نعم هناك اضطراب طيف التوحد ولكن مازالت أسبابه العلمية غير معلومة والمداخل العلاجية الحاسمة غير متاحة

Part of the increase has to do with awareness and changing diagnositc criteria.

This talk was also helpful:

https://youtu.be/_MBiP3G2Pzc

Absolutely! 100% in agreement with that

Great care needs to be taken in the use of words like 'epidemic'. Autism is not a disease that spreads and something to be prevented. Autism is a neurodevelopmental difference that we are getting much better at recognising and are learning how to adapt the environment to include all differences. The suggestion that it becomes a 'medical and physiological issue' as stated above misunderstands what it is to be autistic.

I fully agree that words like epidemic are inappropriate to refer to a human condition like autism. However, the medical and physiological issues of this highly heterogeneous condition (or systemic disorder with varying degrees), cannot be ignored. When they are ignored, scientists and engineers will not be aware of the issues and their knowledge will not be properly leveraged to build accommodations and support for those who badly needed. Owing to the high heterogeneity of autism and the deficits in the diagnosis and current treatments, science has fallen far behind to help support the affected families. Yet we can repurpose technology from other fields and help build a new transformative way of thinking about the autistic individual and his/her capabilities and predispositions. Autism is not a 'disease' to cure. It is a broad range of conditions that can be physiologically explained and scientifically studied, tracked and treated, much as any other human condition is.

Some diagnosis of conditions mimicking autism symptoms at the early stage can only be confirmed through a genetic testing and the tester needs some preliminary suspicions in order to run a non exhaustive test. This limited knowledge of early signs of many conditions leads to an integration of the child who presents with speech delay and/or some eye contact impairment under the umbrella of autism. This is the case for Rett syndrome or Prader Willy when the child does not present with specific symptoms at the time of testing. The propagation of knowledge and fear with social medias has also a role in seeing more and more parents bring children earlier and earlier for diagnosis. Some parents will bring infants with the concern that the child has poor eye contact and facial expression. It has happened that the young infant is diagnosed with possible autism at and age when visual acuity testing is difficult to run but would explain the issue described by the parents. The problem with an increase of the diagnosis of autism is that children are signed up for early intervention programs when their accurate diagnosis does not justify behaviourism or occupational therapy. Toddlers may respond with anxiety to therapies leading to the addition of meltdowns confirming autism.

Indeed, this is a very accurate description of what we see with our families at clinics and home settings. In some cases parents grow concerns about developmental delays and bring their child to the clinic seeking a diagnosis. In other cases, however, clinicians push the autism diagnosis onto the family and the whole pipeline of interventions initiate, whether or not the toddler will benefit from it. With very poor to none physiological assessment of early somatic sensory motor milestones as basic building blocks of social interactions, these toddlers and young children are thrown into the interventions under a one-size-fits-all model. It is tragic to see the damage that this does to their nascent nervous systems and the consequences of it in the form of trauma, anxiety and other issues that then call for behavioral modification methods in a vicious circle that only benefits the system in place, but negatively impacts the child and the family. In the US, we the taxpayers (unknowingly) support this deficient model. Unfortunately the research that would help change it and improve it is sidelined and not properly funded. It seems hard to see a way out of it. Families feel trapped as do researchers trying to help them.

I don't know how I got labelled as 'East Coast Community Healthcare'.

I work in London UK NHS (National Health Service) and sense that our approach is very different. Our diagnoses are based on observations from as many professionals and settings as possible SLT, OT, Ed Psych, school observations and above all parents, plus ADOS-assessment clinics. The current evidence shows that differential diagnosis is not possible before the second year. (references available) There is no genetic test currently that can confirm the diagnosis, only one that may indicate that there's a small likelihood of a sibling also having autism. In most London boroughs, and I believe the same is found throughout the UK, we adopt a comprehensive framework that looks at Social Communication, Emotional Regulation and Transactional Support (SCERTS). We do not use behavioural interventions e.g. ABA (though some parents may pay for this privately). Sensory processing support forms a key part of interventions, without a focus on these needs a child will not be available for support with social communication. Perhaps we have the advantage of being able to provide free interventions based on a child's profile of strengths and areas where they are challenged.

It is a far better model than the one currently running in the US. Here we get families desperate for alternative therapies but forced to ABA because it is the only one covered by default at the schools and in the early intervention programs under the medicare insurance. In recent months we got (in NJ) approval for insurance coverage of developmental models and sensory processing/integration based therapies (some forms of OT) that parents can get with a multidisciplinary team at some hospitals. These are otherwise out of pocket and costly to families. However, the prevalence of the behaviorist pipeline across the board continues and it is worrisome owing to profound conflicts of interest found at each step of the process. Some research has started to appear in high profile journals denouncing these practices. Parents have initiated several lines of inquiry and different fields are engaging to denounce the malpractices. It is only the beginning of transformation in autism.

It will be very interesting to see the evolution of all of it amidst COVID constraints. Many pre-schoolers in general cannot even hold a pencil correctly, or turn the page of a book (they attempt to do so by swiping the finger as if it was a tablet), when they return to in-person classes. Somatic sensory motor control milestones have regressed or are underdeveloped, according to teachers and parents, and this in turn is having an impact on all other aspects of their cognitive development, social perception and social life -but it is highly non-obvious to the naked eye. We study and model these interactions in the lab, but the research has yet to make it to the clinical domains and to the education settings. The diagnostics tools do not include any of it in their criteria. If they did, not only we could help the kids, but we could do so based on a large body of research from other fields of neurodevelopment.

The background problem of all Galtonian taxonomy lies in the destruction of meaningful patterns at data acquisition. Configural frequency analysis or mediation offers a direct approach to the freqencies of configurations/patterns, which allows to mitigate this "scandal" www.biposuisse.ch

EBT - "I fully agree that words like epidemic are inappropriate to refer to a human condition like autism. However, the medical and physiological issues of this highly heterogeneous condition (or systemic disorder with varying degrees), cannot be ignored." - this resonates with my recent discoveries on how a dysfunctional reverse arterial intramural drainage of the cerebral parenchyma as steered mostly by the nasal pterygopalatine ggl. (PPG) efferents (vulnerable from ethmoïditis e.g. in long Covid-19) "from inside" and an inflammation of the skulls bone marrow conveying immune cells through the newly discovered calvario-meningeal tubes (Cai et al.) on the meninges "from the outside" is apt to translate microbial and other toxic ORL-pathologies into large cortical not just developmental parietal and contiguous cortical damages as resulting in intuitive dysfunctions of the autism spectrum - with a pervasive role of (partly microbially subverted ) mast cells. Since SARS-CoV-2 truly attacks the PPG favoring orthostatic intolerance and MECFS also by not tonically inhibiting mast cells - it may at times be appropriate even to talk in terms of epidemia. (www.biposuisse.ch/perugia; www.biposuisse.ch).