More families of autistic kids sue Disney parks

[Gomer]

Which brings up another question and pardon my ignorance, which rides does WDW offer which would be suited for those with autism?

I wouldn't think there would be a way to identify those rides and modify the DAS for those rides while keeping the current system in place for others. Plus this modification would most likely lead to confusion and abuse and we are back at the start again.

Yes, I wasn't meaning to say that you could select a subset of rides to restrict DAS use to. Just that a large portion of those with autism will likely be put off by fast moving rides, roller coasters, or rides where you get splashed with water. Meaning that to many Universal (or other non-disney parks)doesn't offer much apparel, where as Disney has a large number of sensory stimulating but non threatening rides that provide exactly the input many with autism are seeking. Even, back and forth, or circular motion in non threatening environments with repetitive and predictable music cues.

But you could never restrict it as there is such a wide variety of people and rides that they would be interested in. Any classification in that vein would limit too many from use.

 

[ParentsOf4]

The whole point of that paragraph is to cover Disney if the DAS is not enough. However if all you ever do is give the blanket solution then you are not really meeting the statement. The Florida Human Rights Commission felt that was the case in 5 separate instances and that the accommodation of just a DAS was not reasonable.

As intended by ADA and interpreted by the Courts, I believe DAS is a "reasonable" modification. Something less beneficial than DAS could be "reasonable". Something more beneficial than DAS also could be "reasonable".

Remember, when it comes to ADA, "reasonable" does not mean equal or fair. Instead, the Supreme Court ruled an "accommodation is not reasonable if it imposes undue financial and administrative burdens." In other words, the ADA standard used to define reasonableness is cost and complexity. Disney voluntarily created DAS and GAC before it, so DAS and GAC both would appear to be "reasonable" modifications per the ADA standard.

Instead, the Commission opinioned that DAS "was a blanket accommodation that did not take into account the nuances between various disabilities or the fact that Complainant’s son’s disability required more assistance than other cognitive disabilities." In other words, DAS was an insufficient accommodation given that nature of the plaintiff's disability.

Disney did not argue that what the plaintiffs asked for (a return to a unlimited FP+ system) was unreasonable. Instead, Disney argued it was an unnecessary modification. Quoting from the Commission's report, Disney argued that the:

Complainant has failed to show that the DAS card program has not accommodated their disability.​

Those with disabilities are not entitled to whatever they want. Instead, quoting from ADA, they are entitled to:

modifications [that] are necessary to afford such goods, services, facilities, privileges, advantages, or accommodations to individuals with disabilities​

This is an important distinction because higher Courts have used this "necessary" standard to determine what's fair. Those with disabilities receive only what's needed to accommodate their disabilities, nothing more.

In court, the plaintiffs will need to present compelling cases that, as a result of their ADA protected disabilities, something more than DAS is necessary.

 

[Kate Alan]

Which brings up another question and pardon my ignorance, which rides does WDW offer which would be suited for those with autism?

I wouldn't think there would be a way to identify those rides and modify the DAS for those rides while keeping the current system in place for others. Plus this modification would most likely lead to confusion and abuse and we are back at the start again.

It's honestly impossible to narrow down simply because of the variety of sensory issues. As was said above, autistic people who are sensory avoidant in regards to bright lights or sounds may want to avoid rides like, say, Aerosmith or Buzz Lightyear, while they find the dark rides in Fantasyland very appealing. Others may have issues with water, so something like Splash Mountain or Kali River Rapids would be trouble. Still others may be sensory seeking, in which case coasters or rides where you feel movement are of a particular appeal.

In my particular instance, I'm sensory seeking when it comes to rides. The faster the coaster, the better (and I say this as someone with a definite fear of heights, lol). I love the movement that comes from rides like ToT or Star Tours. I'm not bothered by flashing lights at all - it's doesn't typically cause sensory overload for me unless I'm already well on my way there. Loud noises don't cause a problem, but certain pitches or frequencies can. Thankfully I am at a point where I can combat this in a variety of ways (thank god for the invention of the iPod!).

One of the reasons laying down a blanket policy like the GAC or DAS is so difficult is because there isn't really a one size fits all approach to autism - it's a spectrum that can affect people in very different ways.

