BLOOMINGTON, IND. - Data from local school and federal public health officials suggest that children in Monroe County, Ind., are diagnosed with autism at nearly double the epidemic rate that afflicts the nation.

On Dec. 18, 2009, the Centers for Disease Control and Prevention (CDC) released a new report that put the incidence of autism in the United States at 1 in 110 for children born in 1996, or 0.9 percent of the population. A survey, sponsored by the Maternal and Child Health Bureau of the Health Resources and Services Administration and published in the journal Pediatrics in October, showed 1 in 91 children between the ages of 3 and 17 had autism.

According to figures submitted by the Monroe County Community School Corp. (MCCSC) to state and federal governments last year, one in every 60 students, or 1.7 percent, had an Autism Spectrum Disorder (ASD) diagnosis in December 2008.

'Autism and the Indiana Environment Blog'

"We just see a lot more kids with these behaviors and symptoms that fit under the spectrum."- Kathleen Hugo, MCCSC special education director
Both sets of data confirm the skyrocketing rates of autism diagnoses, which even the top autism researcher in the nation said last week is real and most likely the result of environmental factors.

The CDC study used education, health and other records in 11 states, not including Indiana, to estimate autism prevalence and is the third such study the agency has released. The first measured children born in 1992, the second in 1994.

While the first two showed nearly identical autism rates of 1 in 150, the latest shows a 36 percent increase in ASD prevalence between 1994 and 1996.

The MCCSC data suggest a parallel trend. When children born in 1992 entered the first grade in 1998, 0.5 percent of the school population was diagnosed with an ASD. Two years later it was 0.6 percent. When kids born in 1996 entered first grade, it had jumped to 0.9 percent.

And while special education data are among the more comprehensive measures of autism prevalence, CDC warns they should not be used exclusively. Using only single-source datasets to identify trends "most likely underestimate ASD prevalence and might not adequately capture changes in the ASD population over time," the latest study says.


The CDC numbers would not surprise MCCSC Special Education Director Kathleen Hugo and Assistant Director Jan McCollough, who sat down for an interview in their temporary offices on East Miller Drive on Bloomington's south side 10 days before the CDC announcement.

"We just see a lot more kids with these behaviors and symptoms that fit under the spectrum," Hugo said. "We are identifying more kids with autism."
"In 1998, 13.5 percent of MCCSC students were enrolled in special education for one or more of the 17 diagnostic categories. In 2008, the total was 16.4 percent."
Those diagnosed with ASDs exhibit social, communication and behavioral impairments that fall under three broad diagnoses: Autistic Disorder, Asperger's Disorder and Pervasive Developmental Disorder-Not Otherwise Specified (PDD-NOS). All are part of a broader class of Pervasive Developmental Disabilities.

Autism ranks fourth in terms of MCCSC special education enrollment, behind Learning Disabled, 5.3 percent of the student population; Communication Handicapped, 4 percent; and Other Health Impaired, which includes Attention Deficit Hyperactivity Disorder, 2 percent.

Hugo had previously provided copies of MCCSC's annual Child Count reports to the state and federal governments from 1998 to 2008. Child Count reports quantify the number of students receiving special education under 17 separate diagnoses, she said. They are required by the federal Individuals with Disabilities Education Act (IDEA).

Originally passed in 1975, IDEA's goal was to develop and implement effective programs and services for early intervention, special education and related services to citizens with disabilities.

In 1998, 13.5 percent of MCCSC students were enrolled in special education for one or more of the 17 diagnostic categories. In 2008, the total was 16.4 percent.


Hugo, who is in her third year as MCCSC director of special ed, said IDEA doesn't just require school districts to report who receives services. A provision called the "Child Find Mandate" requires them to proactively identify those in their jurisdictions who are eligible for such services.
"There is no question that there has got to be an environmental component here."- Dr. Thomas Insel, National Institute of Mental Health chair, quoted in Age of Autism
"The school system's obligation is to seek out and find all kids who need our services," she said.

Hugo and McCollough said the path for identification and diagnosis of autism and other developmental disabilities generally begins with parents. School psychologists and officials then conduct evaluations and collect data and, hopefully, reach a consensus on diagnosis with the parents.

"There isn't a blood test," Hugo said. "It's a decision made using data. And it's based on the needs of the child."

McCollough said autism diagnoses are not the only thing that is increasing. So are the complexities of the students' conditions. Each is unique, requiring its own set of educational and therapeutic approaches.

"All our services are individualized," she said.


Hugo and McCollough are focused on the provision of services to students on the autism spectrum, rather than identifying what causes the condition, which is a subject of considerable debate.

"I think it's a mystery," Hugo said. "There are a lot of different opinions."

But in an interview with Brooklyn-based author and journalist David Kirby, the director of the National Institute of Mental Health and chair of the federal government's Interagency Autism Coordinating Committee (IACC) lent support to the notion that autism is triggered by environmental factors in genetically predisposed individuals.

"There is no question that there has got to be an environmental component here," Dr. Thomas Insel told Kirby during an interview the same day the CDC results were released.

The real question, he noted in an article Kirby penned in the Age of Autism blog, is how genetics and environment interact.

"I don't think in those terms, exactly, that it's either genetic or it's environmental," he told the former New York Times reporter turned Huffington Post blogger. "From my perspective, it's almost always going to be both. And the only question is: How do you nail down this interaction, how do you go after it?"

Steven Higgs is author of the "Autism and the Indiana Environment Blog" and editor of The Bloomington Alternative. He can be reached at .