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The definition and prevalence of autism: A review

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Abstract

Sixteen studies of the prevalence of autism in childhood, using epidemiological methods in defined populations in Europe, the USA and Japan, in English or with English summaries, were found in the published literature. Age specific rates varied from 3.3 to 16.0 per 10,000. Eight studies gave rates for a sub-group of ‘typical’ autism varying from 1.2 to 8.4. Reasons for variations were sought by examining geographic and demographic details of the populations screened, methods for initial screening and final examination of possibly autistic children, demographic and clinical details of children identified as autistic, and criteria used for diagnosis. There was evidence, independent of diagnostic criteria, of a higher prevalence among children of first generation immigrants to Europe from ‘exotic’ countries. Apart from this, all differences could be due to variations in diagnostic practice and increasing awareness of the manifestations of autistic conditions throughout the range of intelligence, from severely retarded to average and above. However, it remains possible, though not proven, that rates do vary over place and/or time. The problems of defining a sub-group with ‘typical’ autism among the wide spectrum of children with the triad of impairments of social interaction, communication and imagination are discussed and the value of such a sub-grouping questioned.

Résumé

16 études de prévalence de l'autisme dans l'enfance faisant appel à des méthodes épidémiologiques sur populations définies en Europe, aux U.S.A., Canada et au Japon, en anglais ou avec des résumés anglais ont été relevées dans la littérature publiée. Les taux varient de 3.3 à 16.0 pour 10.000. 8 études donnent des taux pour un sous-groupe d'autisme typique de 1.2 à 8.4. Les raisons de ces variations ont été recherchées en examinant les données geographiques et démographiques de la population concernée, les méthodes de repérage initial et d'examen final des enfants possiblement autistes, les données démographiques et cliniques des enfants identifiés comme autistes, et les critères utilisés pour le diagnostic. Il y avait à l'évidence, indépendamment des critères diagnostiques, une prévalence plus élevée parmi les enfants de première génération émigrant en Europe depuis des pays “exotiques”. A part cela toutes les différences pouvaient être dues aux variations dans la pratique diagnostique et la prise de conscience croissante des manifestations des conditions autistiques au travers des écarts d'intelligence, depuis les formes sévèrement retardées jusqu'à la moyenne et au-dessus. Cependant, il reste possible, bien que non prouvé, que les taux varient selon les lieux et l'époche. Les problèmes de définition d'un sous-groupe avec autisme typique parmi le spectre large des enfants avec la triade de défauts d'interaction sociale, de communication et d'imagination sont discutés ainsi que la valeur d'un tel sous-groupe.

Zusammenfassung

In der englischsprachigen Fachliteratur (mindestens die Zusammenfassung in englischer Sprache) fanden sich 16 Prävalenzstudien zum Autismus im Kindesalter unter Anwendung von epidemiologischen Methoden in definierten Bevölkerungsstichproben aus Europa, USA, Kanada und Japan; die altersspezifischen Raten variierten zwischen 3,3 und 16,0/10.000. Acht Studien gaben Raten für “typischen” Autismus an: 1,2 bis 8,4/10.000. Nach Ursachen für die unterschiedlichen Prävalenzangaben wurden kritisch gesucht unter Prüfung der geographischen und demographischen Details der gescreenten Bevölkerungsstichproben, der Methoden des initialen Screenings und der endgültigen Untersuchung von möglicherweise autistischen Kindern, der demographischen und klinischen Details von Kindern, die aus autistisch identifiziert wurden, und der diagnostischen Kriterien. Es fanden sichunabhängig von diagnostischen Kriterien. Es fanden sichunabhängig von diagnostischen Kriterien-Hinweise für eine höhere Prävalenz unter Kindern von Eltern, die aus “exotischen” Ländern nach Europa eingewandert waren. Hiervon abgesehen, könnten alle Prävalenzunterschiede auf verschiedenen diagnostischen Vorgehensweisen und einem erhöhten Bewußtsein für die Manifestationen autistischer Störungen über die gesamte IQ-Verteilung (von schwer geistig behindert bis durchschnittlich bzw. überdurchschnittlich) beruhen. Es ist jedoch möglich, obgleich bislang nicht bewiesen, daß die Raten von der Zeit bzw. dem Ort abhängen. Die Probleme, die sich aus der Definition der Untergruppe “typischer Autismus” ergeben, werden diskutiert angesichts eines weiten Spektrums von Kindern mit Beeinträchtigungen der sozialen Interaktion, der Kommunikation und der Phantasie. Der Sinn dieser Untergruppenbildung wird in Frage gestellt.

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Wing, L. The definition and prevalence of autism: A review. European Child & Adolescent Psychiatry 2, 61–74 (1993). https://doi.org/10.1007/BF02098832

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