Lopez-Duran: Recent Autism Increases Are NOT Due to Different Diagnostic Criteria

Nestor Lopez-Duran PhD is a clinical child psychologist and researcher, currently working as an Assistant Professor of Psychology at the University of Michigan. Lopez-Duran also authors the Child Psychology Research Blog which purports to offer research based commentary on child psychology. Professor Lopez-Duran takes A closer look at the new CDC autism prevalence rates and draws a number of interesting conclusions:

- The same diagnostic criteria was used in 2002 and 2006. The changes are NOT due to differences in diagnostic criteria.

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Within State variability is so great that it is very likely that fluctuations in prevalence between states are due to methodological differences.

- HOWEVER, significant increases were also observed between sites that did not have changes in methodological procedures between 2002 and 2006.

- Thus, the increases from 2002 to 2006 are unlikely to be due to methodological differences

- There were no major changes from 2000 to 2002, which highlights the significance of the changes in diagnoses from 2002 to 2006

Professor Lopez-Duran, as always, provides some of the most disciplined, objective, non-ideological, non-agenda driven autism research commentary on the internet.  In his comments he expressly refrains from drawing any conclusions about WHY the prevalence rate of autism increased from 2002 to 2006.  His analysis is most important to the various autism causation debates  in highlighting the fact that changed diagnostic criteria are not factors in the recent autism increases reported by the CDC.

Those who deny that autism is rising, particularly those with access to influential mainstream media outlets to express their views, and those internet bloggers who claim to be "science" bloggers,  should discontinue their repeated knee jerk reliance on changes in diagnostic criteria dating back to 1993-4 to explain why autism is rising. 

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HBOT Treatment for Autism? Avoid the Autism Hub, Read "Translating Autism"

Anyone reading blog commentaries about the latest HBOT study, or any other autism treatment study, should seek credible analysis from detached, professional sources if they want a proper understanding of the study in question. Any bloggers listed at the Autism Hub should be avoided unless you are simply seeking an example of the anti-cure element of the neurodiversity cult and the extent to which it colors their commentaries. If you are seeking balanced, objective commentary about the HBOT study avoid the AH-ND bloggers and check out Autism Research Blog: Translating Autism by Nestor Lopez-Duran Ph.D.

Nestor Lopez-Duran is a a clinical child psychologist and neuroscience researcher working at a large Midwest university-based child psychiatric institute. His Translating Autism blog is easily one of the best on the internet for obtaining rational, balanced and professional assessment of autism studies of any kind. I mention it frequently on this blog and believe it should be a bookmark for anyone with a genuine interest in autism disorders and autism studies. Mr. Lopez-Duran has commented on the recent Rossignol HBOT study in Hyperbaric treatment for children with autism: First controlled clinical trials and provides an assessment of the studies strengths and weaknesses including the perception that the authors of the study are in a conflict of interest - not as a way to trash the study but to point out ways the study could have been improved. He comments on the merits of the study:

"The authors found that hyperbaric treatment resulted in significant improvements in overall functioning, receptive language, social interaction, and eye contact. These findings were affected by the age of the child, in that children over the age of 5 showed more improvement to the treatment than children under 5. In addition, the treatment did not seem to work for children with an initial ADOS score above 50th percentile. This indicates that the treatment is most effective with children with more severe autism (ADOS score below the 50th percentile).



In general, the study design was strong. The authors made great efforts to make sure that the two treatment conditions were nearly identical. That is, kids in the control condition were exposed to procedures that mimic the real hyperbaric treatment (being inside the chamber, etc). Thus, it is very unlikely that the results observed were due to a placebo effect. The study also moves in the right direction by presenting evidence for the efficacy of treatments that are usually considered controversial or untested. We need more research on alternative treatment interventions that will help us determine which interventions are actually effective."

