18 February 2007 (UTC)
 * It would help if you were more specific. aLii 01:33, 9 March 2007 (UTC)
 * It does suffer from having been derived from autism frequency by only throwing out the egregious and obvious errors and irrelevancies, there is clearly more work to do. SOme editors will wish to put them all back in, I see this POV stuff is well under way.  Midgley 21:13, 9 March 2007 (UTC)
 * Well, as an example, the citation to the (UK) National Autistic Society is invalid, bordering on fraudulent. The NAS says that it's difficult to ascertain the exact incidence of autism and does not discuss any increase in incidence. --Leifern 13:35, 13 March 2007 (UTC)
 * As you insist on being vague, am I correct in assuming that you mean this one? It looks like a fair article to me, and references numerous journal articles. Would you be happier if the journal articles were referenced directly?
 * I can see that there is scope for balancing the point that some people are convinced that there is a huge increase in cases, whereas others are saying that it is not clear-cut. The NAS reference, although it has the latter viewpoint, is not referenced for that. I've just added a citation needed tag to "Public health organizations and researchers have not yet determined causes for the increase in reports of Autism."
 * Do you have any further points other than balancing the lead and first section? It seems like a sentence or two and a few extra references would do the trick. aLii 14:00, 13 March 2007 (UTC)
 * Yes, sorry that is the reference. The article is written in 1999 and takes no position - even at that point - on whether there is an increase in incidence, and discusses only the difficulty of measuring incidence. I've pretty much given up on making this subject matter NPOV, as it seems to be dominated by individuals who will not be convinced how serious this problem is until it either affects them personally or it is blindingly apparent. It all reminds me of Schopenhauer's quote: "All truth passes through three stages. First, it is ridiculed. Second, it is violently opposed. Third, it is accepted as being self-evident." --Leifern 14:04, 13 March 2007 (UTC)
 * In an article about the incidence of autism, a difficult topic of some interest to many people for various reasons, in a section of that article on the incidence in a particular country, a reference to a national organisation discussing the difficulty of measuring incidence there seems to me quite reasonable. A reference stating that incidence was increasing would perhaps be useful for an article called ((Autism epidemic)), but this is not the article called autism epidemic (nor is any other article, since nobody has been able to write one that passed muster) and therefore there is no need for all references to state that the incidence is increasing.  References stating what the incidence _is_ at a particualr time, or set of times, would fit right in, and references to the various nations' organisations' views on the difficulty of estimating incidence in 1999, 2000, 2001, 2002, 2003 4 5 6 7 and indeed 8 would be useful contributions - a useful editor might offer them, if they exist.  If they don't exist, then cavilling about the use of what has been published as WP:RS is unreasonable, pointless, non-contributory, adverse to process, and many other things not suitable for presence here.  But consistent.  Midgley 00:07, 14 March 2007 (UTC)
 * Midgley, it's always a challenge to parse your version of English prose, but let's be clear here: "Autism epidemic" redirects to this article. The current title reflects an attempt at arriving at an NPOV article and should encompass findings that support an increase in the incidence of autism. As for your feeble attempts at personal attacks, they only reflect poorly on you.
 * Leifern, no-one wants "to hide the truth" or even anything remotely similar. However one should attempt to stick with the prevailing medical opinion, rather than the opinions of the few. Global warming could be re-written as a complete hoax, if you were to believe some scientists. Putting in some references to the supposed epidemic is perfectly reasonable, if done so with the proviso that it isn't the prevailing opinion. aLii 17:17, 13 March 2007 (UTC)
 * Leifern's comments don't really indicate that he can read. "invalid, bordering on fraudulent. The NAS says that it's difficult to ascertain the exact incidence of autism".  That is why the reference is adduced.  Try reading without the red filter of rage, the English is very straightforward.  Midgley 23:58, 13 March 2007 (UTC)
 * Yes, I'm illiterate, too. --Leifern 09:23, 5 July 2007 (UTC)
 * If anyone needs it side by side, here is the actual article text "The National Autistic Society estimated the prevalence of autism spectrum disorders in the total population at one in 110 and regarded the incidence and changes in incidence with time as unclear.[22]." I suggest the totally disputed tag be removed. Midgley 00:10, 14 March 2007 (UTC)
 * Midgley, please refrain from condescending personal attacks. --Leifern 08:51, 5 July 2007 (UTC)

Picture
See previous mentions here. By all means present an alternative picture to illustrate the article. A picture of an epidemiologist is relevant to an article on an epidemiological topic. Midgley 21:32, 9 March 2007 (UTC)

Incidence
"Silicon Valley cluster A 2002 BBC article indicated that one in 150 children in the region had an autistic spectrum disorder.[39] A 2001 article in Wired suggested that the cluster is a result of a link between autistic disorders and computer skills.[40]"

Can we find anything about incidence in that or for it? An indication of the incidence _around_ Silicon Valley would also be useful, particularly to examine whether there is actually evidence of a cluster there. 1/150 is not higher than many of the claims that rattle around WP for prevalence in the general population. Midgley 01:39, 16 March 2007 (UTC)
 * In the paragraph below, on the Amish, for instance, there is an unsourced assertion that the surrounding incidence is 1/166 (coupled with a suggestion that that times 22000 is "dozens", but it is a figure even if not of incidence.)  A difference between 1/166 and 1/150 is less than impressive - it looks like 7% which is a rather subtle clustering. Midgley 01:53, 16 March 2007 (UTC)

Oz - the same, below

A peer-reviewed paper showed the number of Australian children with autism spectrum disorders was between 60 per 10,000 and 100 per 10,000 (0.6% to 1%). This paper also showed different ways of presenting "prevalence" gave very different figures but represented the same underlying rate of autism spectrum disorders in the population. In particular, the number of young (under 10 years of age) children diagnosed with autism spectrum disorders does not equate to the prevalence of autism spectrum disorders in an overall population.

Another report commissioned by the Australian Advisory Board on Autism Spectrum Disorders with funding from the Commonwealth Department of Families, Community Services and Indigenous Affairs, published in 2007 shows autism prevalence of 62.65 per 10,000 in Australian children aged 6 to 12 years.

England A more recent study from Kent has reported the following prevalences (per 10,000): pervasive developmental disorder 82.8 (male to female ratio 6:1), childhood autism 23.7, Asperger's syndrome 11.8 and autistic spectrum disorder 47.3 [37].

It looks more and more as though an article on Autism (Prevalence) might be viable. Midgley 00:06, 16 July 2007 (UTC)

US

"A recent estimate by the National Autism Association is of approximately 500,000 autistic spectrum cases in the United States, including up to 1 in 150 children. Anne McElroy Dachel of the NAA noted that 80% of autistic Americans are under the age of 18. " Prevalence...

"The rising enrollments in special education classes in the nation's public school system provide another estimate of prevalence, subject to confounding factors. In Ohio in 1992-93 there were only 22 reported cases of autism, but by 2003-04 there were 5,146; in Illinois, there were five cases in 1992-93, and 6,005 in 2003-04; in Wisconsin, 18 cases of autism in 1992-93 and 3,259 in 2003-04. As many as 1.5 million Americans may have some form of autism, including milder variants, and the number is rising. Epidemiologists estimate the number of autistic children in the US could reach 4 million in the next decade.

