Journal of the American Academy of Child & Adolescent Psychiatry
Volume 46, Issue 6 , Pages 721-730 , June 2007

The Autism Epidemic: Fact or Artifact?

  • ASHLEY WAZANA, M.D.

      Affiliations

    • Corresponding Author InformationCorrespondence to Dr. Ashley Wazana, Department of Psychiatry, Montreal Children's Hospital, 4018 rue Sainte Catherine Ouest, Montreal, Québec H3Z 1P2, Canada
    • ,
  • MICHAELINE BRESNAHAN, Ph.D.
    • ,
  • JENNIE KLINE, Ph.D.

,Accepted 21 December 2006.

REFERENCES 

  1. American Psychiatric Association . Diagnostic and Statistical Manual of Mental Disorders, 3rd edition (DSM-III). Washington, DC: American Psychiatric Association; 1980;
  2. American Psychiatric Association . Diagnostic and Statistical Manual of Mental Disorders, 3rd edition-revised (DSM-III-R). Washington, DC: American Psychiatric Association; 1987;
  3. American Psychiatric Association . Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV). Washington, DC: American Psychiatric Association; 1994;
  4. Baghdadli A, Picot MC, Pascal C, Pry R, Aussilloux C. Relationship between age of recognition of first disturbances and severity in young children with autism. Eur Child Adolesc Psychiatry. 2003;12:122–127
  5. Baker HC. A comparison study of autism spectrum disorder referrals 1997 and 1989. J Autism Dev Disord. 2002;32:121–125
  6. Barbaresi WJ, Katusic SK, Colligan RC, Weaver AL, Jacobsen SJ. The incidence of autism in Olmsted County, Minnesota, 1976–1997: results from a population-based study. Arch Pediatr Adolesc Med. 2005;159:37–44
  7. Barton M, Volkmar F. How commonly are known medical conditions associated with autism?. J Autism Dev Disord. 1998;28:273–278
  8. Bernard S, Enayati A, Roger H, Binstock T, Redwood L. The role of mercury in the pathogenesis of autism. Mol Psychiatry. 2002;7:S42–S43
  9. Bertrand J, Mars A, Boyle C, Bove F, Yeargin-Allsopp M, Decoufle P. Prevalence of autism in a United States population: the Brick Township, New Jersey, investigation. Pediatrics. 2001;108:1155–1161
  10. Buitelaar JK, Van der Gaag R, Klin A, Volkmar F. Exploring the boundaries of pervasive developmental disorder not otherwise specified: analyses of data from the DSM-IV Autistic Disorder Field Trial. J Autism Dev Disord. 1999;29:33–43
  11. Centers for Disease Control and Prevention . Parental report if diagnosed autism in children aged 4–17 years-United States, 2003–2004. MMWR Morbid Mortal Wkly Rep. 2006;55:481–486
  12. Chakrabarti S, Fombonne E. Pervasive developmental disorders in preschool children. JAMA. 2001;285:3093–3099
  13. Clark T, Feehan C, Tinline C, Vostanis P. Autistic symptoms in children with attention deficit-hyperactivity disorder. Eur Child Adolesc Psychiatry. 1999;8:50–55
  14. Clarke DF, Roberts W, Daraksan M, et al. The prevalence of autistic spectrum disorder in children surveyed in a tertiary care epilepsy clinic. Epilepsia. 2005;46:1970–1977
  15. Costello E, Foley D, Angold A. 10-year research update review: the epidemiology of child and adolescent psychiatric disorders: II. Developmental epidemiology. J Am Acad Child Adolesc Psychiatry. 2006;45:8–25
  16. Croen LA, Grether JK. Response: a response to Blaxill, Baskin and Spitzer on Croen etal. (2002), “The Changing Prevalence of Autism in California.”. J Autism Dev Disord. 2003;33:227–229
  17. Croen LA, Grether JK, Hoogstrate J, Selvin S. The changing prevalence of autism in California. J Autism Dev Disord. 2002;32:207–215
  18. Dales L, Hammer SJ, Smith NJ. Time trends in autism and in MMR immunization coverage in California. JAMA. 2001;285:1183–1185
  19. Fombonne E. Epidemiological trends in rates of autism. Mol Psychiatry. 2002;7:S4–S6
  20. Fombonne E. Epidemiological surveys of autism and other pervasive developmental disorders: an update. J Autism Dev Disord. 2003;33:365–382
