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Global Prevalence of Autism and Other Pervasive Developmental Disorders

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      Abstract

      We provide a systematic review of epidemiological surveys of autistic disorder and pervasive developmental disorders (PDDs) worldwide. A secondary aim was to consider the possible impact of geographic, cultural/ethnic, and socioeconomic factors on prevalence estimates and on clinical presentation of PDD. Based on the evidence reviewed, the median of prevalence estimates of autism spectrum disorders was 62/10 000. While existing estimates are variable, the evidence reviewed does not support differences in PDD prevalence by geographic region nor of a strong impact of ethnic/cultural or socioeconomic factors. However, power to detect such effects is seriously limited in existing data sets, particularly in low-income countries. While it is clear that prevalence estimates have increased over time and these vary in different neighboring and distant regions, these findings most likely represent broadening of the diagnostic concets, diagnostic switching from other developmental disabilities to PDD, service availability, and awareness of autistic spectrum disorders in both the lay and professional public. The lack of evidence from the majority of the world's population suggests a critical need for further research and capacity building in low- and middle-income countries. Autism Res 2012, 5: 160–179. © 2012 International Society for Autism Research, Wiley Periodicals, Inc.

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      Most cited references 93

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      Diagnostic and statistical manual of mental disorders.

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        The autism diagnostic observation schedule-generic: a standard measure of social and communication deficits associated with the spectrum of autism.

        The Autism Diagnostic Observation Schedule-Generic (ADOS-G) is a semistructured, standardized assessment of social interaction, communication, play, and imaginative use of materials for individuals suspected of having autism spectrum disorders. The observational schedule consists of four 30-minute modules, each designed to be administered to different individuals according to their level of expressive language. Psychometric data are presented for 223 children and adults with Autistic Disorder (autism), Pervasive Developmental Disorder Not Otherwise Specified (PDDNOS) or nonspectrum diagnoses. Within each module, diagnostic groups were equivalent on expressive language level. Results indicate substantial interrater and test-retest reliability for individual items, excellent interrater reliability within domains and excellent internal consistency. Comparisons of means indicated consistent differentiation of autism and PDDNOS from nonspectrum individuals, with some, but less consistent, differentiation of autism from PDDNOS. A priori operationalization of DSM-IV/ICD-10 criteria, factor analyses, and ROC curves were used to generate diagnostic algorithms with thresholds set for autism and broader autism spectrum/PDD. Algorithm sensitivities and specificities for autism and PDDNOS relative to nonspectrum disorders were excellent, with moderate differentiation of autism from PDDNOS.
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          Prevalence of disorders of the autism spectrum in a population cohort of children in South Thames: the Special Needs and Autism Project (SNAP).

          Recent reports have suggested that the prevalence of autism and related spectrum disorders (ASDs) is substantially higher than previously recognised. We sought to quantify prevalence of ASDs in children in South Thames, UK. Within a total population cohort of 56 946 children aged 9-10 years, we screened all those with a current clinical diagnosis of ASD (n=255) or those judged to be at risk for being an undetected case (n=1515). A stratified subsample (n=255) received a comprehensive diagnostic assessment, including standardised clinical observation, and parent interview assessments of autistic symptoms, language, and intelligence quotient (IQ). Clinical consensus diagnoses of childhood autism and other ASDs were derived. We used a sample weighting procedure to estimate prevalence. The prevalence of childhood autism was 38.9 per 10,000 (95% CI 29.9-47.8) and that of other ASDs was 77.2 per 10,000 (52.1-102.3), making the total prevalence of all ASDs 116.1 per 10,000 (90.4-141.8). A narrower definition of childhood autism, which combined clinical consensus with instrument criteria for past and current presentation, provided a prevalence of 24.8 per 10,000 (17.6-32.0). The rate of previous local identification was lowest for children of less educated parents. Prevalence of autism and related ASDs is substantially greater than previously recognised. Whether the increase is due to better ascertainment, broadening diagnostic criteria, or increased incidence is unclear. Services in health, education, and social care will need to recognise the needs of children with some form of ASD, who constitute 1% of the child population.
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            Author and article information

            Affiliations
            Department of Psychiatry, Montreal Children's Hospital MontrealCanada and Birkbeck, University of London London, UK
            Sangath Goa, India
            The Korea Institute for Children's Social Development Seoul, South Korea
            Child Study Center, Yale University School of Medicine New Haven, USA
            Nelson R Mandela School of Medicine, University of KwaZulu-Natal, South Africa and Mailman School of Public Health, Columbia University New York, NY, USA
            Mexican Autism Clinic Mexico City Mexico
            Psychology Department, La Universidad del Zulia Maracaibo, Venezuela
            Centre for Global Mental Health, London School of Hygiene and Tropical Medicine London, UK and Sangath Centre Goa, India
            Developmental Disorders Program, Mackenzie Presbyterian University São Paulo, Brazil
            Center for Behavioural Science and School of Medicine, Nankai University Tianjin, China
            World Health Organization Montreal, Canada
            Department of Psychiatry, Montreal Children's Hospital Montreal, Canada
            Author notes
            Address for correspondence and reprints: Eric Fombonne, Department of Psychiatry, Montreal Children's Hospital, 4018 Ste-Catherine West, Montreal, QC, H3Z 1P2, Canada. E-mail: eric.fombonne@ 123456mcgill.ca
            Journal
            Autism Res
            Autism Res
            aur
            Autism Research
            Blackwell Publishing Ltd
            1939-3792
            1939-3806
            June 2012
            11 April 2012
            : 5
            : 3
            : 160-179
            22495912
            3763210
            10.1002/aur.239
            Copyright © 2012 Wiley Periodicals, Inc., A Wiley Company

            Re-use of this article is permitted in accordance with the Creative Commons Deed, Attribution 2.5, which does not permit commercial exploitation.

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