" Prevalence, with embedded commented out unreferenced content from earlier, some of it from much earlier. Midgley 00:28, 16 July 2007 (UTC)

Pennsylvania
There are 74,000 Pennsylvanians diagnosed with autism spectrum disorders.

China "There are 1.8 million reported cases of autism in China with over 10,000 known cases in Shanghai . This gives a prevalence of 1 in 720 for the country (based on a population of 1.3 billion people ) and 1 in 1600 for Shanghai (based on 16 million population).

" as for US, embedded previous redacted content

California is considered to have the best reporting system for autism in the USA because of its promise of educational services to handicapped children with a diagnosis of autism. According to data released in late 2005 by the California Department of Developmental Services (DDS), new cases &mdash; of professionally diagnosed full syndrome DSM IV autism &mdash; entering the DDS system indicated a decline, from 734 new cases during the second quarter of 2005 to 678 new cases during the third quarter of 2005, a 7.5% decline in one quarter.

As of August 1993, a total of only 4,911 cases of autism had been logged in DDS's client-management system, a number excluding milder autism spectrum disorders such as Asperger's syndrome. By April 29, 1999, the DDS reported a State-wide incidence rate of about 15 to 20 per 10,000, triggering alarms about the increase.

As of 2005, the DDS reported 28,046 cases, but that the rate of increase peaked in 2002 and has dropped slightly since. According to data released by DDS in January, 2006, the number of new cases of professionally diagnosed full syndrome autism entering California's developmental services system in 2005 was the lowest since 2001. The DDS year end report documents that, in 2005, California added 2,848 new cases of autism to its system. Not since 2001, when 2,725 new cases were added, has California added fewer new cases of full syndrome autism to its system. Ever since the record year of 2002, there has been a slow, steady decline in the number of new autism cases entering the 37-year old DDS system, even though levels have still not yet reached the 1 in 166 reported by population-based studies.

The use of the term "New Cases" has come into question and DDS has written that "New Cases" should not be calculated as the difference in the numbers between quarters . Concerns have been raised that "New Cases" could reasonably include older people newly diagnosed, and immigrants.

The total caseload handled by the state continues to increase much faster than population growth, but the recent trend points to a decrease in the caseload increase per quarter. . The awareness curve might be levelling off. It has also been pointed out that the caseload does not yet meet the levels found in population studies.

According to a report by the DDS the prevalence of children diagnosed with full-syndrome autism in California nearly doubled between 1999 and 2002, from 10,360 to 20,377. The report stated, "(B)etween Dec. 31, 1987, and Dec. 31, 2002, the population of persons with full-syndrome autism has increased by 634 percent."

California's increase in childhood autism was not due to flawed diagnosis, according to a 2002 study led by University of California, Davis pediatric epidemiologist Robert Byrd. 1,685 newly diagnosed autistic children had entered the state's regional center system the previous year, making a 273 percent increase over an 11-year period from 1988 to 1999 during which period the state's population increased by approximately 20%. The data again included only children with classic autism, discounting those with PDD-NOS, Asperger's etc. "The sheer complexity of this phenomenon prevents any clear conclusions," the report stated. "What we do know is that the number of young children coming into the system each year is significantly greater than in the past." However, a reanalysis of this report's data showed that the observed increase in autism was canceled out by an observed decrease in mental retardation, indicating that diagnostic substitution had occurred.

The above looks good (except phrasing definitions of numbers as "concerns have been raised" wich really doesn't do the job. But none of it is incidence.

Midgley 00:36, 16 July 2007 (UTC)

Australia
The Victorian Education Department reported a 276 percent rise in students with autism spectrum disorder between 2000 and 2005.

Prevalence reference:
 * NIH.gov - 'Prevalence of autistic spectrum disorders in Lothian, Scotland: An estimate using the 'capture-recapture' technique', M.J. Harrison, A O'Hare, H. Campbell, A. Adamson, J McNeillage, Arch Dis Child. May 10, 2005

Header/Lead
"While the causes for this trend remain uncertain and difficult to ascertain, factors such as environmental shocks, changing diagnostic criteria, and greater awareness of autism are cited."

The trend isn't really made out in the article, although the lead has been rewritten to assert it. Causes are more topics for autism (aetiology) than the question of what we know about the incidence. The latter two clauses are relevant to difficulties in measuring incidence, but they seem rather deeper than the lead need be. Midgley 00:43, 25 July 2007 (UTC)

incidence in Amish community
The reference is broken. I'd suggest that a note that the incidence among Amish has been suggested to be low, along with whatever it might be known to be, and references go back when avaialble.

"

Amish anomaly
No formal or prospective study of incidence or prevalence has been conducted. Informal efforts to assess the prevalence of autism in the Amish community revealed only a few cases of autism. About 22,000 Amish live in Lancaster County, yet only three or four Amish with autism have turned up so far in an informal survey of Lancaster County. 132 would be expected if the prevalence in society at large is 1-in-166. Dr Frank Noonan, a Lancaster County family doctor, reported that other conditions were found in expected numbers. The Department of Health and Human Services may study the Amish community. There are substantial confounding factors among Amish lifestyle and genetic restriction and homogeneity. "

What's with the boxes?
I noticed that the current version of the article has some green boxes floating next to the text; I was wondering where they came from....


 * The first is located smack-dab at the top of the article, right next to the lede. It provides definitions for incidence (epidemiology) and prevalence.


 * The second contains a table of data showing new cases of autism in the United States from 2001 to 2005.


 * The third one provides a definition/distinction between "new cases" and "incidence".

As far as I know, no other Wikipedia article breaks out specific definitions into little boxes floating next to text. Where technical language or terms of art need explanation, we provide a brief definition in the body text. For longer or more thorough definitions, we rely on wikilinks to detailed articles. (This is an advantage of wikimarkup and HTML over paper&mdash;we don't need to have the little breakout boxes which might be found in a child's textbook or magazine article.) I'll be removing the first and third boxes and merging them back into the text as appropriate.