 

[1023]

I was not going to post on this thread again. Here's a recap:

Disney provides DAS to those with a disability. If a guest has issues with the blanket policy they ask the guest to speak with guest relations. When guest relations decides that DAS is sufficient, guest disagrees and litigates. Some apparently decide to peruse a local remedy through some commission structure that has no legal authority. Regardless, we now have litigation because someone wants to skip the lines. While Disney adopted this policy in the face of widespread abuse, it did so with the caveat that you could speak to guest relations for "more" accommodation.

While the attorneys may have failed to use this argument, I will. Since Disney adopted this policy and is following it, where is the lack of accommodation? If the guest (or responsible party) has been heard at guest relations and they decide that the DAS is enough accommodation isn't Disney following their policy? Should the guest truly be allowed to decide that the policy wasn't accommodating enough? Wouldn't granting every guest that claims a disability a FotL pass be an "administrative burden" problem? It would.

My Concern:

Allowing this set of lawsuits succeed will bring on the need for a set of laws or regulations that define every element of every disability and the required accommodation for each. Failure to do so (creating legislation) would create a glut of similar cash grabs and not just against Disney. The broadly reaching term "reasonable accommodation" (the reason we have this problem to begin with) will have to be defined for every "public" place in the US. Zoos, Theme Parks, Aquariums, Concert Venues, etc....

Ultimately:

This will be decided in some court rooms. We will either have rampant abuse, or the same system in place. Until then, I have nothing more to say about the lawsuits.

*1023*

 

[Bairstow]

Random thought:

People on this forum tend to give WDW grief because compared to other Disney parks, things there are never changed or updated.
Is this one of the reasons the park has become particularly appealing to some children on the autism spectrum? Because it's a fun place that can be counted on to never change?

 

[Gomer]

Random thought:

People on this forum tend to give WDW grief because compared to other Disney parks, things there are never changed or updated.
Is this one of the reasons the park has become particularly appealing to some children on the autism spectrum? Because it's a fun place that can be counted on to never change?

Absolutely. I've said this before. With autism its all about routine. As a theme park consumer I get excited when DIsney creates something new. But I also get a huge sense of dread knowing it is change that could severely impact my son's enjoyment. People like to make fun of Epcot for being a half day park now. Well we spend 3.5 days there on a week vacation and go on Nemo, SSE, LwtL, Imagination, and GFT at least 4-6 times a piece. If they "fix" nemo one day and return it to it original or better condition, I'll probably have a significant problem on my hands.

Luckily for me individually, none of his favorites have been touched (although I'm interested to see how he reacts when we go in September as pirates will be down and its one of his favorites to ride 4-5 times per trip)

Point being, and I've ranted about this before, people with Autism are disney's perfect client base as they actually don't necessarily want to see change. Maintenance would be a plus, but my son would be perfectly content to spend his entire life there without a single new ride ever being created. The known quantity is his preference.

 

[KordovaJD]

Presented without commentary:

You're a much stronger person than I.

 

[KordovaJD]

Oh I understand what Disney will try to do, I am simply pointing out why the attorney left out the ADA in the complaint. Most complaints of this nature cite both ADA and the Unruh Civil Rights Act in an effort to widen the net as much as possible. In this case the attorney left it out on purpose because he knew exactly what Disney would do.

Just wanting to point out one fact regarding the venue discussion above. For the most part this thread is tl;dr. So this may already appear here somewhere.

Disney is a Delaware corporation. As a result, any suit upon the Unruh Civil Rights Act would actually allow for instant diversity jurisdiction and immediate removal to Federal court.

They won't be able to keep this out of Federal court by not pleading the ADA.

 

[TheScreed]

Just wanting to point out one fact regarding the venue discussion above. For the most part this thread is tl;dr. So this may already appear here somewhere.

Disney is a Delaware corporation. As a result, any suit upon the Unruh Civil Rights Act would actually allow for instant diversity jurisdiction and immediate removal to Federal court.

They won't be able to keep this out of Federal court by not pleading the ADA.

I think they might be able to keep it out of federal court by pleading that the amount in controversy is less than $75,000 -- if all they really want is an injunction requiring FOTL for anyone claiming some kind of mental disability, plus some "shut up and go away" money. But I don't know all of the facts and have not read the pleadings.

 

[AEfx]

One of the reasons laying down a blanket policy like the GAC or DAS is so difficult is because there isn't really a one size fits all approach to autism - it's a spectrum that can affect people in very different ways.

