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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 references83

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          Diagnostic and statistical manual of mental disorders.

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            Pervasive developmental disorders in preschool children.

            Prevalence rates of autism-spectrum disorders are uncertain, and speculation that their incidence is increasing continues to cause concern. To estimate the prevalence of pervasive developmental disorders (PDDs) in a geographically defined population of preschool children. Survey conducted July 1998 to June 1999 in Staffordshire, England. The area's 15 500 children aged 2.5 to 6.5 years were screened for developmental problems. Children with symptoms suggestive of a PDD were intensively assessed by a multidisciplinary team, which conducted standardized diagnostic interviews and administered psychometric tests. Prevalence estimates for subtypes of PDDs. A total of 97 children (79.4% male) were confirmed to have a PDD. The prevalence of PDDs was estimated to be 62.6 (95% confidence interval, 50.8-76.3) per 10 000 children. Prevalences were 16.8 per 10 000 for autistic disorder and 45.8 per 10 000 for other PDDs. The mean age at diagnosis was 41 months, and 81% were originally referred by health visitors (nurse specialists). Of the 97 children with a PDD, 25.8% had some degree of mental retardation and 9.3% had an associated medical condition. Our results suggest that rates of PDD are higher than previously reported. Methodological limitations in existing epidemiological investigations preclude interpretation of recent high rates as indicative of increased incidence of these disorders although this hypothesis requires further rigorous testing. Attention is nevertheless drawn to the important needs of a substantial minority of preschool children.
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              Epidemiological surveys of autism and other pervasive developmental disorders: an update.

              This paper was commissioned by the committee on the Effectiveness of Early Education in Autism of the National Research Council (NRC). It provides a review of epidemiological studies of pervasive developmental disorders (PDD) which updates a previously published article (The epidemiology of autism: a review. Psychological Medicine 1999; 29: 769-786). The design, sample characteristics of 32 surveys published between 1966 and 2001 are described. Recent surveys suggest that the rate for all forms of PDDs are around 30/10,000 but more recent surveys suggest that the estimate might be as high as 60/10,000. The rate for Asperger disorder is not well established, and a conservative figure is 2.5/10,000. Childhood disintegrative disorder is extremely rare with a pooled estimate across studies of 0.2/10,000. A detailed discussion of the possible interpretations of trends over time in prevalence rates is provided. There is evidence that changes in case definition and improved awareness explain much of the upward trend of rates in recent decades. However, available epidemiological surveys do not provide an adequate test of the hypothesis of a changing incidence of PDDs.
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                Author and article information

                Journal
                Autism Res
                Autism Res
                aur
                Autism Research
                Blackwell Publishing Ltd
                1939-3792
                1939-3806
                June 2012
                11 April 2012
                : 5
                : 3
                : 160-179
                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
                Article
                10.1002/aur.239
                3763210
                22495912
                10b20910-ffa7-4b15-a921-aab96087965d
                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.

                History
                : 07 June 2011
                : 11 November 2011
                Categories
                Review Article

                epidemiology,prevalence,global health,low- and middle-income countries

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