With respect to the second box, I'll probably fold it back into a standard wikitable, using the appropriate syntax. In general, we don't use custom style and formatting for tables because a) custom formatting breaks the consistent Wikipedia style and b) we have CSS to save us from all that gruntwork. TenOfAllTrades(talk) 12:42, 5 July 2007 (UTC)


 * I'll leave this to others, but it is quite clear that incidence is in this context a specific and fairly technical term, and that many people inclined to contribute to articles don't know the difference between prevalence, incidence and frequency. I think that a definition of the term, and for convenience and education of the reader a definition of the term most likely to be confused with it should be near the top of the page.  In another wiki aimed at qualified people we use boxes of many types all over the place, but that doesn't have to be how it is done.  I've seen many articles which define their title in the opening paragraph, but I see that if it was folded into the narrative, it isn't there now.  Back to you for a solution, please.  Midgley 00:00, 16 July 2007 (UTC)

NPOV
It is against Wikipedia policy to simply revert an NPOV tag. I'd offer specific information why the tag is warranted in the Talk page, and have tried to do so in the past; but since Midgley seems to respond to such criticism with personal attacks against me, I am inclined to only warn readers that this article needs work to become impartial and await further efforts to make it that way. --Leifern 12:50, 5 July 2007 (UTC)


 * But Leifern, we've already discussed this and you could come up with no reasons to add a NPOV tag other than your personal subjective reasons. Unless you can actually give some real reasons this time, the tag should still not stay. aLii 12:57, 5 July 2007 (UTC)


 * All the discussion I've seen is you asking for more specifics and Midgley doing his level best to insult me. The problem with the article is that it places undue weight on the point of view that autism incidence increase is a result of factors such as changing diagnostic criteria, selection biases because of greater awareness or availability of services, or the favorite one, the financial interest of lawyers. These may contribute to the rise, but there is nobody credible who is claiming it would account for all of it. In fact, the underlying cases suggest that the issue is very complex. --Leifern 13:04, 5 July 2007 (UTC)


 * I suggest that an article on what the incidence of autism _is_ is likely to tax the available talent, never mind accounting for changes in it. Logically it seems sensible to start off by finding good sources for the incidence, then for incidence at different times and places, and then going on to presenting the notable theories for why the differences are observed.  As far as particulars go, I'll note again that this article was prepared by removing most material that wasn't on incidence from an article that conflated incidence and prevalence and a decided POV.  There remains some still to go - the Silicon Valley cluster bit being prevalence rather than incidence...
 * I do like the idea about an NPOV tag with secret warranty. I don't like what appears to be a personal attack above.  It should be removed or redacted.  THe theory that unless a complete account is in an article it is NPOV is novel, as is the theory that the remedy of anyone who knows about the topic is to await change.  Neither seem effective.  Midgley 23:47, 15 July 2007 (UTC)

Silicon Valley Incidence
The incidence in (presumably children conceived in) the valley would be interesting. The material remaining in the article was however about prevalence. I've parked it here.

"See Silicon Valley cluster below.

Silicon Valley cluster
A 2002 BBC article indicated that one in 150 children in the region had an autistic spectrum disorder and asserted this was many times the prevalence in the surrounding area (see California below) A 2001 article in Wired suggested that the cluster is a result of a link between autistic disorders and computer skills.

"

Incidence anyone? Midgley 23:53, 15 July 2007 (UTC)

Redacted from Denmark: integral to article?
"Further, there was with no discernable rate of change in incidence before and after the criteria change. " The spelling would be easy enough, but it isn't clear what this originally was intended to mean. Second integral perhaps? Midgley 00:36, 25 July 2007 (UTC)

Introduction
"Many of the most well-funded public health systems in the world note a significant increase in the incidence of autism." Unsupported by the article. Midgley 23:29, 24 August 2007 (UTC)

NPOV #2
This article leans too far towards curing Autism. The use of Dan Olmsted as a source is particularly disputed as his reliability and accuracy has been questioned heavily in many quarters. This article should be balanced between curable disease and genetic condition and at present it is not. 203.17.215.98 04:06, 25 September 2007 (UTC)


 * The first part of this criticsm makes no sense, as the word "cure" appears nowhere in the article. I agree that Olmsted is not peer-reviewed and is not as reliable a source as others are. Also, the first citation for Olmsted is bogus (the URL is to something else) and the citations under "External links" are not needed as per WP:LINKS. I fixed the Olmsted problem thus. The article is still in sad shape of course. Eubulides 05:13, 25 September 2007 (UTC)


 * I've logged in this time (for some reason it didn't work today). Dan Olmsted has a reputation of being pro cure - that's the reason for the first sentence. He is used ad nauseam by the mercury militia in order to prove a false point, and makes no attempt (that I'm aware of) to deny it. He is mostly cited re the theory of the Amish not being vaccinated and the incidence of Autism in that community is "non existant". I don't believe that myself because it makes no sense. Of course I can hardly say that in the article.
 * Something else that should be discussed - is this article worth a seperate page? There's a lot of material here that perhaps should be merged with other articles such as Autism and Aspergers Syndrome. I think more opinions should be pursued with the view of possibly nominating this for an AfD. Curse of Fenric 10:52, 25 September 2007 (UTC)
 * The material on this page is ill-suited for Autism or for Asperger syndrome; it is relatively low quality (being a list of primary sources, rather than relying on high-quality reviews), and has too much detail. Autism dismisses the subject of this web page entirely, saying "Autism's incidence, despite its advantages for assessing risk, is less useful in autism epidemiology, as the disorder starts long before it is diagnosed, and the gap between initiation and diagnosis is influenced by many factors unrelated to risk." Ideally an expert with some free time (i.e., not me :-) would write a page Prevalence of the autism spectrum that talked about prevalence of ASD, subsuming the useful part of this page's data, and we could then remove the page. Maybe a first step is to rename it to something with "prevalence" in the title? Eubulides 17:42, 25 September 2007 (UTC)
 * I would go as far as to say that an article devoted to prevalence or incidence is not needed. But you bring up a good point about the quote from the Autism article. Maybe there should be an article simply titled Autistic Spectrum Disorder (unless there's one already - I haven't checked) where the prevalence and incidence - take your pick - could be covered. I don't know where your experience places you on writing articles as you indicated compared to me, but I couldn't do it even though I am aware of the NPOV rules - because I admit to having a vested interest in keeping the cure line off of Wikipedia. And in the process probably violate WP:SOAP while I'm about it. I am an Aspie BTW, and a member of the Aspies for Freedom forum and a proud proponent of Neurodiversity. Curse of Fenric 21:19, 25 September 2007 (UTC)
 * Ah there IS an ASD article! I'll shift the stats from this page to that one under another tab. Curse of Fenric 21:21, 25 September 2007 (UTC)
 * Done - and I think now we should send this to AfD Curse of Fenric 21:42, 25 September 2007 (UTC)


 * I disagree that Autism spectrum is a better home for this information. It is no better a home than Autism or Asperger syndrome would be. The quote from Autism about incidence versus prevalence is just as relevant to Autism spectrum as it is to Autism. Did you read the material that you moved? Wasn't most of it for autism, rather than for ASD? That would be another argument against moving it to Autism spectrum. Eubulides 22:10, 25 September 2007 (UTC)

This page was born out of a page called Frequency of Autism, that was deleted and redirected to this page (which was then quite new). You might find both the deletion discussion, and the old take page Talk:Frequency of autism illuminating. Also, because it was redirected rather than outright deleted, the history and prior content is still available. --Limegreen 22:32, 25 September 2007 (UTC)


 * Thanks for the pointer. I figured it had something to do with an old controversy, but the text in question isn't fringe material so I don't think that's an issue. I see now that Makwy2 has undone some of the change to this page, which means that there is now a lot of duplication between Autism (incidence) and Autistic Spectrum. What a mess. Eubulides 23:30, 25 September 2007 (UTC)


