"The attached study is my independent research.
All conclusions reflect my views and not those of any of the organizations to
which I belong."
F. Edward Yazbak, MD, FAAP.
Note: The information
on this website is not a substitute for diagnosis and treatment by a qualified, licensed professional.
The just released Report on Autism to the California Legislature, shows a
massive and persistent rise in the incidence of this disease.
"In the past 10 years, California has had a 273% increase in the number
of children with autism who enter the developmental services system---1,685 new
cases last year alone" said State Senate President pro Tem John Burton in a
press conference, following the release of the report. This spectacular increase
reported was evident in all regional centers from San Diego to Eureka.
In Section E of the executive summary ( page ii ), the authors point out that
the data in the report do not include persons in California who are not part of
the Development Services system, and formulate the following ( quoted ) two
A. The number of persons entering the system with autism has increased
dramatically over the past 11 years relative to the other developmental
B. The accelerated rate appears to be sustaining an upward trend into future
years.( 1 )
The California Education Department figures also show a similar, almost four
fold increase in autistic syndromes, from 2,157 cases in April 1993 to 8.084
cases in April, 1998. In the school year 1997-1998 there were 5,727,3053
students in the school system, and 632,238 in special education classes.( 2 )
As the clinical syndrome of autism has changed in the last few years, the
diagnostic criteria had to be changed. Some of these changes may have been
reflected in the high figures reported originally, but it is the sustained
increase of this entity, year after year, that impressed us most, and prompted
us to try to find out whether a similar picture was reported by other states.
When we looked at the New Jersey school figures ( 3 ), which follow, we
realized that the east coast was just as affected, and that the tragedy was not
limited to Brick Township, which attracted national attention, when the presence
of 40 cases of autism among the township's 6,000 children was revealed.
||Student Body age 3 to 21
||Students in Special Ed.
||% of all students
||% of students in Special Ed.
We then proceeded to look at the Illinois figures, to see whether the center
of the nation was similarly affected, and noted the same unrelenting increase in
seven years. ( 4 )
Students with Learning Disabilities
In the Northern Suburban Special Education District ( NSSED ), which
comprises the school districts of the northern suburbs of Chicago, and where
very stringent criteria are adhered to, the number of cases of autism, almost
tripled between 1994-95 and 1998-99. In the same period, the incidence of the
disease as compared to the total student population went up by 183%.
Other states chosen at random reported similarly impressive rises in autistic
syndromes, among their student population.
On 12/1/1997, The Pennsylvania Department of Education identified 2243
students as autistic among a total school population of 1,1814,081.This
incidence is 102% higher than it was four years earlier, on 12/1/1993, when
there were 1,072 autistic students in the system..
Similarly in 97-98, Colorado schools had 223 students included in the Autism
/ PDD ( pervasive developmental disorder) category, 699,135 students in all in
the system ( K-12 ), and 66,979 in special education classes, an incidence of
0.03% of the total and 0.33% of the special education population.. In 1992, only
16 students were listed as autistic - PDD.
In the State of Washington, the education department reports the following
figures for the last two completed years :
||Children with Autism
||Students in special ed.
In four years in Missouri, the total student population increased by 3.8%
while the number of children with autism rose by 123%, as noted in the following
||Students ( K-12 )
||% of total students
Rhode Island autism figures were scrutinized in somewhat greater detail,
because we had access to the actual yearly statistical profiles of special
education of the Rhode Island Department of Elementary and Secondary Education.(
The following table shows that the number of autistic children in Rhode
Island more than doubled between June 95 and June 98 :
|Year & Date
||Students in Special Ed
||# of cases of Autism
||% of Special Ed
||% of totalStudent Body
The Mean percent of Autism / PDD cases compared to all special education
categories increased from 0.063 in June of 95 to 0.105 in June of 97, and the
median percent went up from 0.033 to 0.084, in the same period.
We have every reason to believe that this trend will continue to be evident
in the next statistical report due June 30, 1999.
The higher incidence in the younger two age groups suggests an ongoing and
In Rhode Island, children suspected of having autism, are evaluated by well
trained multidisciplinary teams at one or two centers, and seen by a small
number of pediatric neurologists and psychiatrists, with particular expertise in
the field. The diagnosis is therefore reached with great care, and only when all
needed criteria are present. It is only then, that the child is referred to the
local school department, where he or she is again reviewed by its team of
experts, and appropriately placed.
