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Sat 1A Fombonne-Epidemiology of Asds Epidemiology of Autism Spectrum Disorders: update on rates, trends and new studies The Help Group Summit 2012 Oct. 27th, 2012 Pr. Eric Fombonne Oregon Health & Science University Outline • Past and recent prevalence surveys • Best current estimate for ASDs • World wide efforts on ASD epidemiology • Time trends: is there an epidemic? 75 65 Prevalence of autism in 34 surveys 55 45 35 25 15 5 25 -51965 1970 1975 1980 1985 1990 1995 2000 22 .5 19 20 17 .5 27 10 15 11 26 12 .5 13 18 10 24 12 Rate / Rate 10,000 16 7.5 21 6 14 5 1 2 4 9 20 23 2.5 7 17 15 5 0 3 8 1965 1975 1985 1995 Year of Publication Newschaffer, 2007 Time trends: AD (Rate/10,000 and 95% CI) Year of publicaon: r=.43 p <.001 Year of publicaon x Region : n.s. Elsabbagh,...,Fombonne Autism Research 2012 Relative rates of AD and PDD NOS Study Definition for other PDD AD PDD NOS Ratio Lotter (1966) behaviour similar to 4.1 3.3 0.8 autistic children Brask (1970) ‘other psychoses’ or 4.3 1.9 0.4 ‘borderline psychotic’ Wing et al (1976) socially impaired 4.9 16.3 3.3 (triad of impairments) Hoshino et al autistic mental 2.3 2.9 1.3 (1982) retardation Burd et al (1987) ‘autistic-like’ 3.3 > 7.8 2.4 Cialdella & other forms of 4.5 4.7 1.0 Marmelle (1989) ‘infantile psychosis’ Relative rates of AD and PDD NOS Study Definition for other PDD AD PDD NOS Ratio Fombonne & other PDDs 4.6 6.6 1.4 Mazaubrun (1992) Fombonne et al other PDDs 5.3 10.9 2.1 (1997) Powell et al. autism-spectrum 7.8 13.0 1.7 (2000) disorders CDC (2000) PDD NOS 40 27.0 0.7 Baird et al (2000) PDD NOS 27.7 27.1 1.0 Chakrabarti & PDD NOS 16.8 36.1 2.1 Fombonne (2001) Childhood disintegrative disorder (CDD) Prevalence N M/F estimate 95% CI1 (/10,000) (/10,000) Burd et al., 1987 2 2/0 .111 .013; .399 Sponheim & Skjeldal, 1 ? .152 .004; .848 1998 Magn. & Sæm., 2001 1974-93 2 2/0 .234 .028; .844 1964-732 4 3/1 .311 .085; .795 Chakrabarti & 1 1/0 .645 .016; 3.59 Fombonne 2001 1 : 95% CI derive from exact binomial calculations 2 : data from Magnusson (1977) Asperger syndrome in recent autism surveys Autism AS Autism / AS Prevalence N Prevalence N Ratio Sponheim & Skjeldal, 1998 4.9 32 .3 2 16.0 Taylor et al., 1999 8.7 427 1.4 71 6.0 Kadesjö et al., 1999 72.6 6 48.4 4 1.5 Powell et al. 2000 - 54 - 16 3.4 Baird et al. 2000 27.7 45 3.1 5 9.0 Chakrabarti & Fombonne 16.8 26 8.4 13 2.0 2001 Recent surveys of PDD Autism PDDNOS + AS All PDD Age rate / M / F % IQ rate / M / F % IQ rate / 10,000 ratio normal 10,000 ratio normal 10,000 CDC, 3-10 40.5 2.2 37 27.0 3.7 51 67.5 2000 Baird et al, 7 30.8 15.7 60 27.1 4.5 - 57.9 2000 Chakrabarti 4-7 16.8 3.3 29 44.5 4.3 94 61.3 & Fombonne 2001 Great Britain Stafford London Staffordshire surveys 92-95 96-98 cohort cohort Combined samples N=15,500 N=10,903 N=26,403 N P N P N P 95% CI Autistic disorder 26 16.8 24 22.0 50 18.9 14.1-25.0 PDD NOS 56 36.1 27 24.8 83 31.4 25.0-39.0 Asperger 13 8.4 12 11.0 25 9.5 6.1-14.0 CDD 1 0.7 1 0.9 2 0.8 0.1-2.7 All PDDs 961 61.9 64 58.7 160 60.6 51.6-70.7 1: One girl with Rett syndrome has been excluded Chakrabarti & Fombonne, (2005) Montréal Survey • Sample – Largest school board (LB Pearson) for Anglophone children in West Montréal – 55 schools; 27,749 pupils from K to grade 11 – Children with PDD identified through special education code (ASD) that provides extra funding to the school – 180 children with PDD identified on October 1st 2003 Fombonne et al., 2006 PDD prevalence Montréal Survey : 180 subjects Prevalence 95% CI Autism 21.6/10,000 16.5 - 27.8 PDD NOS 32.8 /10,000 26.4 - 40.2 Asperger 10.1/10,000 6.7 - 14.6 CDD 0.4 /10,000 0.0 - 2.0 All 64.9 /10,000 55.8 - 75.0 Fombonne et al., 2006 New Montreal survey • Sample – English Montreal School Board (EMSB) for Anglophone children – 71 schools; 23,635 pupils from K to grade 11 – Children with PDD identified through special education code (ASD) that provides extra funding to the school – 187 children with PDD identified on April 1st 2008 Lazoff, Fombonne et al., (2010) (Can J psych) New Montreal survey Male Female Total Prevalence /10,000 (95% confidence N N N interval) PDD -NOS 88 15 103 43.6 (35.2 – 52.0) Autistic 50 10 60 25.4 (19.0 - 31.8) Disorder Asperger 19 4 23 9.7 (5.8 – 13.7) CDD 1 0 1 0.4 (0.0 – 1.3) Total 158 29 187 79.1 (67.8 - 90.4) Lazoff, Fombonne et al. (2010) (Can J Psych) New Montreal survey: trends in birth cohorts 