 * This article was intended to have most fringe material removed. I'm not sure the material on this page really belongs on the ASD page, not that I think it is very useful in its present state. However, I think I'm currently sceptical about the utility of pretty much every article I've ever seen on pretty much any mental health related subject.--Limegreen 01:02, 26 September 2007 (UTC)


 * I've reverted Makwy2's edit, and put a note in the edit summary that he or she should come here before doing anything. When I shifted the material to the ASD article I did make a few changes to what was here (ie replacing "Autism" with "Autistic Spectrum Disorder" where appropriate). The mess was caused by Makwy2's edit here, not what I did to be honest. Curse of Fenric 01:40, 26 September 2007 (UTC)


 * The mess was partly due to Makwy2, who didn't understand what was going on; but not entirely. The material does not belong in Autistic spectrum, for reasons described above. Autism (incidence) is not perfect either, but it is a far better place for it. Why move the material to a worse place? The only justification I saw was that you don't like the "cure line". But the material in question has nothing to do with cures, so that justification does not make sense to me. Eubulides 04:26, 26 September 2007 (UTC)


 * Agree with Eubulides. Makes no sense in Autistic spectrum. This is the closest fit, and I've also reverted you here and there, so there's now no duplication. Let's discuss this; why should this content be at Autistic spectrum? Cool Hand Luke 05:00, 26 September 2007 (UTC)


 * Because it's relevant to the whole issue of the Autistic Spectrum. We need to merge this stuff up across the board because the little things are being diverted and in the process articles lose their neutrality. The worse the article, the more vulnerable it is to bias. That's why the Autistic Spectrum article is the best place for stuff like this. This prevalence/incidence thing affects the whole spectrum - not just Autism (which is why it shouldn't be shifted to the Autism article or any other articles on the Spectrum for that matter).
 * This article is NOT the best fit at all - because I am of the opinion that this article is not neccessary and should be deleted. Curse of Fenric 12:16, 26 September 2007 (UTC)


 * I understand your position, and in a world without pseudoscience I would agree with you. However, there's a group of people who make claims about the supposedly rising incidence of autism, especially in relation to the MMR vaccine. I think these people have made incidence a notable subject in its own right (notability is objective on wikipedia), and that this is far too much detail to go into broad articles on the topics. Would it be better if we moved this content to Autistic spectrum (incidence)? Cool Hand Luke 14:17, 26 September 2007 (UTC)


 * Two things. First, the terminology of "autism" versus "autism spectrum" is not 100% standardized. Many researchers, when they write "autism", do not mean the classic disorder, which is also known as "autistic disorder" or "childhood autism" or "infantile autism". They mean either that disorder, or PDD-NOS, or Asperger's; or perhaps they also include Rett syndrome and childhood disintegrative disorder. With that in mind, it is not of crucial importance to rename this article from "Autism (incidence)" to "Autism spectrum (incidence)" (please, not "Autistic spectrum (incidence)"; "Autistic spectrum" is common but these days "autism spectrum" is more often used by researchers). The main problem with the title of this article is the "incidence", part, not the "Autism" part. That is because almost all the statistics discussed here are about prevalence, not incidence. If we're going to rename it, we should rename it to Prevalence of autism, or something like that. Eubulides 16:20, 26 September 2007 (UTC)

(unindent) Luke, I'm of the opinion that pseudoscience has no business on Wikipedia. It's not proper science and therefore it can not be verified. The people who are preaching the issue with the MMR vaccine are in fact tarnishing the whole thing - because they can't back it up scientifically. The originator of the theory, Andrew Wakefield, was hauled before the UK Medical Board with a threat to his license to practice for his sheer carelessness with that. The only notability of this lies in the section on controversy - not incidence. Anyway - the other issue is that stats really don't tell the story without taking into account the root condition (the Spectrum Disorder). Put the two together and you have a balanced presentation. Seperate them and you have the makings of one huge mess of information that can't be deciphered correctly by researchers who want to know about Spectrum Disorders.

Eubulides - I really think we are doing the whole thing a disservice if we don't standardise the whole thing ourselves here on WP. The reality is - and this is starting to come out as you have said - the Autistic Spectrum Disorder is the root condition from which rises, Autism (low and high functioning), PDD-NOS, Aspergers and so on. You'll find that the stats on this page in fact include all ASD's, not just Autism. Anyone who uses "Autism Spectrum" is wrong and needs to be corrected PDQ.

The bottom line is that we have recognise that if we seperate bits of the whole story of ASD's that allow panic merchants to ply their trade we are failing the root mission of WP. Not withstanding notability. We have to place a line between fact and fiction (including pseudoscience - which at present belongs in the controversy area and should be kept right out of other areas) - and incidence/prevalence is one of those controversial areas. As they say, you can make statistics prove anything you want. Again - I would prefer it if this article was merged elsewhere and deleted. It doesn't help the true understanding of ASD's being seperated like this. Curse of Fenric 22:39, 26 September 2007 (UTC)


 * Wikipedia should be consistent about using standard terminology that reliable sources use, but it is not the place to impose standard terminology on others. There is not a general agreement in reliable sources that ASD is a "root condition" in the sense that you describe. Autism spectrum disorder is used by many reliable sources, for example, Rutter 2005, Newschaffer et al. 2007 , Schechtman 2007 . These days, autism spectrum disorder is used more often by reliable sources than autistic spectrum disorder is. Finally, I don't understand why issues of pseudoscience, Wakefield, etc. are relevant here. None of the material that was moved or reverted mentions Wakefield or fringe theories. Eubulides 03:21, 27 September 2007 (UTC)


 * I was looking to standardise the layout here, not dictate terms to others, Eubulides. Sorry if that wasn't clear. I'm disappointed in those sources you provided because I just can't accept it as right. Anyway. As far as pseudoscience goes, it was Luke who brought that up. I agree with you - it's not relevant here. But there was a fringe theorist that was removed from here (and rightly so). Dan Olmsted. Curse of Fenric 11:11, 27 September 2007 (UTC)


 * Right, fringe theories are bad. However, when fringe theories compel reliable authorities to compile detailed information refuting them, we should include it because it's notable. There's obviously a demand for this subject; there used to be two articles on it due to a POV fork! Cool Hand Luke 17:44, 27 September 2007 (UTC)


 * Luke is correct. You might find the original text of the page instructive .--Limegreen 22:09, 27 September 2007 (UTC)


 * Are you guys saying that notability supersedes verifiability? If you are then I have to vigorously disagree. It doesn't alter the fact that the demand that you speak of, Luke, is in fact the problem. Too much rubbish is being spread around by panic merchants looking for answers simply because they can't handle the commitment required to look after kids with an ASD. That's belongs in the controversy area, not here. And Limegreen - I found the original text extremely offensive and I ask that you remove the link, please. We should be treating the whole issue of this section of Wikipedia with the rules of verifiability up the front. The controversial stuff - whilst it may pass the notability rules - belongs away from the established information areas where the conditions are described.
 * Bluntly - the demand for this stuff comes from people who are keen to label Autism as a disease to be cured. It is not, it is a genetic condition at it's base and can never be anything else. Curse of Fenric 11:18, 28 September 2007 (UTC)