The unfortunate thing is that GAC/DAS/what have you have to be blanket policies because the ADA is a blanket law.

What the whole thing really comes down to is that because all disabilities, mental or physical, must be treated the same by law, and no evidence or proof can be asked for, much less required - it simply is impossible to enforce any standards as they can only go by whatever someone says they need.

Because of the lovely way the Internet shares information globally, the system was apparently taken advantage of because of this flaw in ADA. The intention was to protect patient privacy, but instead it has resulted in complete powerlessness in enforcement.

While it was always possible to "game" the system, we've all heard anecdotal stories of some teenager wearing a fake cast to get to the head of rides, but for whatever reason folks have a hard time morally with doing something as overt as that but will walk in to City Hall and say "Yeah, my kid can't wait in lines" is pretty simple and easy to justify ("Well, he DOES hate standing in them!") when the kid doesn't actually have a medical diagnosis. And of course, the larger problem of so many people having medical diagnosis anyway these days - when something like 40+% of kids has either ADD, is somewhere on the Autism spectrum, it's slowly becoming the norm and not the exception.

Personally, I think the ADA needs to be modified to allow a place like WDW to require a doctors form. Now some will immediately say "oh, but there are bad doctors out there who will cheat" but in truth, it's going to be far far less abused than the system that makes you show no evidence.

My niece is physically disabled, and although she'd gladly go through all the queues as normal, Disney simply doesn't allow it on so many attractions, and even newer ones aren't really designed for wheelchair access. Even though her disability is very visible and obvious, she would gladly provide documentation. I'm sure most parents of children who need assistance would have no issue whatsoever doing so as well. A trip to WDW isn't spontaneous, it's well-planned, and most of these folks are under regular medical care anyway so it's really not a big deal.

But, until the ADA is modified, this is pretty much what we are stuck with.

 

[flynnibus]

The unfortunate thing is that GAC/DAS/what have you have to be blanket policies because the ADA is a blanket law.

What the whole thing really comes down to is that because all disabilities, mental or physical, must be treated the same by law, and no evidence or proof can be asked for, much less required - it simply is impossible to enforce any standards as they can only go by whatever someone says they need.

Because of the lovely way the Internet shares information globally, the system was apparently taken advantage of because of this flaw in ADA. The intention was to protect patient privacy, but instead it has resulted in complete powerlessness in enforcement.

Wrong on so many levels...

The law is not 'blanket' and you don't have to treat disabilities the same. In fact, the law is completely the opposite of that.. Its written to say offer something that fits the person's need... not 'do this for everyone'

Second.. the lack of proof is not to protect privacy - it's to avoid discrimination. The standard is people should not be burdened to be included because the entire point of the law was to encourage inclusion by DEFAULT... not exception. They did not want people to be EXCLUDED at almost any cost.. and to require people to carry around stuff and PROVE they need something was contrary to the idea of inclusion by default.

The struggle is blanket solutions to specific problems... and there should be more defenses on the side of the business to say your need conflicts with the basic premises everyone complies with.

 

[PhotoDave219]

Just wanting to point out one fact regarding the venue discussion above. For the most part this thread is tl;dr. So this may already appear here somewhere.

Disney is a Delaware corporation. As a result, any suit upon the Unruh Civil Rights Act would actually allow for instant diversity jurisdiction and immediate removal to Federal court.

They won't be able to keep this out of Federal court by not pleading the ADA.

Thanks. No, that wasnt brought up before.

 

[AEfx]

Wrong on so many levels...

So nice to see you, too.

The law is not 'blanket' and you don't have to treat disabilities the same. In fact, the law is completely the opposite of that.. Its written to say offer something that fits the person's need... not 'do this for everyone'

I believe we have had this discussion before on this topic.

You are jumping to conclusions based on semantics. You seem familiar with the law but don't always seem to grasp the practicalities of how it is applied, which is what I generally have opinions on, and because of that you misunderstand the point I'm actually making. I can do my part to be more clear.

Yes, the ADA is a blanket law that was written almost exclusively with physical disabilities in mind. It applies to mental/developmental disabilities as well, by design - however, it was written at a time that frankly there were a lot less folks who were classified as having mental vs. physical needs.

