A review of: Montiel-Nava, C., Pena, J.A. (2008). Epidemiological findings of pervasive developmental disorders in a Venezuelan study. Autism, 12(2), 191-202. DOI: 10.1177/1362361307086663
I decided to write a brief review of this article for two reasons. First, I often hear questions about how the rate of autism in the US, Canada, and the UK compare to that found in other countries. The answer to this question is relevant, although not as illuminating as most would like, to the major scientific debates regarding the perceived increase in rate in autism during the last two decades and the role of specific environmental factors in the development of autism. The second reason is more personal. Once upon a time, when Michael Jackson was on top of the charts, I called Venezuela my home.
The authors examined the rates of autism in a large metropolitan area of Venezuela, a country of 26,000,000 people with a large youth population (33% under the age of 14). In the first step of the study, the authors reviewed local medical records to identify children with a diagnosis of ASDs. The authors found 610 current cases in children between 3-9 years of age. Then, the authors independently confirmed the diagnosis in about 70% of the sample (N=430). The remaining children did not meet standard DSM-IV criteria or there was insufficient information to achieve an adequate diagnosis. This resulted in a prevalence rate of 1.7 per 1,000. Although this is much lower than reports in the US and other industrialized countries, the authors stated that unlike some previous reports, their methods provided rates for documented (identified) cases and did not include estimations of children that may be affected but have not yet been identified. In addition, the authors used only administrative sources for case identification (medical records) instead of large scale direct community assessments. Reliance on only administrative sources has been shown to provide lower prevalence rates. In summary, the rates of autism in Venezuela appear to be much lower than in other industrialized countries. However, the specific methods used in this study may have affected the results; in addition to the more common explanations, such as more limited access to specialized services, limited awareness about autism in the population, and higher stigma associated with these disorders, all of which limit service-utilization in developing countries.
A final note: I was informed by two Venezuelan MDs that thimerosal was still routinely used in vaccines in Venezuela. However, I sent a request for clarification to the pediatricians’ organization in Venezuela and a governmental health official, since I was not able to confirm this information from any reliable online source.
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