 * If I understand you aright, you're now worried about a link on a talk page to an old version of an article? If so, I'm afraid I disagree. That's the last thing to worry about. Right now, for example, as a result of recent edits, Thiomersal is greatly biased in favor of the thiomersal-causes-autism crowd; there's a lot of stuff in there that should be moved to Thiomersal controversy. Please worry about material like that; it's not worth your time or mine to worry about links from talk pages to history. Eubulides 16:12, 28 September 2007 (UTC)


 * Eubilides I only mentioned the link seperately. It shouldn't have been introduced to the discussion (in other words you're right). My commentary about that was aimed at Limegreen and no one else. I can do without offensive distractions like that, and that's why I addressed it. I am an Aspie and proud of it, and distractions are not on - on top of my view of the article as it stood.
 * Incidence/Prevalence is an issue that the same crew that are jumping on thiomersal are leaping all over. That's why I want it out of here. That's the link it holds with the thiomersal controversy - and that was my point. I hope that makes my position clearer. Curse of Fenric 10:49, 29 September 2007 (UTC)
 * Fenric, Eublides is right. I didn't mean the original version was illustrative in that it was somehow "correct", but that if you looked at it you might note that it shares the same author as the recent edits to thiomersal. --Limegreen 21:54, 29 September 2007 (UTC)


 * Fenric, I don't mean to say that a fringe conspiracy theory should be covered. Writing about such things is often undue weight. It's notable, however, when mainstream scientists gather and publish very good epidemiological evidence which refutes the fringe theory. Like it or not, parents and others will look here with all sorts of fringe nonsense in their head. Mainstream sources refute the theories, and we must follow the sources. Limegreen and Eubulides are both right that these articles are under constant attack. Even with this article's many imperfections, it's not in terrible shape. I applaud your vigilance, but we need it elsewhere right now. Cool Hand Luke 22:13, 29 September 2007 (UTC)

(unindent)Limegreen - my point about the original writing was that it offended me. I was never going to look past that into what you wanted me to look at. That's why it was a mistake to link me that way. You could have just said it without linking me. OK - you didn't know, and that's OK. Just FYI.

Luke, we need the vigilance in all parts of the ASD area and related areas (yes, including thiomersal). I don't have time to go to all areas, but it seems to me like you guys have the others in hand. What is needed is a layout that fulfils all the sourced material in the best way - and seperates the facts from the controversies. This article belongs in the controversy area.

But if you guys want my help, tell me which articles (aside from thiomersal I assume) is being grabbed by the curebies right now and I'll see what I can do. I'm not supposed to be active as my user page indicates. Curse of Fenric 22:14, 1 October 2007 (UTC)

If it had changed, why it might have
I've taken this out, not becuase there is anything wrong with it, but because it is in the wrong article. ---

There has been public concern that the MMR vaccine or the vaccine preservative thiomersal have contributed to an increase in the incidence of autism; the consensus of the medical and scientific community is that there is no scientific evidence to support these hypotheses, but decreasing uptake of vaccines has led to outbreaks of serious childhood diseases.

--- It is in several articles where it is the right article, but here it is entirely subsumed within one of the possible explanations for changes in reported incidence - that incidence has changed. Once one decides that incidence has changed - which is not supported by the article in its present state, I think - one might start considering what the cause of that was. But not till then, and it is a very different piece of epicemiology. Curing the condition is of course entirely absent from this article, and the suggestion of bias was quite surprising. Midgley (talk) 13:51, 7 December 2007 (UTC)

Prevalence and Incidence
Prevalence is different from incidence. When I first drafted this I thought it was important enough to define at the top of the page, but that has been nibbled away. I think this predisposes to the continued confusion.

The prevalence of autism and spectral disorders may well be interesting, but it is the argument over the incidence of autism etc that is much more interesting and far more critical in disucssion of causes. If a cause is removed the prevalence will not be reduced rapidly or greatly, however the incidence will be.

Some of the confusion and conflation into "frequency" may be deliberate, some is acidental.

If an examination of the prevalence is desired then it is best to write one. Any remaining prevalence information in this article really should have been stripped out by now, but generating an article by removing everything that shouldn't be in it is is quite a large job. 13:16, 7 December 2007 (UTC)

The US section at present is purely prevalence - not incidence, not change in incidence with time - I think this was a momentary abberation since there has been a lot of good editing going on. Can we remove or revert that please?

One of the few bits of actual information on research-verified incidence in the US - Olmstedt COunty figures - with references that worked when I looked at them has gone away with no discussion. Was that a mistake, or did someone think there was a significant problem with them? Midgley (talk) 13:44, 7 December 2007 (UTC)


 * As far as I can tell, all the data presented in this article is about prevalence, not incidence. Which makes sense, since almost all statistics-gathering uses prevalence. Much of the data is incorrectly presented as being about incidence; I haven't gotten around to fixing that. The title of this article is greatly misleading: it should be Autism prevalence rather than Autism (incidence). That will also require some cleanup, though. Eubulides (talk) 21:57, 7 December 2007 (UTC)


 * I removed the Olmsted County reference in October because I thought it didn't add much to the U.S. section. Newschaffer et al. 2007's fine review of autism epidemiology doesn't cite that study, which suggests they didn't think all that much of it either. However you are correct that it is about autism incidence (unlike most studies) and since the title of this article ia about incidence it's more relevant than some other studies, so just now I put it back in with a better summary and citation. Eubulides (talk) 22:28, 7 December 2007 (UTC)


 * Thanks. I disagree on two things:-
 * 1. There is no preponderance of data on prevalence in the article, and the dicussion is of incidence, not of prevalence.   Historically, the source of the article content was an article called variously "Autism Epidemic" or "autism frequency" which was incompletely clear about what it was discussing.  I'm unsure what the proportions of statistics gathering on prevalence and on incidence are, even in my own area, but there is a specific reason for looking at incidence rather than prevalence (actually there are several, but this one is relevant) which is if the incidence is actually changing, or if something depends on whether the incidence is changing.  The duration of the condition also affects this - prevalence of pneumonia is not very interested, since we don't tend to have beds for it rather than any other acute medical condition, but the incidence is very interesting, rising at this time of year in the N. hemisphere.  The incidence of pneumonia or other respiratory conditions in travellers landed recently from aircraft is very interesting, the prevalence of respiratory illness in passengers currently on aircraft may well have something to do with it... but the two figures are not interchangeable.  With conditions requiring long complex care the prevalence does affect how much one puts aside for providing it, but the changes in incidence affect how that is projected to change in subsequent years, and is reflected in the age-specific prevalence.
 * Most specifically, if something that causes autism stops happening, then there will be almost no change in prevalence. However the cohort reaching the point or age of exposure to that environmental variable will show a sharp decrease in incidence.  The incidence may not be measurable until a year or five after that event, but again, we are interested in incidence as a clue to cause, not prevalence.


