An Autism Epidemic?

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Epidemic is a powerful word, it generates bold headlines, congressional hearings, research

dollars and dramatic high-stakes hunts for culprits. It is a word that has lately been attached
to autism. How else to account for the fact that a disorder that before 1990 was reported to
affect just 4.7 out of every 10,000 American children now strikes as many as 67 per 10,000,
according to new data from the U:S: Centers for Disease Control and Prevention- the
equivalent of 1 in 150 kids.

But what if there is no epidemic? What if the apparent explosion in autism numbers is
simply the unforeseen result of shifting definitions, policy changes and increased awareness
among parents, educators and doctors? That is what George Washington University
anthropologist Roy Richard Grinker persuasively argues in a new book sure to generate
controversy. In Unstrange Minds: Remapping the World of Autism. Grinker uses the lens of
anthropology to show how shifting cultural conditions change the way medical scientists do
their work and how we perceive mental health.

In addition to rising awareness of autism, Grinker points to these factors:

Each new edition of the Diagnostic and Statistical Manual of Mental Disordersthe bible of
mental healthhas revised the criteria for identifying autism in ways that include more
people. Two conditions on the milder end of the autistic spectrum Aspergers syndrome
and the awkwardly named PDD-NOS (pervasive developmental disorder, not otherwise
specified)were added to the DSM in 1994 and 1987, respectively. Grinker and others say
50% to 75% of the increase in diagnoses is in these milder categories.

U.S. schools are required to report data on kids who receive special-education services, but
autism wasn't added as a category until the 1991-92 school year. No wonder the numbers
exploded-from 22,445 receiving services for autism in 1995 to 140,254 in 2004. Grinker

points out that "traumatic brain injury" also became one of the 13 reportable categories in
1992, and it had a similar spike.

In some states, parents of children with autism can apply for Medicaid even if they are not
near the poverty line. A diagnosis of mental retardation doesn't always offer this advantage.

As services have become more available for kids with autism, more parents are seeking a
diagnosis they would have shunned 30 years ago, when psychiatrists still blamed autism on
chilly "refrigerator" mothers. Doctors are also more willing to apply the diagnosis to help a
patient. "I will call a kid a zebra if it will get him the educational services I think he needs",
U.S. National Institute of Mental Health psychiatrist Judith Rapoport told Grinker.

For all the reasons above, many kids previously given other diagnosis are now called
autistic. University of Wisconsin researcher Paul Shattuck has found that the number of
kids getting special-ed services for retardation and learning disabilities declined in 47 states
between 1994 and 2003, just as those getting help for autism was rising. In 44 states, the
drop exceeded the rise in autism.

As convincing as Grinker's analysis seems, arguments about the apparent epidemic will
probably continue. It is simply impossible to accurately reconstruct the past incidence of
the disorder, given how radically definitions have changed. Those who believe the increase
is real often focus on the mysterious lack of autistic adults. With their conspicuous
symptoms like hand flapping and little or no language, "I think we would be recognizing
them in institutions", says Dr. Robert Hendren, executive director of the M.I.N.D: Institute
at the University of California, Davis. Grinker says autistic adults are out there but wearing
other labels. "Where are the adults with fetal alcohol syndrome?", he asks. No one over 40
has the condition, thought to affect up to 1 in 500 kids, since it was not recognized until the
mid-

Selecciona la opcin correcta.

1

El autor del artculo utiliza la palabra "epidemic" en el ttulo

1.

aunque genere encabezados muy alarmantes en los peridicos.

2.

para poder referirse al aumento de casos de este padecimiento.

3.

por los presupuestos millonarios que se otorgan para investigacin.

En el segundo prrafo se menciona que el incremento en el nmero de casos de

autismo pudiera deberse

1.

al aumento en la conciencia en padres y mdicos sobre este

padecimiento.

2.

a los cambios previstos en las definiciones mdicas sobre esta

enfermedad.

3.

al cambio drstico en la poltica gubernamental en relacin a este

trastorno.

Cul de los siguientes temas no aparece en el libro "Unstrange Minds: Remapping

The World of Autism?"

1.

La visin antropolgica acerca de los cambios en la medicina.

2.

La manera en que los psiclogos ahora perciben la salud mental.

3.

Las causas culturales de los cambios de perspectiva sobre la salud.

En el manual conocido como la "Biblia" de la salud mental,

1.

existen varios criterios para identificar los diversos tipos de autismo.

2.

se han aadido, por lo menos, tres trastornos ms desde el ao de 1987.

3.

se han ampliado los criterios para identificar los problemas de autismo.

El sistema educativo estadounidense

1.

propici el aumento de los casos documentados de autismo en 1995.

2.

debe informar sobre quienes reciben apoyos educativos especiales.

3.

clasifica al autismo, entre otras, como una lesin cerebral traumtica.