  21. Fombonne E. The prevalence of autism. JAMA. 2003;289:87–89
  22. Fombonne E, du Mazaubrun C. Prevalence of infantile autism in four French regions. Soc Psychiatry Psychiatr Epidemiol. 1992;27:203–210
  23. Fombonne E, Du Mazaubrun C, Cans C, Grandjean H. Autism and associated medical disorders in a French epidemiological survey. J Am Acad Child Adolesc Psychiatry. 1997;36:1561–1569
  24. Fombonne E, Simmons H, Ford T, Meltzer H, Goodman R. Prevalence of pervasive developmental disorders in the British nationwide survey of child mental health. J Am Acad Child Adolesc Psychiatry. 2001;40:820–827
  25. Gillberg C, Steffenburg S, Schaumann H, et al. Is autism more common now than ten years ago?. Br J Psychiatry. 1991;158:403–409
  26. Gillberg C, Wing L. Autism: not an extremely rare disorder. Acta Psychiatr Scand. 1999;99:399–406
  27. Hillman RE, Kanafani N, Takahashi TN, Miles JH. Prevalence of autism in Missouri: changing trends and the effect of a comprehensive state autism project. Mol Med. 2000;97:159–163
  28. Howlin P, Wing L, Gould J. The recognition of autism in children with Down syndrome-implications for intervention and some speculations about pathology. Dev Med Child Neurol. 1995;37:406–414
  29. Howlin PM. Diagnosis in autism: a survey of over 1200 patients in the UK. Autism. 1997;1:135–162
  30. Jick H, Kaye JA, Black C. Changes in risk of autism in the UK for birth cohorts 1990–1998. Epidemiology. 2003;14:630–632
  31. Kaye JA, del Mar Melero-Montes M, Jick H. Mumps, measles, and rubella vaccine and the incidence of autism recorded by general practitioners: a time trend analysis. BMJ. 2001;322:460–463
  32. Lingam R, Simmons A, Andrews N, Miller E, Stowe J, Taylor B. Prevalence of autism and parentally reported triggers in a north east London population. Arch Dis Child. 2003;88:666–670
  33. London E. The environment as an etiologic factor in autism: a new direction for research. Environ Health Perspect. 2000;401–404
  34. Madsen KM, Lauritsen MB, Pedersen CB, et al. Thimerosal and the occurrence of autism: negative ecological evidence from Danish population-based data. Pediatrics. 2003;112:604–606
  35. Magnusson P, Saemundsen E. Prevalence of autism in Iceland. J Autism Dev Disord. 2001;31:153–163
  36. Mandell DS, Maytali M, Novak MA, Zubritsky CD. Factors associated with age at diagnosis among children with autism spectrum disorders. Pediatrics. 2005;116:1480–1486
  37. Newschaffer CJ. Investigating diagnostic substitution and autism prevalence trends. Pediatrics. 2006;117:1436–1437
  38. Newschaffer CJ, Falb MD, Gurney JG. National autism prevalence trends from United States special education data. Pediatrics. 2005;115:e277–e282
  39. NIST (2006), Gamma distribution, in Engineering Statistics Handbook. Available at: http://www.itl.nist.gov/div898/handbook/eda/section4/eda4274.htm. Accessed March 15, 2007
  40. Nordin V, Gillberg C. Autism spectrum disorders in children with physical or mental disability or both: I. Clinical and epidemiological aspects. Dev Med Child Neurol. 1996;38:297–313
  41. Powell JE, Edwards A, Edwards M, Pandit BS, Sungum-Paliwal SR, Whitehouse W. Changes in the incidence of childhood autism and other autistic spectrum disorders in preschool children from two areas of the West Midlands. Dev Med Child Neurol. 2000;42:624–628
  42. Rapin I. Autism, Language Disorders Nosology Preschool Children With Inadequate Communication: Developmental Language Disorder, Autism, Low IQ Clinics in Developmental Medicine no. 139. London: MacKeith; 1996;
  43. Rasmussen P, Borjesson O, Wentz E, Gillberg C. Autistic disorders in Down syndrome: background factors and clinical correlates. Dev Med Child Neurol. 2001;43:750–754