1991-2002 Prevalence of ASD, USA 2006 14 12 0.9% 10 8 6 Prevalence per 1000 4 2 0 Health records only Health and education records USA Outline • Past and recent prevalence surveys • Best current estimate for ASDs • World wide efforts on ASD epidemiology • Time trends: is there an epidemic? Recent review of surveys • 63 published surveys • 50 on AD, 14 on ASP, 12 on CDD, 26 on PDD • half published since 2001 • AD: 2.2/1,000 • ASP: 1/1,000 • CDD: 2/100,000 • PDD: ~ 7 to 9/1,000 • Some studies have PDD rates over 1% • 1.1% in NJ- USA (CDC, 2007) • 1.3% in Arizona (CDC, 2009) • 1.2% in the UK (Baird et al. 2006) • 1.3% in some birth cohorts (Lazoff, Fombonne et al., 2010) • 1.8% in Japan (Kawamura et al. 2008) Fombonne et al 2011 Equivalences 90/10,000 = 9/1,000 = 0.9% = 1 child in 110 Correlates of ASD • The proportion of children with cognitive functioning within the normal range is 30% for autistic disorder and 55% for all PDDs • Consistent male overrepresentation for autistic disorder (4.4:1), CDD (9:1), and all PDDs (5.5:1) • Association between higher proportion of normal IQ subjects and a higher male/female ratio (Spearman’s r: 0.53; p = .007) • Regression, or loss of skills, occurs in about 1 in 4 children with PDD Autism Surveys : Other findings . no association with social class in post 1980 surveys . association with immigrant status or ethnicity : largely unsupported . geographical variation in prevalence * methodological variation between studies confounds comparisons * limited evidence not in favour of between-countries variations in rates. Baron-Cohen et al., 1999 EXAMPLE OF A RECENT CLUSTER IN STAFFORD, UK 14 ‘villages’ 10,500 Inuit inhabitants 4,500 under age 18 An unusual observation amongst Inuits from Northern Quebec • Based on N~4,500 subjects under age 18, we expect ~30 subjects with ASD • One would reject the hypothesis of equal prevalences if Nobs<21, but we found no case • Specificity: the curious case of Kujjuarapik where half the village is Cree and they have ASDs • Not attributable to migration, differential mortality, cultural expression,.. • Pre- and post-natal exposure to neurotoxicants (including methylmercury) is high Outline • Recent prevalence surveys • Best current estimate for ASDs • World wide efforts on ASD epidemiology • Time trends: is there an epidemic? Korean Autism Study (KAS) Research Design • Total Population Study No sampling • Mechanisms to Identify Children 1. Mandatory Educational System 2. Home Schooling 3. Disability Registry • Two Stage Design 1. Multi-Informant Screening 2. Confirmative Dx with ADOS & ADI-R Cultural differences: Autism versus Reactive attachment disorder ? Issues in survey data analysis: weighting for non-response Target Population N=20,000 Normal Special needs 19,000 1,000 Screening phase: sampling fractions, and participation rates N=20,000 Normal Special needs 19000 1,000 3,800 250 50% 80% 1,900 200 Screen negative Screen positive Screen positive Screen negative 1,710 190 100 100 Diagnostic phase: sampling fractions and participation rates N=20,000 Normal Special needs 19,000 1,000 3,800 250 Screening Screening 50% 80% 1900 200 Screen negative Screen positive Screen positive Screen negative 1710 190 100 100 1/5 1/2 1/4 1/2 855 38 50 25 50% 50% 80% 80% ASD - ASD + ASD - ASD + ASD - ASD + ASD - ASD + 425 2 18 1 5 35 18 2 Prevalence estimation in the special needs population N=20000 Normal Special needs 19000 1000 ASD response__ rates11 samples fractions P 250 N 80% (35 0.811 2 0.8 4) (2 0.8 11 4 0.8 4) P 1000 200 P 49% Screen positive Screen negative 100 100 1/2 1/4 50 25 80% 80% ASD negative ASD positive ASD negative ASD positive 5 18 35 2 Mexico study: Leon, Guanajato Funded by Autism Speaks, study in progress Study objectives To provide the first estimate of the prevalence o f ASDs in a representative sample of Mexican children aged 8 To identify clinical, educational, cognitive, familial and social correlates of ASD in Mexican children To describe retrospectively the developmental trajectories (first symptoms, first contacts and responses with health care/ educational professionals, delays and barrers in accessing diagnostic and treatment services,..) of children confirmed with an ASD diagnosis in order to identify targets for service improvement in Mexico Study area State of Guanajuato, one of the 32 states of Mexico.
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