 * 2. Autism (Prevalence) is a perfectly reasonable topic to write about, but it should not be this article, and it should not be redirected to this article.  The two could be subsumed into an article called Autism (Epidemiology) but that should cover several other aspects and would be a large and probably difficult and unruly topic.  Autism (Incidence and Prevalence) would be a reasonable article, I suggest it would best be approached by coalescing two Good Articles one on incidence and one on prevalence and start with a clear description of the difference between the two.  Meanwhile I remain surprised that so much argument is present in WP about the rate of change of incidence with so little actual information on the incidence in particualr places at particular times.  SOme of it arises from people who are so sure that there is an epidemic that such mundane matters as counting how many cases occur in the cohort born in each successive year is superfluous to their discussions.  Midgley (talk) 19:52, 9 December 2007 (UTC)

Incidence in sub-groups
The first and last sentences in this are clearly in the right place, the rest I suspect should be removed for the moment, unless there are actual incidence figures or discussions that can usefully be quoted. Midgley (talk) 20:05, 9 December 2007 (UTC)

Probably prevalence
" Reports of autism grew dramatically in the U.S. in the 1990s and early 2000s. For example, in 1996, 21,669 children and students aged 6–11 years diagnosed with autism were served under Part B of the Individuals with Disabilities Education Act (IDEA) in the U.S. and outlying areas; by 2001 this number had risen to 64,094, and by 2005 to 110,529. "

Wrong definition

 * The incidence rate of a condition is the rate at which new cases occurred per person-year, for example, "2 new cases per 1000 person-years".

Er, no... Not here. Midgley (talk) 16:32, 10 December 2007 (UTC) I'd try for a definition along the lines of how many of the babies born in a particular place in a particular short time period eventually are shown to be autistic/spectral. The prevalence that is worth directly contrasting with that is the number of people of a particular sort currently living in a particular area. The "particular sort" thing I agree is without a good reference (there was a bad one at one time I think) but I think is a useful thing to put back in with a reference to the assertion that engineers or programmers who mate produce children with a higher risk, and incidence of autism, and I'd say at present the statement that this has not been shown. If we don't then someone will wander by and add it as though true... Midgley (talk) 17:18, 10 December 2007 (UTC)


 * The quoted definition is the standard one used in epidemiology. See the cited textbook reference, which says incidence is defined by "relating the numbers of new cases to the person years at risk, calculated by adding together the periods during which each individual member of the population is at risk during the measurement period". A definition related to how many babies eventually have autism is equivalent to the standard definition if we assume that all cases of autism begin at birth, but such an assumption is controversial, as some theories hypothesize that cases of autism are caused by postnatal environmental factors, and a careful article should not make such an assumption without stating it. After all, this article started out as Autism epidemic and was based on environmental theories that are widely popular; we cannot simply ignore them merely because they lack scientific support. Infant mortality also messes up the proposed nonstandard definition. Eubulides (talk) 18:11, 10 December 2007 (UTC)

This article is actually about prevalence
I agree with much of what you say about incidence and prevalance and so forth, but I'm afraid that with autism things are a bit different than with influenza. Almost all the cited data in this article is about prevalence, not incidence. The article's discussion may be about incidence, but when you follow the references and see what actually is being measured, it's prevalance. And there are some good reasons for this. To quote Autism, "Autism's incidence, despite its advantages for assessing risk, is less useful in autism epidemiology, as the disorder starts long before it is diagnosed, and the gap between initiation and diagnosis is influenced by many factors unrelated to risk. Attention is focused mostly on whether prevalence is increasing with time." This quote is backed by Newschaffer et al. 2007, the most-recent high-quality review of autism epidemiology that I know of. Eubulides (talk) 20:12, 9 December 2007 (UTC)


 * I'm surprised and a little perplexed. I've looked at the references.  The word incidence occurs in the titles of several of them.  The title of the article is "incidence".  I wrote the first go of it by deliberately setting out to remove everything that did not relate to incidence.  The last change made was to remove a chunk that doesn't clearly enough relate to incidence rather than prevalence, frequency or "service" in the USA and reinstate a piece specifically on the incidence in Olmstedt county.   I'd be fascinated to read the article that I thnk we both agree is not without merit, on autism prevalence, with that being a good name for it.  Attention may well be focussed upon prevalence, but I suggest applying a little ray of it to incidence.  Midgley (talk) 16:28, 10 December 2007 (UTC)


 * The word incidence does appear in some titles, notably Honda et al. 2005 and Barbaresi et al. 2005, but if you read the sources you'll see that they are talking about cumulative incidence, not incidence rate. In a disorder where the cure rate is essentially zero, there is little practical difference between cumulative incidence and prevalence. For example, Honda et al. 2005 reported cumulative incidence up to age 7; under the reasonable assumption that death and cure rates were negligible, this is equivalent to the point prevalence at age 7. Eubulides (talk) 18:35, 10 December 2007 (UTC)
 * This may help to explain why it would be a mistake to have separate articles on autism incidence and prevalence. There should be just one article, which talks about the frequency of autism, and which discusses both incidence and prevalence and clarifies the relation between the two. The vast majority of our audience doesn't care about the fine distinctions between cumulative incidence and point prevalence; what they care about is the risk that their child will be autistic, and whether that risk is increasing or decreasing with time. This audience will be far better served by one article rather than having two dueling articles on essentially the same subject. Eubulides (talk) 18:35, 10 December 2007 (UTC)


 * I'd also suggest looking for the source of the quoted paragraph. Midgley (talk) 16:30, 10 December 2007 (UTC)
 * Sorry, I've lost context. Which quoted paragraph is that? Eubulides (talk) 18:35, 10 December 2007 (UTC)

NPOV and deletion of talk page
To not mention possible environmental factors and to question whether it is uncertain that actual prevalence has increased; is grossly misleading. And who deleted the Talk page? --Leifern (talk) 21:17, 19 December 2007 (UTC)


 * Nobody deleted the talk page, as far as I know. I think Epidemiology of autism got renamed to some other page (sorry, I don't know which; it was before my time), so the old talk page probably moved with it. As for environmental factors, good point, I'll add something. Eubulides (talk) 21:30, 19 December 2007 (UTC)

