Diagnoses in young children of autism spectrum disorder (ASD) have increased worldwide over the last decade – and at first, reported rates in Israel were lower than those reported in the US and Western Europe.
However, a new collaborative study by Ben-Gurion University of the Negev (BGU) in Beersheba, Clalit Healthcare Services, ALUT (Israel Association for Autistic Children), and the Health Ministry in Jerusalem shows we have caught up. It disclosed a “dramatic increase” here in the prevalence of ASD between 2017 and 2021, with a four-fold increase in young two- to three-year-old children and a doubling in older ages.
Their findings were published earlier this month in Autism Research under the title “Large increase in ASD prevalence in Israel between 2017 and 2021.” The team, led by BGU’s Prof. Ilan Dinstein, analyzed data from the National Insurance Institute (NII), which handles social security for the entire population of Israel, and from the largest public health fund, Clalit Healthcare, which treats 52.8% of the Israeli population. According to NII data, the number of individuals with a formal diagnosis of ASD, one to 17 years old, increased from 14,914 in 2017 to 32,222 in 2021.
The results show a shift towards early ASD diagnosis so that in 2021, the ASD prevalence was 1% among two- and three-year-old children and almost 2% among four- and five-year-old children, the researchers wrote. From 2017 to 2021, according to NII data, ASD prevalence rates of two- and-three-year-old (day-care) children increased from 0.27% to 1.19%, four- to six-year-old (pre-school) children increased from 0.8% to 1.83%, and eight-year-old children increased from 0.82% to 1.56%. Children 10 years old and older exhibited slightly smaller changes in prevalence rates.
Countries like Israel, with centralized ASD registries that monitor the entire population, can deduce the actual ASD prevalence of their population instead of estimating it from samples. Israel’s registryis managed by the NII, which provides parents of children under the age of 18 who have a formal diagnosis with a monthly child disability allowance of NIS 3,000.
“Our analysis shows that the ASD population is growing rapidly, particularly at young ages, which means that education and healthcare services are confronted with a huge challenge to keep up with providing the necessary services,” said Dinstein of BGU’s psychology and cognitive and brain sciences departments and deputy-director of the Azrieli National Center for Autism and Neurodevelopment Research.
Research studies such as these are important benchmarks that government ministries can rely on in their preparations for assisting those with ASD, the team said. “Previous research we has shown that ASD children who are diagnosed earlier – as early as two years old – are three times more likely to improve in their communication and social skills in contrast to children who are diagnosed at older ages, but this requires intervention and the availability of services and support.
Dr. Dorit Shmueli, a pediatric neurologist and head of child development at Clalit’s community division, added: “The increase in autism diagnosis is global, for many reasons, the main ones being the expansion of the definition of ASD so that today it includes children with normal cognitive functioning – and an increase in awareness, both by parents and by educational frameworks.
In Israel, the increase in requests for autism diagnosis and the dramatic increase in the number of children receiving a diagnosis are clearly felt in child-development services. A comprehensive national plan and allocation of resources are required to respond to the growing needs, the authors wrote.
Prof. Gal Meiri, director of the child and adolescent psychiatry unit at Soroka-University Medical Center and medical director of the BGU’s Azrieli National Research Centre for Autism and Neurodevelopment, commented: “The large increase in the prevalence of autism here corresponds with global data in this field. This increase challenges clinicians and the various systems that provide services to children and people with autism and intrigues researchers in Israel and around the world. Autism is a disorder that accompanies people with autism and their families throughout their lives. The early and intensive intervention has been proven to be effective and advances children with autism, and the new data require attention and preparation by policymakers in this area so that proven interventions can reach every child and every person who needs them.”
Ronit Shussel, director of the knowledge, research and training division at ALUT said that her voluntary organization sees great importance in concentrating data pertaining to the autistic population here and the various services they receive. In the absence of inclusion of data at the national level, Israel won’t be able to provide the population with available and high-quality services required to promote their optimal integration into society and the community. There is already a significant shortage of educational, welfare and medical services, and without intervention and service planning, this gap will deepen in the coming years.”
“While it is important that the health system in Israel is diagnosing ASD at very young ages, it is equally important that intervention services be available to those who are diagnosed – with such fast growth, this is clearly a challenge,” Dinstein concluded. “These children will likely require support at various levels during adulthood as well. This study is, therefore, a wake-up call for the government to start planning ahead,”