This Letter was published in the New York Times on January 3, 2025
To the Editor:
Re “Study Clears Vaccines for a Surge in Autism. So What Is Behind It?” (news article, Dec. 25):
As a practicing behavioral/developmental pediatrician with over four decades of experience, I believe that this article fails to mention the most important reason rates of autism have soared in the last 20-plus years.
It cites broadened diagnostic criteria and increased awareness, but not the fact that the autism diagnosis is the key to getting insurance companies to support the main intervention for autism, applied behavioral analysis, or A.B.A. treatment, one of the few proven effective treatments for autism.
What is generally less well known is that most behavioral problems in a toddler or preschooler will respond to A.B.A. treatment. Pediatricians and pediatric psychologists feel the pressure to provide the autism diagnosis. Where in the past they might have diagnosed the child with developmental or language delay, now with any signs of even borderline autism, the evaluators will hedge the diagnosis toward autism. It’s another case of “follow the money.”
Lawrence Diller
Walnut Creek, Calif.