Looking at the recent changes: I made this change accordingly. Eubulides (talk) 22:05, 19 December 2007 (UTC)
 * "Reported incidence" is ambiguous; are we talking incidence rate, cumulative incidence, research-reports, administrative incidence? Better to use something less ambiguous such as "the number of children known to have autism".
 * The reported rate of new cases of autism is what I'm getting at. As the diagnostic criteria are based on psychiatric rather than neurodevelopmental criteria, it's a little much to say that any kids are "known" to have autism.
 * "Some speculate". Several reliable sources agree that some of the reported increase is due to changes in diagnostic practice. Putting in "Some speculate" is out of place here.
 * To the extent that the etiology of autism in general is unknown, and the composition of causes for the rise is unknown, there certainly is speculation.
 * "Others assert that environmental factors must play a role". Let's leave the discussion about the disputants in the controversy page; this page should use less-charged wording.
 * So less-charged wording is to attribute it all to non-environmental causes?
 * "Some researchers have found that". Likewise, this wording should go; the article should be about autism, not about autism researchers.
 * That makes no sense. It is common to attribute a finding to those who claim it.
 * Your edits are improvements over the first version, but the article still reads like a crude propaganda piece. The controversy should be mentioned, and though several people find support for the changing diagnostic criteria view, the support for this is tenuous at best. I appreciate your effort, but suggest that you read up on all sides of the controversies rather than accepting one side uncritically. --Leifern (talk) 22:20, 19 December 2007 (UTC)
 * I added a new section Epidemiology of autism which mentions the controversy. No doubt further improvements could be made; suggestions are welcome. The article does not say that all the changes are due to diagnostic criteria, only that some of the changes are. I don't know of any reliable sources that disagree; if you know of any, please let us know. Eubulides (talk) 22:30, 19 December 2007 (UTC)

Merge from "Autism (incidence)"
Currently Epidemiology of autism lists Autism (incidence) as a subpage. There is considerable duplication, and Autism (incidence) is small enough that it should be merged into Epidemiology of autism. Eubulides (talk) 21:19, 19 December 2007 (UTC)


 * No objection, so I did the merge. Eubulides (talk) 02:26, 24 December 2007 (UTC)

Comorbid Conditions
Maleness is a comorbid condition? I know some conservatives have argued that our society is at war with the masculine, but is being male really a disorder now? 128.164.107.161 (talk) 17:02, 3 November 2008 (UTC)


 * The article says maleness is a comorbid condition, not a comorbid disorder. Eubulides (talk) 18:12, 3 November 2008 (UTC)


 * Such a statement is not supported by the reference . Risk factor yes; Comorbid conditon no. Furthermore, disease/disorder is implicit when using the term comorbidity.128.192.84.143 (talk) 23:10, 4 November 2008 (UTC)


 * Ah, right you are of course. What was I thinking? Also, the exact same material is already in Epidemiology of autism . I fixed the problem by removing the bogus duplication. Thanks. Eubulides (talk) 00:47, 5 November 2008 (UTC)

paragraph makes poor sense
"Several contributing environmental risk factors have been proposed ..."

It is aetiology rather than epidemiology, and is muddled. Difficult, I know... Midgley (talk) 13:20, 6 July 2009 (UTC)


 * Thanks for catching that. The simplest fix is to remove the word "contributing", which I did here as well as on a couple of other autism-related articles. Eubulides (talk) 16:28, 6 July 2009 (UTC)

Rates for U.S. need to be more clearly defined
There is no mention of specific percentage rates, or x per 1000 people. —Preceding unsigned comment added by 67.166.122.57 (talk) 07:57, 28 December 2009 (UTC)


 * Thanks for pointing out the problem. I it. Eubulides (talk) 09:12, 28 December 2009 (UTC)

A Request
My name is Stephen Arnold and I got Autism Speaks to fund a study (it should be completed in about a year) to either prove or disprove my theory on what is behind the current rise in autism rates. I have written two papers on the subject but due to the complexity of this topic and abundance of evidence they are both quite long. I was hoping that one of you could give me feed back on the first paper which is 28 pages long not including references. I apologize if I have violated Wikipedia etiquette, but I did not know how else to ask my question. —Preceding unsigned comment added by Arnold5404 (talk • contribs) 16:00, 20 January 2010 (UTC)

Page loading efficiency and style
This page takes a long time to load, and part of this is due to the use of the standard Wikipedia citation templates such as cite journal. Recently developed faster & smaller templates (such as vcite journal) make the page smaller and faster to load. Let's use them here; they're already in use in Heritability of autism. I just tried it out here, and the generates 145,617 bytes of HTML, 57% bigger than the  (which generates 92,591 bytes of HTML); in one test the current version takes about 6.6 seconds of server time to generate more than twice as long as the 3.1 seconds of the proposed version (the timings are variable but this sort of improvement is common). Eubulides (talk) 02:56, 25 January 2010 (UTC)
 * There is a message at the top of the template documentation saying that the template is not yet ready for use -- that's a little bit intimidating. Looie496 (talk) 16:40, 28 January 2010 (UTC)
 * Yes, I know. This is part of the experiment (using the template on a few real-world pages). I wouldn't worry about that part: I'm watching this page and the template closely, and can fix any problems that arise (possibly even reverting back to the existing templates). Eubulides (talk) 20:38, 28 January 2010 (UTC)

South Korea
According to a study done May 9 2011 the autism rate in South Korea is 1/38: http://www.autismspeaks.org/about-us/press-releases/new-study-reveals-autism-prevalence-south-korea-estimated-be-26-or-1-38-chil — Preceding unsigned comment added by Slartibartfastibast (talk • contribs) 13:50, 23 July 2011 (UTC)

Denmark data innacurate
The study mentioned is out of date and has been discredited

"Dr. Poul Thorsen, one of the co-authors and "scientist in residence" at the CDC 2000-2002, subsequently was terminated by Aarhus University and indicted in Atlanta for embezzlement this year in relation to his $11 million grant from the CDC.

http://www.prnewswire.com/news-releases/scandal-exposed-in-major-study-of-autism-and-mercury-132519518.html — Preceding unsigned comment added by 124.180.175.26 (talk) 12:29, 17 December 2011 (UTC)

An editorial error in the description of the PDD NOS category of Autism Spectrum Disorders, published in the 1994 DSM-IV, inappropriately broadened the PDD NOS construct.
http://www.psychiatry.org/practice/dsm/practice-relevant-changes-to-the-dsm-iv-tr

Quote below from the source linked above from the American Psychiatry Association indicates an editorial error was made in the description of the PDD NOS category of Autism Spectrum Disorders in the 1994 publication of the DSM-IV. Research sourced in the quote below conducted by Dr. Fred Volkmar and colleagues, in 2000, provided results that "about 75% of cases identified by the clinician as not having PDDNOS (true negatives), were incorrectly identified as having PDDNOS according to the DSM-IV." These results provided support both to the concern that the DSM-IV wording inappropriately broadened the PDDNOS construct and for a correction that reversed the criteria for PDD NOS back to the DSM-III-R criteria construct for PDD NOS, in the 2000 text revision for the DSM-IV (DSM-IV-TR).

"Major changes were made the PDD category in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) based, in part, on a large, multi-site, international field trial. However, an editorial change was made in the description of PDDNOS during the final phase of production that had an unintended effect on the definition of PDDNOS.  Instead of requiring “impairment in social interaction and in verbal or nonverbal communication skills” (DSM-III-R, p. 39), DSM-IV states that the “category should be used where there is a severe and pervasive impairment of reciprocal social interaction or verbal and nonverbal communication skills, or when stereotyped behavior, interests, and activities are present” (DSM-IV, pp. 77-78).   Thus, a child with an impairment in only one area (e.g., a child with stereotyped behavior, interests and activities but without evidence of disturbed social interactions could theoretically qualify for a diagnosis of PDDNOS.

