Sunday, February 7, 2010

The Oklahoman Editorial Feb 7, 2010

Autism studies bolster argument to act slowly

OUR VIEWS Prevalence rates vary widely
The Oklahoman Editorial
Published: February 7, 2010

AN insurance coverage mandate for autism therapy was a highlight of Gov. Brad Henry’s 2009 State of the State address. The issue didn’t make the highlight reel in Henry’s 2010 speech. It was never mentioned.

Last year Henry joined legislative Democrats in pushing for the mandate, which supporters say would carry a minimal cost and opponents say would be quite expensive.

One mandate bill was killed last year and that bill can’t be considered this session. The mandate has slipped from attention either for practical reasons — Republican resistance is too strong and the GOP has the majority — or for fiscal reasons: This isn’t a good time to place a financial burden on the insured, including state employees.

This is a good time to ask hard questions about the diagnosis for autism. One day after Henry’s speech, The Wall Street Journal compared two recent studies on the prevalence of autism. The studies agree on some points and disagree on others, but the overarching conclusion is that no one really knows why the prevalence rate varies so widely among locales and from one time period to the next.

The Centers for Disease Control and Prevention puts the national rate for autism spectrum disorder in 2006 at one in 110 American 8-year-olds. That’s up 57 percent from 2002. Why? Is it because more children have autism or because of changing definitions of who has it and who doesn’t?

Columbia University researchers found that the prevalence rate varies greatly within Los Angeles and environs, with higher rates in Beverly Hills than most areas. Why? No one knows.

The theory that early childhood immunizations are responsible for an autism spike is losing credibility. Researchers have struggled in vain to find solid evidence that would prove the theory.

One study says prevalence is greater among the children of highly educated parents. Another study discounts the influence of education. Children born in northwest Los Angeles are four times as likely to be diagnosed with autism as children in any other part of California. Why? No one knows.

Parents of children with an autism diagnosis have made passionate appeals for the coverage mandate. Their emotional arguments are tough to resist, yet the studies cited above offer more reason to urge caution on a mandate that would likely never go away and that would cost the insured ever more money if the diagnosis rate continues to soar.

As awareness builds of autism, more parents are likely to look for signs of trouble and seek a diagnosis. That in turn will likely drive the prevalence rate up. Jon Bai, a federal government epidemiologist, calls the increased rate "a perplexing and urgent concern.”

The pro-mandate side may yet win the argument because the number of autism-diagnosed children is growing so quickly — and so inexplicably.

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