Neither the school systems, nor the parents, want to include a child in this
group, if he or she does not truly belong, and it is therefore probable that the
figures we are quoting are on the conservative side, and that the syndrome is
actually under diagnosed.
Many of the less severe and less flagrant cases, are possibly listed in other
categories, such as Speech Defects, or Behavioral Disorders. On the other hand,
some of the more severely affected children may be receiving care in specialized
institutions, and therefore not included in the statistics we have quoted.
When we looked at the figures from the different school departments in the
1998 report, we were impressed by several unexpected findings :
Barrington and East Greenwich schools with 5,337 students, had 25 cases of
autism, while in West Warwick and Woonsocket there were only 12 autistic
children among the 10,343 students.
Providence, Warwick and Cranston, our three largest school populations with
47,736 students, had 32 children listed as autistic or 0.067%, compared to the
Barrington, East Greenwich & Lincoln school systems which had 40 cases among
their 8,883 students, an impressive 0.450%.
These epidemiological data are very difficult to interpret but the striking
differences between the communities, which we do not believe to be artifacts,
deserve further study.
We shall continue to monitor the Rhode Island picture to see if this trend
continues in the next report.
We are also interested in a cluster of cases in Seekonk, which is quite close
to Barrington, and which we will include in our Massachusetts paper, when that
State Education Department publishes its report in few weeks.
Having been so impressed with the individual States findings, we decided to
go on and review the national picture and the Federal Government's own figures.
All states are now mandated to forward yearly reports to the federal
government. These are tabulated and available through the Center for Educational
Statistics ( 6 ) and then forwarded to the US Congress as annual reports on the
implementation of The Individuals With Disabilities Education Act. ( 7 )
The following is a summary of table 52, of the Center for Educational
Statistics 1997 report ( 6 ):
Diagnostic classification of students receiving special education services
|Autism # in thousands
|% autistic students in Special Ed
|% autistic students in total
We are expecting that the 1998 report of The Center For Educational
Statistics, which will be issued in a few days, to show further increases.
It can be reviewed after July 1, by reaching the Center's web site : (http://nces.ed.gov/pubs/digest98/
Another internet source will be : http://ed.gov/pubs/index.html ( Government
Publications à Disability)
Autism and traumatic brain injury were introduced as separate reporting
categories in the 1991-92 school year as a result of a 1990 Amendment to P.L.
" The Implementation of The Individuals With Disabilities Education Act
( IDEA )"
"To Assure The Free Appropriate Public Education Of All Children With
Every local school system reports all disabilities under the care of the
special education division, to the state department of education, which in turn
forwards the reports to the US Education Department which reports yearly to
It is from those Annual Reports to Congress that the following information
was compiled. ( 7 )
Incidence of Autism as compared to all disabilities since reporting of the
syndrome became mandatory : Number of students served, ages 6-21, 1990-91
through 1996-97 school years.
|Speech / language impairments
|Serious emotional disturbance
|Other health impairments
|Traumatic brain injury
Source: U.S. Department of Education, Office of Special Education Programs,
Data Analysis System The data for 1990-91 through 1993-94 include children 6
through 21 years of age served under IDEA, Part B and Chapter 1 Handicapped
Program. The data for 1994-95 through 1996-97 include all children ages 6
through 21years of age served under Part B ( which includes children previously
counted under the Chapter 1 Handicapped Program.)
The diagnosis of autism and autistic spectrum disorders is difficult in early
childhood unless the student is severely affected. By the age of six, the
clinical picture becomes clearer to everyone concerned, and the inclusion of a
child in this category, by error, is most unlikely. Indeed, as mentioned
earlier, it is probable that mild cases may be included in other categories.
1997 Report, Section 2, Table II-2.
Number of Children Ages 6-21 Served Under IDEA by Disability: 1987-88 and
|Specific Learning Disabilities
|Speech or Language Impairments
|Other Health Impairment
|Traumatic Brain Injury
The following entities, listed in the Diagnostic and Statistical Manual ,
Fourth edition ( DSM IV )
Autistic Disorder (299.00 ) Pervasive developmental disorder, not otherwise
specified or NOS ( 299.80 ) Asperger's Disease ( 299.80 ) Rett's Disorder (
299.80 ) Childhood disintegrative disorder ( 299.10 )
may be included under the category of Autism, or PDD ( Pervasive
Developmental Disorder )
The following data was compiled from Appendix A The Twentieth Annual Report
to Congress, on the Implementation of the Individuals with Disabilities
Education Act (IDEA). 1998.