I said nothing about the accommodations provided needing to be identical, quite the contrary, the point is, when the bill was being written in the late 1980's, "My kid can't stand in line" was not a symptom of a medically recognized disability in all but the rarest of cases (clinical mental retardation). "My wheelchair can't fit in the line" was what it was largely written for before most of these things it is now applying to even existed.

The reason this is such a hot-blooded issue is because we have gone from the term "disabilities" meaning "people with mobility issues" to a world where they are the minority in the "disabilities" community due to the simple fact that there are many more folks who have mental diagnosis that didn't even exist 30 years ago, let alone in such astounding numbers.

In the mid-1980's when the law was written, the amount of children diagnosed with some form of Autism was 1 in 2500. Today, it's 1 in 68.

Again, yes, before we argue the point, the law was written with terminology to cover all disabilities; however, the definition of disabilities has changed quite remarkably since then. Because the accommodations being requested today were not even thought of at the time, it's a far different impact than "reasonable accommodations" meaning making sure there were slopes on curbs to be able to get a wheelchair on, or a wheelchair/shorter entrance to a ride for folks who don't have full mobility which was what it meant at the time.

That's why I see it as a blanket law - because it treats all disabilities the same, when the terminology used in most of it was largely intended to cover external needs (a ramp, etc.), and when it comes to the large numbers of people now covered by the law who have completely internal needs, the same terminology can be grossly misapplied.

Second.. the lack of proof is not to protect privacy - it's to avoid discrimination. The standard is people should not be burdened to be included because the entire point of the law was to encourage inclusion by DEFAULT... not exception. They did not want people to be EXCLUDED at almost any cost.. and to require people to carry around stuff and PROVE they need something was contrary to the idea of inclusion by default.

Well, to be fair, it was included for multiple reasons, of course - like anything, but in practical use yes, privacy was certainly a concern. And the one that most affects this issue which is why I mentioned it, in addition to everything above. It was intended so someone didn't have to explain why they couldn't walk, just that they needed some type of accommodation because of it.

We are talking about this at all because mental/developmental disabilities are an almost completely subjective diagnosis, and because they are in such number now, and no one can require any evidence other than someone saying "my kid can't wait in line". Not only has there been an explosion on the number of children who may medically have that need, it's also very very easy to abuse because of it - which is why this is even an issue folks discuss.

The struggle is blanket solutions to specific problems... and there should be more defenses on the side of the business to say your need conflicts with the basic premises everyone complies with.

Well Zip-a-Dee-Doo-Dah, we agree on that!

 

[flynnibus]

You are jumping to conclusions based on semantics. You seem familiar with the law but don't always seem to grasp the practicalities of how it is applied, which is what I generally have opinions on, and because of that you misunderstand the point I'm actually making. I can do my part to be more clear.

How people try to comply - does not change the law itself. Disney's lazy approach to things does not define the law nor standard... only Disney's angle at trying to be compliant.

Yes, the ADA is a blanket law that was written almost exclusively with physical disabilities in mind. It applies to mental/developmental disabilities as well, by design - however, it was written at a time that frankly there were a lot less folks who were classified as having mental vs. physical needs.

I said nothing about the accommodations provided needing to be identical, quite the contrary, the point is, when the bill was being written in the late 1980's, "My kid can't stand in line" was not a symptom of a medically recognized disability in all but the rarest of cases (clinical mental retardation). "My wheelchair can't fit in the line" was what it was largely written for before most of these things it is now applying to even existed.

I'm going to stop you right there, because there is a major point you are missing and it invalidates basically everything you continue on here. You're missing that the law was amended and EXPANDED in 2008. The law was expanded explicitly because the courts had been making judgements that had been narrowing the law's impact. The 2008 admendments EXPANDED the interpretations, and the DOJ continues to write standards that also iterate on the application of the law. All of this was done in this new world of awareness and explosive interpretation of issues in the autism spectrum. None of this is 'oops' .

Again, yes, before we argue the point, the law was written with terminology to cover all disabilities; however, the definition of disabilities has changed quite remarkably since then. Because the accommodations being requested today were not even thought of at the time, it's a far different impact than making sure there were slopes on curbs to be able to get a wheelchair on, or a wheelchair/shorter entrance to a ride for folks who don't have full mobility.

Again.. reference the amendments act of 2008... the design standards of 2010 (which continue to be updated). This is not a matter of rules written in another era not keeping up with today.