By contrast to the objective, informed "translation" by Lopez-Duran of the Rossignol HBOT study, Autism Hub and Neurodiversity commentators simply mock this and any other study which suggests that an autistic child might benefit from a specific treatment for autism. The reason for the knee jerk, lock step reaction of AH-ND members to studies of autism treatments is simple - they are anti-cure, anti-treatment. They do not want to be treated for their autism, or do not want THEIR loved ones with autism treated, and they do not believe that parents and other caregivers should be permitted to treat or cure autism in their own autistic loved ones or patients. Any study which purports to show the effectiveness of an autism treatment is anathema to them. (Hence the hostility by AH-ND bloggers towards ABA, parents seeking ABA for their own children, and ABA practicioners).

Do'C at Autism Street is one of the leading AH-ND "scientific" minds. In a recent post about the Rossignol HBOT study he was kind enough to prepare a list of "skeptical" blog comments about the HBOT study. Several of the comments are at Autism Street and LB/RB, two Autism Hub blogs. You can tell by the titles that these comments are not going to be balanced or objective assessments of the HBOT study:

"Mild HBOT For Autism - A Brief Skeptical Guide


March 29, 2009 by Do'C Printer-Friendly Version Printer-Friendly Version


For readers who may be interested in a skeptical perspective with regards to “mild” hyperbaric oxygen therapy for autism, I’ve assembled a short list of links. These are articles that I’ve enjoyed reading, found interesting, or written myself.


In no particular order:


HBOT: Under Pressure
http://photoninthedarkness.com/?p=131


HBOT: Is it just a bunch of hot air?
http://photoninthedarkness.com/?p=127


Hyperbaric Oxygen for Autism
http://www.theness.com/neurologicablog/?p=496


Is there no end to unscientific treatments for autism?
http://www.sciencebasedmedicine.org/?p=249


Mild hyperbaric therapy for autism - Shh!…don’t say it’s expensive
http://leftbrainrightbrain.co.uk/?p=2041


Autism, HBOT, and the new study by Rossignol et al.
http://leftbrainrightbrain.co.uk/?p=1987


When High Does Mean Low: Autism, mHBOT, and Dan Rossignol
http://leftbrainrightbrain.co.uk/?p=686


Does Rossignol et al. show HBOT’s effective?
http://ebdblog.com/2009/03/21/does-rossignol-et-al-show-hbots-effective


Ridiculous Autism Treatment Statements - Part One - ICDRC Website on HBOT
http://www.autismstreet.org/weblog/?p=130


Hyperbarics and Hypotheses
http://www.autismstreet.org/weblog/?p=60


Nitpicking Sloppy Science
http://www.autismstreet.org/weblog/?p=40


Autism HBOT: First Look
http://www.autismstreet.org/weblog/?p=36


Hyperbaric Oxygen as a Treatment for Autism: Let the Buyer Beware
http://autism.about.com/b/2009/03/14/hyperbaric-oxygen-as-a-treatment-for-autism-let-the-buyer-beware.htm


Hyperbaric Oxygen for Autism? Not so fast
http://www.randi.org/site/index.php/swift-blog/492-hyperbaric-oxygen-for-autism-not-so-fast.html

As a parent of a severely autistic boy of 13 I am not prepared, on the basis of this one study, and notwithstanding indications of positive gains by severely autistic children in the study, to seek HBOT treatment for my son. I would want to see further studies done by other researchers, and I am not arrogant enough to believe that I am properly educated or prepared to assess these studies myself.

I will rely upon the information provided by informed, professional commentators like Lopez-Duran and credible, responsible agencies that review these studies. If further studies confirm the benefits suggested in the Rossignol study and if it is recommended by credible sources as an evidence based treatment then I would consult my son's pediatrician and consider HBOT treatment option for him. In the meantime though I will continue with ABA for my son which has helped him in so many ways and which has a solid evidentiary basis and overwhelming professional support for its safety and effectiveness. And I will give no weight to the Autism Hub and Neurodiversity commentators who are ideologically opposed to the development of effective treatments and cures for autism. Theirs is an ideological, not an evidence based, opposition to all possible autism treatments.