Number of children, age 6-21, with Autism, Speech and language Impairments,
Emotional Disturbances and all disabilities in the 50 United States, the
District of Columbia and Puerto Rico.
Table AA9, pages A-30, A-22, A-24, A-20
Autism, speech and language impairments, and emotional disturbances, were
compared because symptoms of all three entities are somewhat similar.
|Speech & Language Impairments
During the equivalent 1987-88 to 1993-94, in which autism figures were not
tallied, the total number of disabilities rose from 4,110,690 to 4,769,631 an
actual rate of increase of 16%.
This decrease in the percentage rate of all disabilities, between the two
periods, makes the striking jump in the incidence of autism, all the more
significant. ***** Tables AA2 to AA6, page A2-A14 Age of the children served
under IDEA, Part B., 1996-97
Of the 34,082 autistic children aged 6-21 under IDEA, there were 21,465 aged
6-11 versus 10,005 aged 12-17 and 2626 aged 18-21.
Table AA 14, page A43, Number of children with autism & total
disabilities by age group, 1991-92 through 1996-97 school years.
Autism has been increasing at a faster rate than all other
disabilities, and the much higher numbers in the younger age groups suggest that
this trend will continue into the next century.
Autism is a National Emergency.
Because of the tremendous increase we have reported, it is a serious
Certain families seem to have a genetic predisposition to a fragile immune
system. If a mother is repeatedly exposed to certain antigens or environmental
factors, she develops antibodies against them, which she transmits to her
children. If the immature immune system of those children is attacked, early in
life, by several simultaneous antigenic insults, violent complex immune
reactions take place, which affect their whole body, but particularly their
active brain centers, leading to autism. Many afflicted children are born
completely normal, and only develop symptoms at age two to four, and sometimes
later. At this time, the only on- going research is looking at a genetic cause
for the disease. It has not so far, and will probably not, yield major findings.
More importantly, it is unlikely to lead to a reduction in the incidence of this
dreadful disease. Research should therefore be focused on any and all new
environmental insults affecting this generation of children, and their parents',
and only then, will we be able to stop this epidemic, by removing these
offenders. It is therefore imperative that the Federal Government undertake
independent, and far reaching studies of all possible factors.
Smart pediatricians, when faced with obscure diagnoses, always ask parents :
"Can you tell me what you think caused the problem?" "What do you
think happened ?"
The same questions should be asked of parents of autistic children, to find
out where to start looking for answers.
Meanwhile, all involved parents and groups, as well as overwhelmed school
authorities, should band together to pressure the Federal Government to respond.
We are talking about forty thousand precious children.
also Autism 2000
1. Changes in the population of persons with Autism and Pervasive
Developmental Disorders in California's Developmental Services system : 1987
through 1998. A report to the legislature http://www.dds.ca.gov/autismreport.cfm
2. Assessment, Evaluation and Support Unit, Special Education Division,
California Department of Education
3. Total Enrollment And Percent of Pupils With Disabilities By Federal
Categories Office of Special Education Programs New Jersey State Department Of
4. Illinois State Board of Education Report ( 8/20/98)
5. Rhode Island Department of Elementary and Secondary Education. Annual
6. The Center for Education Statistics http://nces.ed.gov/
1997 Report http://nces.ed.gov/pubs/digest97/
7. Twentieth Annual Report to Congress on the implementation of The
Individuals With Disabilities Education Act. http://www.ed.gov/offices/OSERS/OSEP/OSEP98AnlRpt/
Nineteenth Annual report to Congress on the implementation of The Individuals
With Disabilities Education Act. http://www.ed.gov/offices/OSERS/OSEP/OSEP97AnlRpt/
Eighteenth Annual Report to Congress on the implementation of The Individuals
With Disabilities Education Act. http://www.ed.gov/offices/OSERS/OSEP/OSEP96AnlRpt/
Seventeenth Annual Report to Congress on the implementation of The
Individuals With Disabilities Education Act. http://www.ed.gov/offices/OSERS/OSEP/OSEP95AnlRpt/
Sixteenth Annual Report to Congress on the implementation of The Individuals
With Disabilities Education Act. http://www.ed.gov/offices/OSERS/OSEP/OSEP94AnlRpt/