Se consiguen servicios mdicos casi gratuitos en algunos estados de Estados Unidos

1.

an para nios no tan pobres si se les diagnostica como autistas.

2.

si al nio se le diagnostica retraso mental en lugar de autismo.

3.

si los padres solicitan reevaluacin del diagnostico de retraso mental.

Un diagnstico de autismo

1.

no necesariamente hace que los doctores estn ms dispuestos a ayudar

al paciente.

2.

no evita que algunos psiquiatras culpen a las madres "refrigerator" de

este problema.

3.

hubiera sido rechazado por los padres de familia con toda seguridad
hace 30 aos.

De acuerdo al investigador Paul Shattuck de la Universidad de Wisconsin

1.

aument la ayuda por servicios especiales educativos para nios con

trastorno de aprendizaje y retraso mental.

2.

en 47 estados norteamericanos ha disminuido el nmero de nios que

reciben ayuda educativa especial.

3.

en 44 estados norteamericanos ha disminuido el nmero de nios que

reciben ayuda.

El Dr. Robert Hendren y el antroplogo Roy Richard Grinker

1.

coinciden en su opinin acerca del incremento del autismo en

Norteamrica.

2.

concuerdan en algunos puntos acerca del tratamiento en los casos de

autismo.

3.

difieren en su opinin acerca del incremento del autismo en aos

recientes.

Considerar que existe una epidemia

1.

es ms cmodo que pensar que existen mltiples causas para el

padecimiento.

2.

implicara ajustarse a la definicin que tenemos de la enfermedad y no

modificarla.

3.

cientficamente genera preguntas sobre los hechos que conforman este

padecimiento.

Care of The Elderly Patient

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corresponde a cada espacio en blanco.
The elderly are a highly heterogeneous group, and individuals become more dissimilar as
they age. Individuals over 65 years of age with or without chronic diseases vary widely
in their physical, behavioral, and cognitive functions. Any clinician can relate the "Tale of
Two Octogenarians" seen in practice on the same day: The end-stage patient afflicted with
Alzheimer's disease seen at the nursing home and the vigorous retiree seen after his golf
game for monitoring of his historically well-controlled hypertension.

Physiologic age rather than chronologic age should be the major determinant of the health
care ___1___ of the elderly. An abrupt ___2___ in any organ or function is almost certainly
due to ___3___ and not due to "normal aging". Therefore, ___4___ in the geriatric
population should not be automatically ___5___ to old age, and it is important to look for
potentially reversible causes of ___6___ . Moreover, treatable conditions should not be
___7___ for fear of side effects of medication.
Improvement or ___8___ of functional abilities is the major goal of medical care in the
___9___ population. Functional disability occurs faster and takes longer to ___10___ in the
elderly, necessitating early preventive measures. Active ___11___ should be made to
maintain functional level even during ___12___ care. Even small changes in function can
make large differences in the ___13___ of life. For example, regaining the ability to oppose
the ___14___ to the other fingers may enable a geriatric patient to become ___15___ in
feeding. Prevention of iatrogenic diseases is also important. For example, ___16___
attention should be paid to prevent the development of decubitus ulcers. A decubitus ulcer
can ___17___ in just few hours, and the mortality rate of those who develop the ___18___
in the first 2 weeks of intensive care has been reported to be as high as73%. Other
___19___ problems in the ICU include aspiration pneumonia, drug toxicity and
interactions, and renal insufficiency.
Multiple concurrent illnesses, cognitive and sensory ___20___ , age related changes in
physiology and pharmacodynamics, ___21___ vulnerability to delirium, and complications
from immobility make management of acute illness in the elderly a ___22___ challenge for
all physicians and other health care providers who care for patients in this age group.

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1
1.

failure

2.

expression

3.

requirements

1.

decline

2.

regulation

3.

behavior

1.

feebleness

2.

disease

3.

senility

1.

lunacy

2.

madness

3.

symptoms

1.

limited

2.

attributed

3.

opposed

1.

managements

2.

interactions

3.

symptoms

1.

undertreated

2.

revealed

3.

reported

1.

transformation

2.

maintenance

3.

changes

1.

geriatric

2.

female

3.

nonfunctional

1
1.

intensify

2.

corroborate

3.

correct

1.

challenges

2.

efforts

3.

reductions

1.

elderly

2.

close

3.

intensive

1
1.

quality

2.

diversity

3.

end

1.

index

2.

thumb

3.

wrist

1.

independent

2.

engaged

3.

reliable

1.

less

2.

close

3.

indiscriminate

1.

decrease

2.

develop

3.

interact

1.

procedures

2.

cuts

3.

lesions

1.

treatment

2.

iatrogenic

3.

surgical

1.

impairment

2.

development

3.

improvement

1.

lessened

2.

increased

3.

diminished

1.

clinical

2.

nursing

3.

functional