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Commentary: Blaxill, Baskin, and Spitzer on Croen et al. (2002), The Changing Prevalence of Autism in California



Journal of Autism and Developmental Disorders, Vol. 33, No. 2, April 2003 (© 2003) Mark F. Blaxill,1 David S. Baskin,2 and Walter O. Spitzer3,4 INTRODUCTION Lisa Croen and colleagues (Croen, Grether, Hoogstrate, & Selvin, 2002) suggest that the real incidence of autism has not increased. They propose instead that a pattern of “diagnostic substitution” has moved Californian patients who would previously have been diagnosed as mentally retarded (Croen, Grether, & Selvin, 2001) into the autism category. Their calculations purport to demonstrate that over 100% of the increase in autism from 1987–1994 is an artifact of changes in diagnostic practices. In your editorial commentary, Eric Fombonne praises the study, and claims “Croen et al. carefully analyzed the California dataset.” We disagree. Croen et al. rest their diagnostic substitution argument on conclusions that are calculated from four solitary pieces of data: “During the study period, [autism] prevalence increased from 5.8 [in 1987] to 14.9 per 10,000 [in 1994], for an absolute change of 9.1 per 10,000 . . . [d]uring the same period, the prevalence of mental retardation without autism decreased from 28.8 to 19.5 per 10,000, for an absolute change of 9.3 per 10,000.” They did not consider the



Journal of Autism and Developmental DisordersSpringer Journals

Published: Apr 1, 2003

DOI: 10.1023/A:1022912115365

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