The proportion of Israeli children diagnosed with an autism spectrum disorder jumped 169 percent in the past decade, according to a study conducted by Maccabi Healthcare Services.
In 2018, one out of every 78 children was diagnosed as autistic, compared to one out of 210 in 2007. For boys, last year’s figure was one out of 48, while for girls it was one out of 222.
Experts said that other Western countries have also seen sharp rises in autism diagnoses.
It’s not clear, however, whether this spike reflects a rise in the prevalence of autism spectrum disorders or merely a rise in the number of cases that are diagnosed due to an increased awareness, that has led more parents to have their children tested. “That’s the question of questions,” said pediatric neurologist Michael Davidovitch, the study’s lead author and the head of Maccabi’s child development services.
The study, conducted by Maccabi’s research institute, was based on the full dataset of Maccabi patients rather than a representative sample. The HMO provides health care to around 25 percent of Israelis, so the dataset included tens of thousands of 8-year-old children, the age chosen for the study.
The results showed that the proportion of boys diagnosed with autism spectrum disorder, or ASD, rose 177 percent since 2007, while for girls the proportion climbed 136 percent. Thus in 2007, one out of every 133 boys was diagnosed with ASD, while last year it was one in 48. Autism is less common among girls, but the diagnosis rate for them nevertheless rose from one in 526, in 2007, to one in 222 last year.
ASD is a neurological and developmental disorder that can produce a broad range of symptoms, including problems with social interaction, language, cognitive or emotional abilities and behavior.
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“This rise in the number of children who are diagnosed has been going on for two decades or more. The diagnoses are very stringent, but nevertheless, there’s a dramatic rise that apparently still hasn’t peaked,” Davidovitch said.
“There’s no doubt that genetics plays a role in the development of autism, but since that doesn’t change in just a few years, the explanation lies in external factors,” he continued. “There’s been an increase in incidence in several areas of developmental medicine, including attention, communication and language disorders.”
Davidovitch cited the increased use of computers and cellphones by both parents and children as a possible factor in the rise in ASD. In people who have an inherited tendency toward autism, excess screen time – especially by parents, but also by babies – may influence development, he said.
“When parents are busy with their screens near their children, they aren’t paying attention to the children or having contact with them,” he said. “It’s likely that this affects their communication development, their concentration and other areas of development, and it might even have a connection to the current rise in autism rates.”
Nevertheless, he said, the rise in awareness and in the number of children being tested presumably mean that cases are being diagnosed today that would have been overlooked in the past. Studies in America have shown that in the past, 60 percent of people diagnosed with ASD were cognitively impaired, whereas today, the rate is less than 40 percent, because the increase in testing means more children defined as “high functioning” are being diagnosed, he explained.
The same trend is evident in Israel, Davidovitch said, and he attributed it to increased awareness among parents, medical personnel and teachers. Medical personnel “see more and more children coming in for diagnosis,” he said.
“Nevertheless, I think the rise in awareness can’t by itself explain the dramatic rise in autism rates, and there’s also a real rise in the incidence of the disorder,” he continued. He attributed this to the effects of overexposure to computer screens at very young ages.
Every child “deserves to have the parent’s completely attention, rather than having to share it with the parent’s cellphone,” Davidovitch said. “For the sake of the child’s development, it’s critical to maintain continuous eye contact and not to miss opportunities for communication during all the baby’s waking hours.”
Davidovitch recommended that parents consult a physician if their child doesn’t respond to his or her name by 12 months; doesn’t point at objects to show interest by 14 months; doesn’t do simple “pretend play” by 18 months; doesn’t maintain eye contract, prefers to play alone or has delayed language development – for instance, lacks significant vocabulary at 18 months, doesn’t respond appropriately to questions or has trouble understanding.
Other potential warning signs are if a child gets upset at small changes and has trouble dealing with changes in routine, is excessively preoccupied with certain things, walks in circles or is unusually drawn to revolving objects, or doesn’t respond appropriately to sensory stimuli (odors, touch, taste, sight).
Prof. Ditza Zachor heads the autism center at Assaf Harofeh Medical Center that is sponsored by ALUT, the Israeli Society for Autistic Children. She said the new study’s results are important because they provide the first concrete proof that “the picture in Israel is similar to that in the broader world.”
In the past, she said, Israel lagged far behind other Western countries in diagnosing ASD. “At a time when more than one percent [of children] were being diagnosed with autism in other countries, here, the diagnosis rates were half a percent. But slowly, we’ve been approaching the proportions we’re familiar with from other Western countries.
“When you look at what’s happening worldwide, you see that incidence of autism is soaring,” she continued. “In the U.S., we’re talking about a frequency of one out of 48 children – a rate of two percent.”
Zachor attributed the rise in diagnosis rates in Israel mainly to increased awareness by medical staff, teachers and parents, as well as better diagnostic tools, which have led to higher diagnosis rates in girls in particular. For years, she said, girls were harder to diagnose because their better social skills often enabled them to conceal problems. “Today, we know more, and the criteria, which have changed over the years, have expanded our understanding of the autistic spectrum.”
Unlike Davidovitch, Zachor considers the influence of environmental factors like increased screen time to be marginal to nonexistent. “There’s still no study that links screen time to autism,” she explained. “We’re talking about neurodevelopmental disorders that occur even before birth, that are strongly linked to genetics and heredity and that are also more common when the parents are older and in cases of in vitro fertilization.”