That's why I see it as a blanket law - because it treats all disabilities the same, when the terminology used in most of it was largely intended to cover external needs (a ramp, etc.), and when it comes to the large numbers of people now covered by the law who have completely internal needs, the same terminology can be grossly misapplied.

The idea of things that impaired major life activities has not changed.. and was never limited to mobility issues. People get sidetracked that the government focused on accessible construction design early in the implementation because they felt that construction and physical barriers were the elements that stood to block the largest numbers of people. Basically... biggest gain for the most people. That isn't that other disabilities were part of the law, simply that the design standards was the noisest part of the law's passing because of the wide impact that would affect every public place.. regardless of if they had issues previously.

Well, to be fair, it was included for multiple reasons, of course - like anything, but in practical use yes, privacy was certainly a concern. And the one that most affects this issue which is why I mentioned it, in addition to everything above

Yet when you read the intro to the law, and the law itself... privacy is not mentioned. amazing huh?

We are talking about this at all because mental/developmental disabilities are an almost completely subjective diagnosis, and because they are in such number now, and no one can require any evidence other than someone saying "my kid can't wait in line"

Focus on the 'impact on major life activities' and less about the medical condition.. and you'll start getting more in line with the law's intent and design.

 

[arko]

As an aside we used the new electronic DAS today and it was very well implemented and easy to use. First the only big change is that when getting one your whole party must be present, or at least your passes/magicbands. The app basically builds your party by reading the bands. One person is assigned as the DAS holder(the person with the disability) and they take their picture which I am guessing shows up on the FP return screen. After that anyone in the party can go to the FP return and someone will scan your band and you whole party will be given a DAS return time which shows up in the MDE app alongside any FP's you might have. You are still limited to one at a time, and as always the DAS holder must ride, they check this by having the DAS holder go first and scan their pass/bands which triggers the screen and then all others scan their passes/bands just like a regular FP. This makes it look like you are using a FP just like anyone else which eliminates the stares and questions some have gotten. The only thing that now makes no sense is that you still have to go to the ride when it should be available at any FP kiosk given its electronic nature. Also they are issuing them for maximum 60 days, if you are a passholder why not make it till your pass expires, this would lessen traffic at guest services.
Otherwise it is still basically the same system.

 

[ParentsOf4]

Yes, the ADA is a blanket law that was written almost exclusively with physical disabilities in mind. It applies to mental/developmental disabilities as well, by design - however, it was written at a time that frankly there were a lot less folks who were classified as having mental vs. physical needs.

...

In the mid-1980's when the law was written, the amount of children diagnosed with some form of Autism was 1 in 2500. Today, it's 1 in 68.

You seem to be operating under the misconception that ADA is somehow out-of-date.

The ADA Amendments Act of 2008 was passed with overwhelming support from both Democrats and Republicans. As @flynnibus writes, the ADAA strengthened the original ADA, with the act explicitly rejecting limitations that the Courts had been placing on the original ADA.

Memory can be a funny thing but as I recall, a lot of the press coverage of the 2008 act focused on mental disabilities, including concerns over the expanding diagnosis of Autism. I believe mental disabilities were a large part of the 2008 debate.

We are talking about this at all because mental/developmental disabilities are an almost completely subjective diagnosis, and because they are in such number now, and no one can require any evidence other than someone saying "my kid can't wait in line". Not only has there been an explosion on the number of children who may medically have that need, it's also very very easy to abuse because of it - which is why this is even an issue folks discuss.

Overwhelmingly, medical professionals view Autism as a real mental disability. So does the U.S. EEOC. Absolutely, there are individuals with 'real Autism'. Regardless of how well/poorly you think Autism is being diagnosed, Disney must provide accommodations to those with 'real Autism'.

People abusing the system should not relieve Disney of its legal obligation to provide accommodations to those with 'real Autism'.

I respectfully suggest that you stop focusing on the potential misdiagnosis of Autism (which is what upsets many on this thread) and instead focus on what services Disney is legally obligated to provide to individuals with 'real Autism'. I suspect that's how the case is going to be decided in court.

