editorial failure at The Australian

The Australian published a beat-up "Disorder in the classroom on the rise " by Jane Hanson, 18/9/2010 (see http://www.theaustralian.com.au/national-affairs/commentary/disorder-in-...).

I'll step through some of the issues ...

  • "an epidemic of autism" is dramatic but true.
  • "incidence as high as one child in 50". They should probably say "prevalence" rather than "incidence". This appears to be on the basis that 1 in 50 Qld public school students is diagnosed with an autism spectrum disorder ... but most private schools don't take these kids so the rate in the population is closer to 1 in 100.
  • "a growing number of medicos, parents and politicians are questioning the validity of the diagnosis" ... show us evidence.
  • "many children are being labelled for life with a disability they simply don't have" ... show us evidence.
  • "early intervention can turn around young lives around" ... it it were available for most children diagnosed with autism/ASD.
  • "every week parents knock on his Brisbane surgery door begging for their child to be diagnosed with autism, even if he knows they are not autistic" ... isn't this everywhere, not just Brisbane? The issue is how health professionals respond.
  • "he says, the rate of autism spectrum disorder in Queensland is officially one in 50 children" ... see above. How "officially"?
  • "'There's no reason Queensland should have three times the rate [of] the rest of the world or any other state in Australia,' he says." The rate in Qld is highest state in Australia ... by a small amount, not 3 times. Australia's rate ASD prevalence is growing, and resemble rates overseas. It would be worth commenting if Australia differed from the situation overseas.
  • "It is being driven by diagnosis-based funding models within the education system." ... most autism/ASD diagnosis is under 6 tears of age, that is before school age.
  • "Does that mean two-thirds of the children carrying the label are misdiagnosed? 'Quite possibly, yes,' says O'Keeffe" ... but many diagnoses in Australia are done (or checked) by teams of specialists in ASD.
  • "The accepted rate of ASD in the Western world is about one in 160" ... perhaps it was, but the rate has moved on.
  • "'I diagnosed the boy with attention deficit hyperactivity disorder and the school told this mother they could not help the child unless she came back to me for a diagnosis of autism,' says Skellern, adding ADHD does not attract funding." There are two issues here. First, Qld Education must provide an effective education for all children ... and ADD/ADHD would affect a child's learning. Second, Skellern repeatedly accuses health professionals of misconduct over ASD mis-diagnosis ... but there has been no convincing evidence.
  • "I'm so angry. They are blackmailing parents ..." ... then complain to Qld Education and the Qld Government that many children who need help don't get it.
  • "there's not a single case of oppositional defiant disorder in Queensland schools." Right, there is no process for recording information that is not used. Again, educational support in Qld should not be tied to clinical disorders, it should be based on the child's education needs. This is not an issue about autism/ASD diagnosis.
  • "Teacher representatives and the DET deny that teachers would see themselves as having a role in diagnosis." They are right.
  • "In the area of special needs, schools and teacher are desperately underfunded." ... mainly because the only election idea politicians have is lower taxes, which means little funding for special education needs. Politicians (and senior bureaucrats) see the rights of children with disabilities are just an embuggerance that complicates their jobs.
  • "a needs-based model of funding" ... this is standard "Yes Minister" language for evenly distributing grossly inadequate funds. Politicians and bureaucrats call this "equity".
  • "... it would become a gigantic rort" ... it is both underfunded and a rort ... how so?
  • "As the architect of the scheme, he [Wells] feels a great sense of responsibility and disappointment. Many children who do not have autism have been labelled for life." Delusions of grandier ... whatever "the scheme" is, it happens all over the world ... he is not responsible.
  • "Skellern's research in 2005 revealed 58 per cent of doctors admitted they had ticked the box for autism when they were unsure the diagnosis was correct. They also admitted to exaggerating children's symptoms to obtain a diagnosis." ... but doctor's don't diagnose autism. In effect, she claims there is widespread professional misconduct ... all over the world. Perhaps a conspiracy?
  • "... schools say: 'We know the child has a problem but without funding we can't help unless they obtain a diagnosis'". Surely, the problem lies with the lack of funding despite knowing "the child has a problem".
  • "O'Keeffe suggested Ben be given time to develop" ... most experts regard this as particularly poor advice. The child needs appropriate early intervention.
  • "the DSM-4 ... is a subjective list dependent on the skill of the doctor to ascertain a disorder". This description is misleading. The DSM-IV is aligned with the World Health Organisations ICD-10. It may not be perfect but is the best we have ... far far better than anything its critics offer in its place.
  • "Six of nine subjective criteria and you have X disorder, five of nine and you do not". Commentators should read the actual diagnostic criteria. A DSM-IV diagnosis of any PDD first involves "severe and pervasive impairment". A person with "severe and pervasive impairment" but who does meet the criteria for a specific disorder (Autistic, Asperger's, etc.) can/should be diagnosed with PDD-NOS.
  • "societies in general are becoming increasingly intolerant to differences between children and putting "pressure on the medical community". This credible working hypothesis needs real evidence.
  • "led to pathologising behaviours that in the past would have been considered within the range of normal". This argues for returning to institutionalising the disabled or pre-pathology practises of losing affected children in the jungle or desert.
  • "'Asperger's is the new term of eccentricity,' she says of the milder end of the autism spectrum." The diagnostic criteria for Asperger's Disorder involve "severe and pervasive impairment". The "milder end of the autism spectrum" is subclinical; it is not Asperger's Disorder.
  • "Before Asperger's was discovered we referred to these kids as eccentric". Before the name Asperger's Disorder was given to a substantial group of people with "severe and pervasive impairment", they could have been diagnosed with PDD-NOS but were largely undiagnosed and apparently had very poor lifetime outcomes.
  • "Mothers whose children had been diagnosed with ADHD went back to their pediatricians and all of a sudden they had a child with autism". Actually, there has been a steady growth in autism/ASD diagnosis rates for over 20 years. There is little evidence of diagnostic substitution from ADD/ADHD to ASD.
  • "Doctors are misdiagnosing children on purpose" ... what evidence is there of this accusation of malpractice.
  • "'We are seeing an increase in the categorisation of students, not an actual increase in disability,' Graham says." Actually, the data shows there is "an actual increase in disability" both in the general population and among the ageing population.
  • "I think parents are being manipulated. I want them to start questioning this ..." Is Graham an academic or researcher? Where is her evidence that parents "are being manipulated"? She can be assured that parents question all "this". They didn't just start because she suggests they should.
  • "For children who are genuinely autistic, the system works extremely well." Actually, young children with ASD have 5% of the funding needed for early intervention from the federal government, and less from most state/territory governments. The AIHW says 15% of young adults with autism change their "primary diagnosis" from autism to intellectual disability ... probably to get services not available to people with autism (is that "works extremely well"?). It looks like people who leave school diagnosed with ASD are not employed and go onto a Disability Support Pension within 5 years. Many spend their lives in the total care of their ageing parents. There is a huge push for massive reform of the disability sector.
  • "it is the medical label itself that is the root of the problem". Well hardly.
  • "many children experience learning difficulties for myriad reasons, including shocking domestic circumstances" ... ah, the old utterly discredited "refrigerator mother" argument.
  • "In New Zealand, a teacher says this child is difficult to teach, for whatever reason, it is verified without a medical diagnosis and assistance is rendered. They don't have kids labelled." Yes, education resources should relate to education issues. But they do (and they should) diagnose children with ASD in NZ.

The Australian would do better to discuss autism/ASD with people who know what they are talking about.