NHS must prioritise health of children and young people
BMJ 2018; 360 doi: https://doi.org/10.1136/bmj.k1116 (Published 14 March 2018) Cite this as: BMJ 2018;360:k1116
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I meant to include as a citation in my previous letter:
Jackie Fletcher, 'Re: NHS chief attacks anti-vax “fake news” for falling uptake', 9 March 2019, https://www.bmj.com/content/364/bmj.l1000/rr-2
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Competing interests: No competing interests
While the number of Autism Spectrum Disorder cases rose in Scottish schools last year by a gigantic 16% [1] this is not apparently the end of the story. According to an ITV report just four days ago there is also a log jam of cases waiting to be diagnosed [2]:
"Tory public health and equalities spokeswoman Annie Wells said Scotland should follow what is “already in place in the rest of the UK”.
She said: “The autism diagnosis process is currently failing patients – the SNP must introduce a three-month waiting time "target and take direct action to tackling delays in autism diagnosis.
"“Having worked closely with the National Autistic Society, it is clear that many youngsters are missing out on vital support in their formative years..."
But even this report does not acknowledge that the queue for diagnosis is a symptom of the extraordinary number of cases now entering the system. It has become a matter of urgency to consider without fear or prejudice what the triggers for this flood might be [3,4,5,6,7,8].
[1] John Stone, 'Latest autism figures from Scottish schools - total numbers have risen by 16% between 2017 and 2018', 12 March 2019, https://www.bmj.com/content/360/bmj.k1116/rr-13
[2] ITV Report, 'Waiting time target for autism patients must be introduced, says Tory MSP', 9 March 2019, https://www.itv.com/news/2019-03-09/waiting-time-target-for-autism-patie...
[3] John Stone, 'Response to David Oliver I (The Indisputable Rise in Autism)' 28 August 2018, https://www.bmj.com/content/362/bmj.k3596/rr-12
[4] John Stone, 'Response to David Oliver II (Risks of Vaccines)' 28 August 2018, https://www.bmj.com/content/362/bmj.k3596/rr-11
[5] CMO/John Stone Correspondence, https://www.whatdotheyknow.com/request/536265/response/1323604/attach/2/...
[6] Vinu Arumugham, 'Role of MMR II vaccine contamination with GAD65 containing chick embryo cell culture in the etiology of type 1 diabetes', 22 July 2017, https://www.bmj.com/content/358/bmj.j3429/rr
[7] Vinu Arumugham, 'Ignoring immunotoxicity of aluminum adjuvants in vaccines, won’t make it go away', 5 April 2018, https://www.bmj.com/content/360/bmj.k1378/rr-14
[8] Vinu Arumugham, 'Milk containing vaccines cause milk allergies, EoE, autism and type 1 diabetes', 17 June 2018, https://www.bmj.com/content/361/bmj.k2396/rr
Competing interests: No competing interests
I once again reproach Prof Viner and RCPCH for not focusing on the rise of autism [1]. The latest figures from Scottish schools show the total numbers for Autistic Spectrum Disorder have shot up in a single year by 16% from 14,973 in 2017 to 17,393 in 2018 [2]. At this rate in a further five years the number will have doubled to 30,000.
I believe they have a responsibility.
[1] Responses to Viner, 'NHS must prioritise health of children and young people', https://www.bmj.com/content/360/bmj.k1116/rapid-responses
[2] Tables 1.8 for 2017 and 2018 Scottish Government Pupil Census, https://www2.gov.scot/Topics/Statistics/Browse/School-Education/dspupcen...
Competing interests: No competing interests
In a letter to The Times today regarding vaccination Prof Viner states [1]:
"We need to find out what specific issues these groups and individuals have with vaccination and address them."
I did not mention vaccines in this correspondence last year [2] where I brought up repeatedly the unexplained tide of neurological impairment engulfing our schools, but pehaps that is something that he and the RCPCH needs to respond to, because it is a catastrophe unfolding in our midst.
As a vaccine critic I am very happy to talk, though I find the terms of the current debate regrettable.
[1] Letters "Immunisation Science and Vaccine Hesitancy" , The Times 1 March 2019, https://www.thetimes.co.uk/article/times-letters-immunisation-science-an...
[2] Rapid Responses to Viner, 'NHS must prioritise health of children and young people
BMJ 2018, https://www.bmj.com/content/360/bmj.k1116/rapid-responses
Competing interests: No competing interests
Repeatedly has Mr John Stone highlighted the curious silence of the BRITISH government, its agencies, in addressing the causes and the relentless increase in autism.
I ask: Do you ladies and gentlemen who rule us believe that, by observing silence, autism will disappear? That autistic people will miraculously heal themselves? That what appears to be an epidemic, will vanish?
Competing interests: No competing interests
Eileen Iorio, I suspect the people who ought to respond are those directly responsible for children's health, while I take it that the author of the survey, Iain Waugh, is fundamentally only collating data. We are so far from acknowledging the gravity of this situation at the moment that I doubt whether any of this has even been reported in the Northern Ireland media.
I also agree that this is going to hit the community in a very uneven way, with implications we can barely even imagine. If half the population are boys and four fifths of the cases are boys this is going to be about 7.5 boys in 100, and about 1.9 girls (and as we know 60% are at the highest level of intervention, and so very disabled). In population terms this proportion perhaps has much harder consequences than when the total numbers were much less. But the biggest problem is that if our governments and the medical profession do not face up to the factors which are driving this then we have no reason to believe after three decades of dramatically rising figures that it will simply not get worse. How are the people who are not disabled going to be able to look after so many who are?
