Where we Stand with Autism

An action so often understands how to disguise itself as a passive experience.

For some decades now, speakers on autism have observed a surge in diagnoses that some have called an epidemic. Once thought of as among the rarest and most severe of clinical problems, affecting no more than one-to-four out of ten thousand, estimates of prevalence in some places have reached as high as one out of forty-four children, with increases looking asymptotic. Autism has commanded attention, and deserves it, not least because no other diagnostic form has undergone such staggering change in perceived quantity and quality—from almost non-existent to seemingly everywhere, from gravest pathology to a wide array of phenomena. It seems as if we are trying to work something out.

Epidemiologists, to whom we ordinarily might turn in such a situation, insist that they have little to offer. They are clear that their methods do not and cannot answer a question some pose, even as others object to its premises: whether the growth in autism diagnoses reflects true change, or is only a function of altered practices and social conditions. The conditions they identify are: more numerous and more liberal diagnostic definitions, diagnostic substitution by autism for other diagnoses like intellectual disability, increased awareness of autism among professional and lay people, and advocacy to diagnose as early as possible. The most this line of work can conclude is that the changes better cover the involved population, even as it can't quite shed a suspicion some have that the language of autism has come to describe people who, for lack of a better way to put it, might not be autistic. But it cannot tell us whether there are more autistic people than there used to be, or even whether—to put it a bit existentially—there is more autism than there used to be.

Without helpful understanding, many fall back on intuition, and autism affords expression of a common one: that trends in mental illness or their