 

[jaklgreen]

It's honestly impossible to narrow down simply because of the variety of sensory issues. As was said above, autistic people who are sensory avoidant in regards to bright lights or sounds may want to avoid rides like, say, Aerosmith or Buzz Lightyear, while they find the dark rides in Fantasyland very appealing. Others may have issues with water, so something like Splash Mountain or Kali River Rapids would be trouble. Still others may be sensory seeking, in which case coasters or rides where you feel movement are of a particular appeal.

In my particular instance, I'm sensory seeking when it comes to rides. The faster the coaster, the better (and I say this as someone with a definite fear of heights, lol). I love the movement that comes from rides like ToT or Star Tours. I'm not bothered by flashing lights at all - it's doesn't typically cause sensory overload for me unless I'm already well on my way there. Loud noises don't cause a problem, but certain pitches or frequencies can. Thankfully I am at a point where I can combat this in a variety of ways (thank god for the invention of the iPod!).

One of the reasons laying down a blanket policy like the GAC or DAS is so difficult is because there isn't really a one size fits all approach to autism - it's a spectrum that can affect people in very different ways.

Plus it has nothing to do with rides they can and can not go on. It is about the fact that some can not wait in the line. If someone is able to wait in line for the ride they want then there is no need for any DAS or GAC. Just wanting to ride certain rides over and over again is not a reason to have a DAS. Heck I bet at least 75% of people that go to WDW are not going to ride certain rides because it makes them sick or uneasy. Just thinking about space mountain makes me sick.

 

[AEfx]

Overwhelmingly, medical professionals view Autism as a real mental disability. So does the U.S. EEOC. Absolutely, there are individuals with 'real Autism'. Regardless of how well/poorly you think Autism is being diagnosed, Disney must provide accommodations to those with 'real Autism'.

People abusing the system should not relieve Disney of its legal obligation to provide accommodations to those with 'real Autism'.

I respectfully suggest that you stop focusing on the potential misdiagnosis of Autism (which is what upsets many on this thread) and instead focus on what services Disney is legally obligated to provide to individuals with 'real Autism'. I suspect that's how the case is going to be decided in court.

And I respectfully suggest that you not put words in my mouth.

I don't know what the heck it is with this topic but people seem to project all kinds of stuff on anything said, turning it to fit whatever statements they wish to make, to an absurd level where a discussion is impossible because no one is actually paying attention to what someone is saying before they rip into them.

I'm not bothering replying to the statements where folks clearly are intentionally obtuse simply because they want to argue with me personally, where what they are saying has nothing to do with what I am, but I certainly will not sit by and let you make the offensive assumption above about me because you could not be more completely off-base.

I have not focused on "potential misdiagnosis". I believe what you are misinterpreting/projecting that upon is my point that if it were not for the abuse of this system by folks who have realized they can say "My kid can't stand in line" and not have any burden of proof of medical diagnosis, we wouldn't even be talking about this. This in no way discounts those with a medical diagnosis who are simply trying to get accommodation within the system. The only thing I have talked about when it comes to diagnosis is the explosion in number, which I don't think even folks in the mood to be so argumentative would debate.

In any case - obviously discussing this here is a waste of time since folks just want to argue to advance their personal agendas or are simply looking to be offended.

 

[biggy H]

So what is wrong with requiring proof whendoig so culd then enable the business to tailor what is required so the customer can then enjoy everything like th rest of the public. As has been seen on her not everybody needs or wants everything that the DAS offers but some could do with more. As long as the business keeps the information given to it to the minimum and keeps it private would it be any differnt than telling everything to loads of medical practioners?

If Disney loses and are forced to, say, give out fotl passes evryone without any proof all that will happen is everyone will just ask for one whether they are actually entitled to one or not and the lines will just increase and then we would be back at square one with people sueing again because they will have a longer wait again.

 

[BuzzKillington]

The reason this is such a hot-blooded issue is because we have gone from the term "disabilities" meaning "people with mobility issues" to a world where they are the minority in the "disabilities" community...

Especially when those with mobility issues who are wheelchair bound and no longer eligible for DAS have to wait in a standard queue and then wait an addition 5 to 10 minutes on top of that for a accessible ride vehicle to come around. Yet, not a peep out of this group who these passes were originally intended.

...there are many more folks who have mental diagnosis that didn't even exist 30 years ago, let alone in such astounding numbers.

And this unfortunate occurrence is due to the medical profession defining autism as a “spectrum disorder,” incorporating both mild and severe cases which has led this diagnosis to a 78% increase in 10 years.