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A sharp spike in autism rates over the last 20 years has experts and non-experts alike wondering about the cause of the disability.

To Columbia sociology Professor Gil Eyal, however, the increase in autism cases is not as sweeping as the numbers suggest. His research shows that the increase has occurred because, for more than half a century, the condition was misclassified as mental retardation. Indeed, the rise in autism cases has coincided with a drop in the number of diagnosed cases of mental retardation.

"This is not an epidemic," says Eyal, who studies the history and modern-day ethnography of autism. "The rise in the number of cases is easily explained by the changing of the diagnostic criteria."

Autism is defined as a spectrum of mental disabilities that affect a person's ability to communicate, form relationships and respond appropriately to the environment. The condition, which varies in severity, appears early in life, generally before the age of three, and persists into adulthood. While some adults with autism function well, others never develop the skills of daily living.

Between 1994 and 2006, the number of 6- to 17-year-old children diagnosed with an autism spectrum disorder in public special education programs jumped from 22,664 to 211,610, according to government data.

Eyal's interest in autism is the result of a career-long interest in the "sociology of expertise," which involves questions like, "What makes someone an expert on any given issue?" He became fascinated by the growing number of parents of autistic children who have become expert on the subject, many serving as a child's cotherapist.

He also wanted to demystify some of the controversial explanations for the sudden rise in autism cases. Some argue that autism is linked to certain infant vaccinations, despite some studies that debunk this link (see accompanying article).

As a non-medical expert, Eyal says he doesn't have the expertise to explain the condition's causes. As a social scientist, however, he says autism cannot be fully understood without historical perspective. According to Eyal, two broad categories of childhood disorders existed in this country during the mid-20th century: emotional disturbance and mental retardation. Emotional disturbance was often treated in psychiatric hospitals as a curable condition with a cause, while mental retardation was treated as a tragic destiny, or "verdict," that required institutionalization, says Eyal.

There is a broad middle ground between the two categories, says Eyal, covering the spectrum of developmental disabilities now classified as autism— disabilities that are treatable, if not necessarily curable. Sadly, says Eyal, the majority of sufferers in years past were improperly labeled retarded and admitted into what he describes as "horrific" institutions with claustrophobic living spaces and a dearth of social activities and treatments.

Getting autism accepted as a legitimate disability has been a lengthy process. In 1969, amid efforts to eradicate mass institutionalization, the National Association for Retarded Children pushed to create the medical term "developmental disabilities," says Eyal, and other groups successfully lobbied Congress to create legislation that permanently shuttered the institutions in the 1970s. In 1975, Congress passed the precursor to the Individuals with Disabilities Education Act, which granted special services and other rights to children with disabilities. Autism was adopted as a category in the legislation in 1990.

Despite these advances, Eyal says autism therapies are still unobtainable for many children who need them, because many medical insurance plans don't cover them.

Now, some states are pushing insurance companies to adopt autism treatments. "The available therapies improve lives by improving functioning, and this has led to societal acceptance," Eyal says. "It's become imperative for treatment to be extended to all children who need it, regardless of their diagnosis."

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