Competing interests: No competing interests
Thank you for highlighting this issue so well, John. It seems clear that autism numbers are climbing rapidly with little to no explanation or alarm from public health officials. Instead the focus appears to be solely on services (or lack thereof) and the increasingly long wait lists for same. Where is the concern for the rise in disability and the reason for this rapid rise in the last 20 years? Many studies point to an environmental cause. Surely it is time to look at this with a sense of urgency, putting aside all fear of controversy?
Am I correct in saying that for a figure of 1 in 21 children, this extrapolates to 1 in 13.3 boys since boys are 4x more likely to have an ASD diagnosis? In the US, recent numbers from the CDC show an overall rate of 1 in 37 boys (26.6 per 1,000*). Is this NI number accurate? 1 in 13 boys? That's one or two boys with ASD in every class in the country. How is this sustainable? What is the long term goal for education, work and housing as these children age out? As rates rise, the cost rises exponentially and the toll on families, both emotionally and financially, is untenable. Can the authors respond? Thank you.
*https://www.cdc.gov/mmwr/volumes/67/ss/ss6706a1.htm?s_cid=ss6706a1_w
Competing interests: No competing interests
Further to my previous letter there are a number of points, particularly in relation to such ideas as autism being a stable presence in society, better recognition etc. Here we see measurements by the same authority across a geographical area and across time. The possibility of more recognition is raised but perhaps that ought to be balanced against the natural unwillingness of government organisations to recognise disability because it costs a great deal of money. The latter could even be represented in the fact that proportionately fewer cases are given Stage 5 classification. What we see is a steeply rising trend everywhere but also social and cultural differences: town against country, wealth against poverty - something which is volatile, uneven and historically aberrant. These trends are in a broad sense "environmental".
If 60% of children with an ASD diagnosis are Stage 5 cases (highest level of intervention) that means a rate of 1 in 57 across the province and perhaps 1 in 36 in Belfast. And there is no possibility that children with that level of disability could simply have been overlooked in the past, and considered more or less normal.
But where do we have the health officials and child doctors with the curiosity and courage to unravel this problem, or even think the unthinkable?
Competing interests: No competing interests
The Northern Ireland Department of Health Information Analysis Directorate are to be commended for producing a detailed analysis of the prevalence of autism in schools in the province authored by Iain Waugh [1], the first from any United Kingdom health body I have seen since the middle of the last decade. The results of this survey are unfortunately in line with data I assembled in this column below [2,3,4,5,6].
The pamphlet records that the rate of diagnosed autism in the province's school has risen from 1.2% of the school population in 2008-9 to 2.9% in 2017 (a leap of 141% and representing a present rate of 1 in 34.5). Also, while the document emphasises that the proportion of complex cases (Stage 5) to the total number of autism cases has declined from 74% to 60%, Stage 5 autism cases have still risen dramatically in relation to the total school population from 0.89% in 2008-9 to 1.74% in 2017-18, i.e. they have nearly doubled and are heading for 2% of the school population.
The pamphlet also records that "that children in urban areas were 1 1/2 times more likely to be autistic than those in rural areas" and that autism has become more connected with social deprivation:
"The prevalence of autism in the most deperived [sic] decile (1) has increased by 2.7 precentage
points between 2008/09 and 2017/18, compared to a 1.7 percentage point increase in the
least derpived [sic] decile (10) over the same period of time".
It is presumably a combination of these factors which leads Belfast's schools to have an autism rate of 4.7% (1 in 21 children). The figures will necessarily be incomplete because the younger children are the less likely they are to have yet received a diagnosis. By contrast a National Statistics survey of mental health for the whole of Great Britain in 1999 found a rate of Pervasive development disorder (i.e. the broadest possible definition of autism type conditions) of 0.2% in 11-15 year-olds (ie. 1 in 500 born c.1984-8), who being secondary students were more likely to have received a diagnosis [7].
Of course, the pamphlet only reports, it does not significantly discuss the causes of this catastrophic growth in a type of disability. I fear that whatever it is driving this phenomenon it will be unpalatable to the present generation of paediatricians and health officials, but how much worse does it have to get before they pay attention?
[1] Information Analysis Directorate 'The Prevalence of Autism (including Asperger Syndrome) in School Age Children in Northern Ireland 2018', published 10 May 2018, https://www.health-ni.gov.uk/sites/default/files/publications/health/asd...
[2] John Stone, 'Re the NHS must prioritise health of children and young people - what about autism', 19 March 2018, https://www.bmj.com/content/360/bmj.k1116/rr
[3] John Stone, 'The government must face up to the autism pandemic, and so must the RCPCH', 26 March 2018, https://www.bmj.com/content/360/bmj.k1116/rr-0
[4] John Stone, ' Re: The government must face up to the autism pandemic, and so must the RCPCH', 1 April 2018, https://www.bmj.com/content/360/bmj.k1116/rr-2
[5] John Stone, 'The hidden crisis - where are the government and RCPCH, and what is their explanation?' 6 April 2018, https://www.bmj.com/content/360/bmj.k1116/rr-4
[6] John Stone, 'The worst figures of all - 600% rise in additional support in a decade in Scottish schools', 13 April 2018, https://www.bmj.com/content/360/bmj.k1116/rr-5
[7] Metzler et al, 'The mental health of children and adolescents in Great Britain' National Statistics 1999, p.33 Table 4.1 'Prevalence of Mental Disorders', Pervasive development disorder is listed under 'less common disorders', http://www.dawba.com/abstracts/B-CAMHS99_original_survey_report.pdf
Competing interests: No competing interests
Re: NHS must prioritise health of children and young people
It is news to me that we have a robust and quick response time for autism assessments in England.
Parents are waiting over a year for such assessments for their children. A recent example known to me was 3 years.
As the number of children presenting as ASD has significantly increased, there has been a significant increase in resistance to diagnose autism in the UK.
Competing interests: No competing interests