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Lopez-Duran Reviews Geirs' Biomarkers of Environmental Toxicity and Susceptibility in Autism

Nestor L. Lopez-Duran Ph.D., at Translating Autism, has posted a review of D Geier, J Kern, C Garver, J Adams, T Audhya, R Nataf, M Geier (2008). Biomarkers of environmental toxicity and susceptibility in autism☆ Journal of the Neurological Sciences DOI: 10.1016/j.jns.2008.08.021. In Heavy metal toxicity and detoxification capacity in autism Lopez-Duran provides an objective, professional, assessment of a controversial study which avoids the rhetorical excesses of both sides of the autism-mercury war.

This recent (September 29, 2008) contribution by Lopez-Duran again confirms Translating Autism as one of the best autism blogs on the internet. In my humble opinion, Translating Autism is an excellent source of balanced, professional, autism information.

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Autism and Mortality Rates

In Mortality Rates in Autism Nestor L. Lopez-Duran Ph.D. , child psychologist, neuroscience researcher and blogger ( Autism Research Blog: Translating Autism) comments on a study examining an important and seldom discussed aspect of autism - mortality rates. Parents don't like to think about their child's life span and the likelihood that it will be shorter than that of the general population - or their own. I know I don't.

Mortality Rates in Autism is Lopez-Duran's review of Mouridsen, S.E., Bronnum-Hansen, H., Rich, B., Isager, T. (2008). Mortality and causes of death in autism spectrum disorders: An update. Autism, 12(4), 403-414. DOI: 10.1177/1362361308091653. He mentions a number of surprising facts disclosed by the Mouridsen et al study which suggests that autistic people, particularly autistic women, die much sooner than the general populaton.

What also struck me was the statement that "The cause of death commonly reported among the cohort with ASDs was epilepsy." My son does not have an epilepsy diagnosis but he does exhibit behavior which appears to me, as a layperson, to reflect epileptic behavior, including physical energy surges which cause him to become rigid and make growling noises, and the increasingly frequent rolling of his eyes back in his head. The possibility of epilepsy in addition to autistic disorder has been more in my mind of late and the thought that it could be a major cause of premature death of autistic persons is unsettling.

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Autistic Self Injury - Study Confirms Self Injurious Tendencies of Children with Autism Disorders

In Injury propensity among children with Autism Spectrum Disorders Clinical Psychologist and blogger Nestor L. Lopez-Duran Ph.D., host of Translating Autism, reviews a study which , in Nestor's words, "provides some compelling evidence indicating a higher risk of injury in children with autism as compared to typically developing children. "

The study - McDermott, S., Zhou, L., Mann, J. (2008). Injury Treatment among Children with Autism or Pervasive Developmental Disorder. Journal of Autism and Developmental Disorders, 38(4), 626-633. DOI 10.1007/s10803-007-0426-9 provides information which confirms what many parents already know - children with autism are more likely to be injured than typically developing children. Generally children with autism disorder are 21% more likely to be injured than their typical peers. Two specific injuries that jump out by their magnitude - children with ASD's are 760% more likely to suffer a poisoning injury and 762% more likely to suffer from a self inflicted injury than their neurotypical peers.

I am no fan of the thinking of those who assert that autism disorder is not in fact a disorder; that it is just a natural variation that should be embraced, but any condition which results in such serious levels of self injury is obviously a disorder. Period.

Interestingly, despite the extreme rhetoric of the "autism is beautiful" crowd which tries to smear parents seeking to cure their autistic children by insinuating that such "curebie" parents are responsible for atrocities like the murder of Katie McCarron the study provides no assistance to their argument - children with ASDs are not more likely to be injured by peers or adults.

As a parent controlling and minimizing self injurious behaviors is one of the several reasons why I use and seek ABA intervention for my profoundly autistic son. His reality includes self aggression. The Michelle Dawsons and Amanda Baggs can ignore that reality. As his father I can not and this study is a perfect indicator of why I can not.

Many thanks, again, to Nestor L. Lopez-Duran for highlighting and explaining this study.

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