SYSTEMATIC REVIEW OF PREVALENCE STUDIES OF AUTISM SPECTRUM DISORDERS

Joanna G Williams ^1*, Carol E G Brayne ¹ and Julian P T Higgins ²

¹ University of Cambridge, United Kingdom
² MRC Biostatistics Unit, United Kingdom

^* To whom correspondence should be addressed. E-mail: jo.williams{at}phpc.cam.ac.uk.

Accepted 22 December 2004

Abstract

Objective:To quantitatively examine the influence of study methodology and population characteristics on prevalence estimates of autism spectrum disorders.

Methods:Electronic databases and bibliographies were searched and identified papers evaluated against inclusion criteria. Two groups of studies estimated the prevalence of typical autism and all autism spectrum disorders (ASD). The extent of variation among studies and overall prevalence were estimated using meta- analysis. The influence of methodological factors and population characteristics on estimated prevalence was investigated using meta-regression and summarised as odds ratios (OR).

Results42 studies met inclusion criteria, of which 37 estimated the prevalence of typical autism, and 23 the prevalence of all ASD. A high degree of heterogeneity among studies was observed. The overall random-effects estimate of prevalence across studies of typical autism was 7.1 per 10,000 (95% CI: 1.6, 30.6) and of all ASD was 20.0 per 10,000 (95% CI: 4.9, 82.1). Diagnostic criteria used (ICD-10 or DSM-IV vs other, OR=3.36 (95% CI: 2.07, 5.46)), age of the children screened (OR=0.91 per year (95% CI: 0.83-0.99)), and study location (e.g. Japan vs North America, OR=3.60 (95% CI: 1.73, 7.46)) were all significantly associated with prevalence of typical autism. Diagnostic criteria, age of the sample, and urban or rural location were associated with estimated prevalence of all ASD.

Conclusions:Sixty-one percent of the variation in prevalence estimates of typical autism was explained by these models. Diagnostic criteria used, age of children screened and study location may be acting as proxies for other study characteristics and require further investigation.

Keywords: AUTISM, META-ANALYSIS, PERVASIVE DEVELOPMENTAL DISORDERS, PREVALENCE, SYSTEMATIC REVIEW

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