Korean autism rate

Initial

In 2011 The American Journal of Psychiatry published a study done in Seoul, Korea, which estimated a rate of 1 in 38 for autism. The US estimate at the same time was 1 in 110. The wayback machine references report on the study. (It does mention skeptics of their methodology.)

To explain, let’s first take a closer look at the study, published online by the American Journal of Psychiatry. It examined the entire 7- to 12-year-old population of a socioeconomically diverse region of Seoul, which included about 55,000 children. Instead of only evaluating children who were already receiving services for autism, the researchers gave questionnaires to teachers and parents of every child in special education programs and two-thirds of the "regular" schools. They followed up with in-person assessments of many of the kids flagged by the survey, and concluded that about .75 percent of the kids who received government services and 2.6 percent of the previously unidentified children were on the autism spectrum.

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Why did the study find so many kids in "mainstream" classrooms, not receiving special support? One explanation may be the Korean school system. Children go to school six days a week, 12 hours a day. They don’t have much recess time, have fewer transitions between classes, and spend more time on rote learning.

Roy Richard Grinker, a cultural anthropologist at George Washington University who worked on the study, said his own child with autism would probably function very well in such a system.

"Many kids with autism who are doing well can adapt to that highly structured situation," he said.

Followup 2015

New study exposes flows in estimates of autism prevelance finds that the estimate may be wrong.

The 2011 study garnered attention for its two-phase design, in which researchers screened more than 20,000 children for autism and then clinically assessed a small proportion2. They extrapolated these findings to South Korea’s population to arrive at their estimate.

Three-quarters of the children the study tagged as having autism did not have a prior diagnosis and were attending mainstream schools. Flagging children based on signs noted in medical and school records — the standard method in the U.S. — may have missed these children.

But the two-stage design is also flawed. The screening method the researchers used is not perfectly accurate, and the results can be skewed by which parents choose to participate. Taking these limitations into account, the analysis, published 29 June in Autism, says the 2011 study’s range for autism prevalence could have been at least 2 to 5.4 percent.

Or in other words, their estimate should have ranged from 1 in 50 to 1 in 18. The 1 in 50 is better than 1 in 38 reported, but still higher than the 1 in 68 which was the US estimate from CDC in 2016. The 1 in 18 is worse--so much worse that you have to wonder how elastic their definitions of autism were.

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Comments

There is a philosophical question about whether something is a feature vs a bug, or a trait vs a disability. If the child gets along fine, maybe it is better to consider them on the normal spectrum than on a disability spectrum. Similarly if they worry along OK with only occasional help.

Draft 1.01: 22-Aug-2017