  44. Rumeau-Rouquette C, du Mazaubrun C, Verrier A, Mlika A. Prévalence des handicaps: évolution dans trois générations d'enfants, 1972, 1976, 1981. Paris: Editions INSERM; 1994;
  45. Rutter M. Incidence of autism spectrum disorders: changes over time and their meaning. Acta Paediatr. 2005;94:2–15
  46. Shah A, Holmes N, Wing L. Prevalence of autism and related conditions in adults in a mental handicap hospital. Appl Res Ment Retard. 1982;3:303–317
  47. Shattuck PT. The contribution of diagnostic substitution to the growing administrative prevalence of autism in US special education. Pediatrics. 2006;117:1028–1037
  48. Shattuck PT. Diagnostic substitution and changing autism prevalence (commentary). Pediatrics. 2006;117:1438–1439
  49. Skellern C, Schluter P, McDowell M. From complexity to category: responding to diagnostic uncertainties of autism spectrum disorders. J Paediatr Child Health. 2005;41:407–412
  50. Smeeth LCC, Fombonne E, Heavy L, Rodrigues LC, Smith PG, Hall AJ (2004), Rate of first recorded diagnosis of autism and other pervasive developmental disorders in the United Kingdom general practice, 1988 to 2001. BMC Med. Available at: http://www.biomedcentral.com/1741-7015/2/39. Accessed January 10, 2007
  51. Sponheim E. Changing criteria of autistic disorders: a comparison of the ICD-10 research criteria and DSM-IV with DSM-III-R, CARS, and ABC. J Autism Dev Disord. 1996;26:513–525
  52. Sponheim E, Skjeldal O. Autism and related disorders: epidemiological findings in a Norwegian study using ICD-10 diagnostic criteria. J Autism Dev Disord. 1998;28:217–227
  53. Szatmari P. A review of the DSM-III-R criteria for autistic disorder. J Autism Dev Disord. 1992;22:507–523
  54. Tantam D. Lifelong eccentricity and social isolation: I. Psychiatric, social, and forensic aspects. Br J Psychiatry. 1988;153:777–782
  55. Taylor B, Miller E, Farrington CP, et al. Autism and measles, mumps, and rubella vaccine: no epidemiological evidence for a causal association. Lancet. 1999;353:2026–2029
  56. Volkmar FR, Klin A, Siegel B, et al. Field trial for autistic disorder in DSM-IV. Am J Psychiatry. 1994;151:1361–1367
  57. Waterhouse L, Morris R, Allen D, et al. Diagnosis and classification in autism. J Autism Dev Disord. 1996;26:59–86
  58. Webb EV, Lobo S, Hervas A, Scourfield J, Fraser WI. The changing prevalence of autistic disorder in a Welsh health district. Dev Med Child Neurol. 1997;39:150–152
  59. Williams JG, Brayne CEG, Higgins JPT. Systematic review of prevalence studies of autism spectrum disorders. Arch Dis Child. 2006;91:8–15
  60. Wing L, Potter D. The epidemiology of autistic spectrum disorders: is the prevalence rising?. Ment Retard Dev Disabil Res Rev. 2002;8:151–161
  61. Wing L, Yeates SR, Brierley LM, Gould J. The prevalence of early childhood autism: comparison of administrative and epidemiological studies. Psychol Med. 1976;6:89–100
  62. Yeargin-Allsopp M, Rice C, Karapurkar T, Doernberg N, Boyle C, Murphy C. Prevalence of autism in a US metropolitan area. JAMA. 2003;289:49–55
  63. Zwaigenbaum L, Bryson S, Rogers T, Roberts W, Brian J, Szatmari P. Behavioral manifestations of autism in the first year of life. Int J Dev Neurosci. 2005;23:143–152

 The authors thank Dr. Ezra Susser who advised in the development of the models and Dr. Bruce Levin for his guidance in the statistical modeling of distribution of age at diagnosis.Article Plus (online only) materials for this article appear on the Journal's Web site: www.jaacap.com.Disclosure: The authors have no financial relationships to disclose.

PII: S0890-8567(09)62151-1

doi: 10.1097/chi.0b013e31804a7f3b

Journal of the American Academy of Child & Adolescent Psychiatry
Volume 46, Issue 6 , Pages 721-730 , June 2007

Article Tools

* Image Usage & Resolution