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Changes in Psychiatrist Diagnoses of Autism and Other Mental Health Conditions in Israel Between 2003 and 2012
The dramatic increase in autism spectrum disorder (ASD) prevalence has been attributed to the broadening of diagnostic criteria, greater awareness, improved case finding methods, and the development of services for children with ASD. Diagnostic substitution has also been suggested as a reason for this increase, with several studies pointing to an increase in the diagnosis of ASD and a decrease in the diagnoses of intellectual disabilities, and other language and developmental disorders. However, to our knowledge, no studies have examined whether shifts in psychiatric diagnoses could contribute to the rise in ASD prevalence.
Objectives:
To describe the changes in diagnoses of autism and mental health disorders in children in Israel between 2003 and 2012, using data from psychiatrists in Maccabi Healthcare Services (MHS), a large healthcare organization in Israel.
Methods:
A search of the MHS computerized databases was conducted for all diagnoses given to children (up to the age of 18) by psychiatrists from 2003 to 2012. Diagnoses were grouped by year and divided into ten broad categories, such as ASD, anxiety, and phobia. If a child received a diagnosis that fell into multiple categories, the diagnosis was listed in all relevant categories. However, if a child received the same type of diagnosis twice or more in a single year, the diagnosis was listed only once. The relative percentage change was calculated and chi square analysis was performed.
Results:
The total number of children diagnosed by psychiatrists in MHS increased from 1499 children in 2003 to 7327 in 2012. ASD accounted for 6.1% of all diagnoses in 2003, compared to 10.4% in 2012, representing a relative percentage increase of 69.2% (p<0.001). Statistically significant (p<0.01) relative increases between 2003 and 2012 were also found for behavior problems (60.7%), anxiety (58.6%) and ADHD (38.4%). A significant (p<0.001) decrease in the relative percentage between the same years was found for psychosis (58.5%), schizophrenia (40.8%) and depression (35.4%). Non-significant changes were found for phobia, obsessive compulsive disorder and bipolar diagnoses.
Conclusions:
Results indicate a substantial shift in psychiatric case mix among children (up to the age of 18) between 2003 and 2012 in one of Israel’s largest healthcare organizations. ASD accounts for a growing proportion of all cases diagnosed by psychiatrists. While there was a relative increase also in behavior problems, anxiety and ADHD, there was a relative decrease in psychosis, schizophrenia, and depression. This shift may reflect psychiatric diagnosis substitution over time with an increasing number of children receiving an ASD diagnosis instead of other psychiatric diagnoses. Possible explanations for the shift in psychiatric case mix include increased awareness as well as a significant increase in services provided to children and adolescents with ASD.