Moving the Goalposts

Although autism is the subject of this article, 'moving the goalposts' is not a new phenomenon. Ask any public-school administrator about 'special needs' students--which happen to be very lucrative.

How else to account for the fact that a disorder that before 1990 was reported to affect just 4.7 out of every 10,000 American children now strikes 60 per 10,000, according to many estimates--the equivalent of 1 in 166 kids?

But what if there is no epidemic? What if the apparent explosion in autism numbers is simply the unforeseen result of shifting definitions, policy changes and increased awareness among parents, educators and doctors? That's what George Washington University anthropologist Roy Richard Grinker persuasively argues in a new book sure to generate controversy

And here come the schools:

U.S. schools are required to report data on kids who receive special-education services, but autism wasn't added as a category until the 1991-92 school year. No wonder the numbers exploded--from 22,445 receiving services for autism in 1995 to 140,254 in 2004. Grinker points out that "traumatic brain injury" also became one of the 13 reportable categories in 1992, and it had a similar spike.

We're not going to argue with clinical specialists on the topic of diagnosis. On the other hand, this sort of attitude is not unusual among MDs, shrinks, et al:

Doctors are also more willing to apply the diagnosis to help a patient. "I'll call a kid a zebra if it will get him the educational services I think he needs," National Institute of Mental Health psychiatrist Judith Rapoport told Grinker.

And then there's the personal money (remember Social Security "Disability" payments for the little darlings?)

In some states, parents of children with autism can apply for Medicaid even if they are not near the poverty line. A diagnosis of mental retardation doesn't always offer this advantage.

By the way, Jim Doyle's Socialized Health mungoes will be reading this, too...

HT: Clay Cramer