Autism: A Disease of the Rich?

The higher rates of diagnosed autism among the wealthy has long been thought to be a result of higher rates of diagnosis (or “diagnostic?ascertainment bias”) – i.e., wealthier families having better access to those who diagnose autism. However, a new paper argues that the disease itself might actually be more common at the higher end of the income spectrum. The paper relied on “abstracted data from records of multiple educational and medical sources to determine the number of children who appear to meet the ASD case definition, regardless of pre-existing diagnosis. Clinicians determine whether the ASD case definition is met by reviewing a compiled record of all relevant abstracted data.” Within all ethnic groups, wealthier parents were more likely to have autistic children, and the pattern held for undiagnosed autistic children as well. Neuroskeptic hypothesizes that paternal age may be partially responsible for the disparity. (HT: Marginal Revolution)[%comments]


Caitlyn

huh. one theory I'd heard was that math/engineering/science ability was somehow genetically linked to ASD, so the rise of tech jobs meant that more people with minor ASD symptoms were working together and making lots of money and getting married to each other. This might support that.

MRB

Hard to tell if wealthier parents = later in life births isn't the culprit, but I think that's probably too obvious to not be controlled for.

Personally, I think it's the hyper-clean, ultra-strict and low-activity diets that white middle and upper class parents by-and-large subscribe to. Those conditions weren't really available to all but the richest until the last 100 years or so, and has only become vogue over the past 40.

Our whole country needs a more 'roughing-it', do-it-yourself, it's-not-going-to-kill you mentality. And not just for the sake of the children.

Tzipporah

I thought that the only correlated risk factor in previous research was educational attainment (but not age) of the mother. How does that relate to the income distribution?

TK

Perhaps because amongst the rich, it's considered a treatable syndrome with all the attendant products and industries that can feed off of it. Amongst the poor, it's a problem with an easy solution: jail.

Drill-Baby-Drill Drill Team

If I was Rich and Autisitic, I am sure my response would be a NON RESPONSE.

Johnny Loaks

It's because rich people get more vaccines! Arrrrggghh!
/jk lolz

Anton Dubrick

From life experience, I have long-noticed a spectrum of disorders that blend into one another that includes variants of autism, borderline personality disorder, and antisocial personality. I also believe that a significant number of wealthy people either obtained their wealth or are descended from from a pattern of anti-social behavior, and/or use their wealth in the manner of borderline personality behavior. Unfortunately, this also implies to me, that this genetic cluster also contains the possibility of producing relatives who are left in their wake with the burden of being borne autism-prone. I am often struck how many wealthy people truly flaunt their antisocial propensities as evidence of superior ego strength.

Lucian Junto

As the father of twin sons, one with full blown autism, the other with the diagnosis of PDD, I can unequivocally state that autism is a disease of the rich. While not limited to some upper economic strata, to properly address the condition is an expensive proposition. Therapies are extremely expensive. The results are more difficult to measure, given the condition of the children, and the elusive nature of the disorder.

Families suffer and shatter due to the stress of caring for an autistic child. The safety net offered by state governments is fraying due to the current economic recession. The federal government needs to step in. A greater variety of services needs to be made available to autistics. There needs to be some sort of stipend to make therapies more affordable. A growing segment of our children is being left to flounder. Without early intervention, consistent therapy, and constant support for families, we will have a major health issue on our hands as these children grow older, and their parents age...and go broke. Brother, can you spare $3 million? (The estimated lifetime cost of caring for an individual with autism).

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Jen Strange

My son Jake has Asperger's syndrome (on the autism spectrum), and our situation doesn't fit with any of these theories. I was 24 when I had him, I only have a bachelor's degree, and I am CERTAINLY not rich. (I'd describe my situation more as clinging desperately to the bottom rungs of the middle class.)

We do not have any "hyper-clean, ultra-strict and low-activity diets" happening at our house. I follow the good-enough theory for house-cleaning AND for parenting - the house is mostly picked up and nothing hazardous? Good enough. My child isn't in physical harm? Good enough. A little dirt won't hurt.

Jake did get all his vaccines on schedule, but he was showing signs of sensory sensitivity in the womb (for example, startling and jumping every time an automatic stapler went off nearby) and from the moment he was born he wouldn't make eye contact, even while nursing. He never had a single reaction to a vaccine, and I don't attribute any of his issues to them.

Nor do I (or Jake's dad) have ANY math/engineering/science ability (seriously), although my dad does.