To assess the impact of the DSM-IV wording, Volkmar and colleagues performed a series of reanalyses of the DSM-IV autism/PDD field trial data (Volkmar FR, Shaffer D, First M. PDD-NOS in DSM-IV.  J Autism Dev Disord 2000 Feb;30(1):74-75). A series of comparisons were conducted to evaluate sensitivity/specificity. Using clinicians' judgment of the presence or absence of PDDNOS as the standard, the DSM-IV wording  had an excellent sensitivity of .98. However, the specificity was only .26, i.e., about 75% of cases identified by the clinician as not having PDDNOS (true negatives), were incorrectly identified as having PDDNOS according to the DSM-IV. These results lend support to the concern that the DSM-IV wording inappropriately broadened the PDDNOS construct. If problems are required in the social area and either communication or restricted interest (i.e., at least 2 criteria present one of which must be from the social area) the sensitivity was .89 and specificity .56.

These results supported a change in the wording of PDDNOS to revert to the original construct. The new wording in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) is as follows:

“This category should be used when there is a severe and pervasive impairment in the development of reciprocal social interaction associated with impairment in either verbal and nonverbal communication skills, or with the presence of stereotyped behavior, interests, and activities, but the criteria are not met for a specific Pervasive Developmental Disorder, Schizophrenia, Schizotypal Personality Disorder, or Avoidant Personality Disorder.”" Yellowboy70 (talk) 23:37, 4 November 2012 (UTC)

"Prevalence Rates of Autism Spectrum Disorders Among the Old Order Amish"
Per the subject titled study, from 2010, linked below, all children, ages 3 to 21, in two Amish dominant counties were screened for the presence of an ASD.

https://imfar.confex.com/imfar/2010/webprogram/Paper7336.html

Quoted from the paper:

"Results:

From September 2008 to October 2009, 1899 Amish children were screened in the two Amish communities. A total of 25 children screened positive for ASD on either the SCQ or the DSM-IV-TR checklist. A total of 14 screened positive for ASD on both screeners. Of those 25 children, 14 were evaluated and seven children were confirmed as having a diagnosis of ASD using the ADI and/or ADOS, and clinical judgment. Interestingly, four of the seven only met ASD criteria on the ADOS but not the ADI. Three of the four who were not diagnosed by the ADI only missed criteria on the Behavioral Domain, which may be attributable to the reporting style of Amish caregivers.

Conclusions:

Preliminary data have identified the presence of ASD in the Amish community at a rate of approximately 1 in 271 children using standard ASD screening and diagnostic tools although some modifications may be in order. Further studies are underway to address the cultural norms and customs that may be playing a role in the reporting style of caregivers, as observed by the ADI. Accurate determination of the ASD phenotype in the Amish is a first step in the design of genetic studies of ASD in this population."

The Amish study mentions Kogan's study in 2009, linked below, that determined a 1 in 91 ASD prevalence from a national survey of parents answering whether or not they had been told that their children, ages 3 to 17, were diagnosed with an ASD. While the data released in this study on the Amish is preliminary, the door to door methodology of screening children is one of the most comprehensive methods of reaching a general community population of children.

http://pediatrics.aappublications.org/content/124/5/1395.abstract

It was interesting in Kogan's study, that among the parents who reported that they were told their children had an Autism Spectrum Disorder at an earlier age, 40% of those children were no longer identified by the parents as having an Autism Spectrum Disorder. These children no longer identified with an ASD, were not included in Kogan's 1 in 91 statistic. It is possible that the editorial mistake in the DSM-IV, in 1994, that inappropriately broadened the diagnostic construct of PDD NOS, resulted in some of those children being re-assessed as not diagnosable with PDD NOS, after that error was corrected in the DSM-IV-TR, in 2000.

The methodology used in the Amish study is more comprehensive in reaching a community wide demographic of children, ages 3 to 21, than the methodology in the South Korea study, referenced and cited above in another section of this talk page, and below is limited to a more restricted age bracket of children scanned in the school system in South Korea for ASD's. Similar methodology used in the most recent CDC prevalence study in the US, of previously recognized diagnosed cases of ASD's in South Korea, yielded a .75% prevalence in comparison to the CDC's current reported prevalence rate of 1.13%. Those identified with ASD's determined in South Korea from the fuller scan of children in mainstreamed classes, yielded an additional 1.89% prevalence of ASD's. So out of the 1 in 38 statistic, provided in the referenced South Korea study, two-thirds of the children were previously undiagnosed.

http://www.ncbi.nlm.nih.gov/pubmed/21558103

Vaccines as a potential causal factor underlying the Autism subgroup of regressive autism most often in the subject of that controversy has been refuted by the most current scientific findings. Regressive Autism is a form of autism severe enough that it would not likely be significantly identified in further Community wide analysis of children among the Amish or in South Korea, as it is not an issue that can reasonably be overlooked by most parents, physicians, or educators in either society.

While vaccines as evidenced in the most current scientific research, have not been shown to be the culprit of the disparity in the prevalence statistics in the South Korean and Amish larger community scans of children, there appears to be substantial elements of heredity and/or environment/culture associated with that disparity beyond diagnostic methodology. Those factors of disparity further studied may lend greater insight in both the causal factors and/or extent of a prevalence increase, over time, in the full spectrum of ASD's.Yellowboy70 (talk) 05:29, 5 November 2012 (UTC)Yellowboy70 (talk) 06:01, 5 November 2012 (UTC)

Bias
The article talks about the thoroughly disproven hypothesis that autism is caused by vaccines as if there was still uncertainty in the matter. It needs to be made more clear that the idea that vaccines cause autism has been completely disproven. — Preceding unsigned comment added by 70.192.135.114 (talk) 15:54, 31 May 2016 (UTC)
 * I noticed that too. There are numerous references in the article which are out of date or discredited, regarding the possibility that vaccines (or thimerasol in the minute or non-existent quantities present in vaccines) are a cause of autism. It is grossly misleading to perpetuate the COMPLETELY DISPROVEN idea that vaccines cause autism. I don't know enough about the subject matter to feel confident in removing some of the inappropriate references, although I can try. For any editors who follow or notice: Please be aware that this is my motive.--FeralOink (talk) 22:31, 31 July 2016 (UTC)

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Issue in Section on Denmark
The section in Denmark has significant issues. It refers to a study from Aarhus University, but provides no references for that specific study. It then does cite a study which shows the opposite finding, but claims it is discredited because one of the authors was charged with fraud and embezzlement, but if you follow the reference the fraud was related to the acquisition of grant money, not the study. Someone should address this. — Preceding unsigned comment added by 2601:601:8280:5D7C:CCDC:C648:DF85:2731 (talk) 21:14, 29 January 2019 (UTC)

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