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Is there an autism 'epidemic'?

The number of pupils diagnosed on the autism spectrum is rising sharply - it has almost quadrupled in California in five years. Carolyn O'Grady examines how British schools are meeting their needs

The incidence of autistic spectrum disorder is rising dramatically. Or at the very least teachers think it is. A survey by the National Autistic Society last May found that 67 per cent of teachers felt there were more children with autism now than five years ago. This was across all age groups and all types of educational provision.

Teachers in seven local education authorities in England, Wales and Scotland said that one in every 86 children they taught had special educational needs related to autism.

The rate of autism reported in mainstream schools responding to the survey was one in every 128 children, a figure far higher than recent official estimates. The society estimates that one in 110 people have autism.

Disturbingly, the figure for primary schools was more than three times higher than in secondary schools. Why? Are there "missing", or undiagnosed children at secondary level? Is there an "autism epidemic"? Or is it due to more awareness and better diagnosis? At present, there are no certain answers.

Some see a link between the rise in autism and the introduction of the MMR (measles, mumps and rubella) vaccine. However, a recent American study published in the New England Journal of Medicine found no evidence of a connection. The study "provides strong evidence against the hypothesis that MMR vaccination causes autism", says Kreesten Meldgaard Madsen of the Danish Epidemiology Science Centre.

But, according to a recent University of California study, better diagnosis and awareness alone cannot explain the dramatic rise in the condition over the last five years (287 per cent in the state of California). The researchers suggest that some people are born with a genetic susceptibility to autism that could be triggered by an unknown external factor.

While the majority of children with autism are in special schools, the number in the mainstream is rising. There are now 7,000 autism-specific places in schools run by the National Autistic Society or similar organisations or in mainstream primary, secondary and special schools.

Increasing numbers of children with autism are supported in mainstream schools by specialist outreach teachers or have full or partial support from a learning support assistant. Frequently, those in the mainstream are children with Asperger Syndrome, at the very able end of the autistic spectrum.

However, there is evidence that children aren't getting adequate support in schools and that teachers are painfully aware of this: just under half of those responding to the NAS survey said they weren't getting enough training or support.

We need "much faster diagnosis and then adequate trained support, plus training for the teaching staff," was one heartfelt comment from a mainstream primary teacher.

Meanwhile, statistics on children and young people with autism and exclusion are disturbing. Children with autism are five times more likely to be excluded than others. "Too often these are young people who are diagnosed after exclusion, and were assumed in school to be deliberately disruptive", says Mike Collins, an adviser to the NAS. "If children are getting diagnosed on or after exclusion, it is a safe bet that many excluded children aren't getting diagnosed at all." As Judith Barnard, the society's director of policy, says: "Many parents of children with autism have to struggle to get a supported place for their child in a mainsteam school, despite the Government's policy on inclusion. Yet this struggle is often for nothing, as these children are so frequently excluded."

Children with an autistric spectrum disorder range across all levels of ability, although 75-80 per cent of children with such a diagnosis have severe or moderate learning difficulties.

The Department of Health's good practice guidance says young people and children with ASD, "share a triad of impairments". Their difficulties have to do with: understanding and using non-verbal and verbal communication; understanding social behaviour, which affects their ability to interact with children and adults; thinking and behaving flexibly, which may show in restricted, obsessional and repetitive activities.

Many children with autism are delayed in learning to speak and some don't develop speech. Difficulty in understanding how others think and feel, and in learning how to behave appropriately is a clear indication of autism. Children and young people are often very literal thinkers and interpreters of language; figures of speech will be taken literally.

Other possible difficulties involve a great need for routine and an over-sensitivity or under-sensitivity to certain sounds, sights and textures. Children with autism tend to play alone or alongside others rather than with them, and can become very fixed on certain patterns or subjects.

Many more boys are diagnosed with autism: four boys to every girl, and with Asperger Syndrome the ratio increases to between nine and 12 boys to each girl.

However, many of these children have enormous strengths. For example, they can focus for long periods on a single activity if it interests them, and can often achieve a high level of skills in tasks where others fail.


* Autism in School - Crisis or challenge? By Judith Barnard et al. From National Autistic Society, 393 City Road, London EC1V 1NGTel: 020 7833 2299. society provides details of courses, fact sheets and further links

* Autistic Spectrum Disorders: Good Practice Guidance From: DfES Publications. PO Box 5050 Sherwood Park, Annesley, Nottingham NG15 0DJ Tel: 0845 6022260

* Asperger Syndrome - practical strategies for the classroom. A teacher's guide. By Leicester City Council and Leicestershire County Council

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