I agree that figuring out what causes autism would be helpful, but I think we also have to just accept that it is what it is. Sometimes there isn't a reason.

jen
http://jenjen.typepad.com/strange/

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ACW

I've never read a study on rates of autism in other countries. Are these results replicated in the UK, Australia, Canada, the Scandinavian countries, and other countries with a high standard of living (and, #2, of cleanliness)? What about the rate of autism among the educated classes in India, whence come so many of our computer programmers and other technocrats?

I still strongly suspect this is still the diagnostic ascertainment bias, combined with the fact that the old stigma attached to the diagnosis has largely dissipated. I think on my older sister, whose original diagnosis (shortly after WW II - and my parents were quite young) was "childhood schizophrenia." In those days, we were told we should move out of the neighbourhood because compared to the Ozzie-and-Harriet ideal, our family "didn't look nice" and our presence brought down property values. (That is the kindest of it.) But when the medical solons changed the name to "autism," and autism became dissociated from (1) retardation and (2) crazy people, autism became an acceptable diagnosis. Parents could look at their child and think possibly a Mozart or Einstein, or a Temple Grandin, or at least a Raymond Babbitt, lurked within that shell.

I would add that I think the diagnosis was delayed for several decades in large part because she is female, and shrinks have it drummed into them that autism is largely a male-associated disorder, so they automatically ruled it out. Another diagnostic bias factor may thus be in play; has anyone studied whether the gender ratio of diagnoses has changed? Perhaps girls who once would have gotten some other label are getting tagged as autistic.

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jimmyc

Parental age was not controlled for. ASD is very complex and exhibits itself in a myriad of ways and thus is bound to be linked to a number of factors. I don't think you can just simply link socioeconomic status alone as a culprit, rather it reveals itself as a symptom. Clearly this body work was a beginning attempt to pin down how to proceed with analyzing this complex issue.

Steve

Nobody has suggested that the very profitable fertility programs might have a role. they are very expensive and can't be afforded by the average prospective parents. Perhaps nature is trying to tell us something but the doctors can beat nature for a $ or two.

Jennifer

One could argue that fertility drugs, which are expensive and more readily available to the rich, contribute. One could argue the genetics angle, that ASD genes are more common in people of higher intellect and thus higher income levels. We could argue that it's more common in older parents who devote more time to their careers and thus have higher incomes once they become parents. One could also argue that higher income folks get their children more vaccines. The possible causes shouldn't undermine the fact that there are many children and parents who need help. I like what Brain Balance has to say about the issue - www.brainbalancecenters.com . While they aren't really talking cause on their site, they do detail the underlying brain issue believed to contribute to all the disorders and discuss ways to correct it, thus eliminating or greatly reducing symptoms. The site is definitely worth a read.

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David Chowes, New York City

Probably many varibles are related to autism -- don't discount that the rich are more likely to notice abberant behaviors in their children, seek a psychiatrist or neurologist and the giving of the diagnosis is somewhat more common.

[I'd like to see research methodology used in all the relevant studies the n's and alpha levels,

Replication is very important,

AR

MRB, do you have any supporting evidence at all for your "hyper-clean, ultra-strict and low-activity diets" theory, or is it just a gut feeling?

Duke

Asperger's Syndrome, which is classified as part of the autism spectrum, may be influencing the numbers here. Asperger's is on the rise, and it is positively correlated with the IQ of parents. Higher IQ mates are more likely to have kids with Asperger's. IQ also correlates with wealth, but it's more likely that autism is linked to the genes that affect intelligence--not the wealth of the parents.

Quill

Older parents would be wealthier because they've had more years to work and accumulate wealth.

Wonks Anonymous

Try this. Poor kids with learning disabilities of any kind are more likely to miss school, develop truancy problems and in general not be recorded in the case records used for this study. You can't diagnose them if they are not there.

Also the schools that they go to are less likely to have people who record such things and they are less likely to have contact with medicine unless there is a life threatening emergency.

But I suppose that this is all O.K. since poor people are disposable resources anyway.

jimi

RE: Lucian

"The federal government needs to step in."

No, it doesn't.

mark

I think that Caitlyn (comment #1) has it right. I think that mild autism can help one focus narrowly more effectively and thus can aid in success in many math/science/law/financial modeling positions. Thus, as Caitlyn notes, these individuals will be successful, but be more likely to produce children with more severe autism, particularly when they marry each other.