Operationalisation of the European Protocol for Autism Prevalence (EPAP) for Autism Spectrum Disorder Prevalence Measurement in Ireland

Prevalence of Autism Spectrum Disorder in Children in Andalusia (Spain)

Autism Spectrum Disorder (ASD) is socially relevant because of its number and the intensity of the medical and socio-educational response it requires. In Andalusia, one in 70 children will be diagnosed with ASD in 2021. It is much more frequent in boys than in girls, being 5.91 times more likely to present it as a boy than as a girl. The age of diagnosis is increasingly younger, standing at 4.4 years. In more than half of primary schools and more than 75% of secondary schools there are an average of three students with ASD per school. It is necessary to develop a network of preferential care centers for students with ASD to generalize specialized care in ordinary modalities.

Screening for Autism Spectrum Condition Through Inner City Homeless Services in the Republic of Ireland

Homeless service users were screened for autism spectrum disorder through one of Ireland's leading not for profit service providers. Keyworkers acted as proxy informants; their caseloads were screened using the DSM-5-Autistic Traits in the Homeless Interview (DATHI). Client current and historical health and behaviour data was collated. A representative sample of 106 eligible keyworkers caseloads were screened, identifying 3% "present" and 9% "possibly present" for autistic traits with the DATHI. These findings suggest a high estimate of autism prevalence and support emerging evidence that, people with autism are overrepresented in the homeless population, compared to housed populations. Autism may be a risk factor for entry into homelessness and a challenge to exiting homeless and engaging with relevant services.

Yield of brain MRI in children with autism spectrum disorder

Autism spectrum disorder (ASD) is a common neurodevelopmental condition. The American Academy of Paediatrics and American Academy of Neurology do not recommend routine brain magnetic resonance imaging (MRI) in the assessment of ASD. The need for a brain MRI should be decided on atypical features in the clinical history and examination. However, many physicians continue to use brain MRI routinely in the assessment process. We performed a retrospective review of indications for requesting brain MRI in our institution over a 5-year period. The aim was to identify the yield of MRI in children with ASD and calculate the prevalence of significant neuroimaging abnormalities in children with ASD and identify clinical indications for neuroimaging. One hundred eighty-one participants were analysed. An abnormal brain MRI was identified in 7.2% (13/181). Abnormal brain MRI was more likely with an abnormal neurological examination (OR 33.1, p = 0.001) or genetic/metabolic abnormality (OR 20, p = 0.02). In contrast, abnormal MRI was not shown to be more likely in children with a variety of other indications such as behavioural issues and developmental delay.      Conclusion: Thus, our findings support that MRI should not be a routine investigation in ASD, without additional findings. The decision to arrange brain MRI should be made on a case-by-case basis following careful evaluation of potential risks and benefits. The impact of any findings on the management course of the child should be considered prior to arranging imaging. What is Known: • Incidental brain MRI findings are common in children with and without ASD. • Many children with ASD undergo brain MRI in the absence of neurological comorbidities. What is New: • Brain MRI abnormalities in ASD are more likely with an abnormal neurological examination and genetic or metabolic conditions. • Prevalence of significant brain MRI abnormalities in ASD alone is low.

Predictors of autism spectrum disorder diagnosis in a spanish sample of preterm children with very low birthweight: A cross-sectional study

Background and Aims

Autism spectrum disorder (ASD) is a neurodevelopmental disorder with a higher likelihood of being diagnosed in preterm populations. Likewise, low birthweight has also been connected with an increased likelihood of ASD. The objectives were to study the frequency and define the relationship between ASD, gestational age, birthweight, and growth percentiles for preterm children.

Methods

A sample of preterm children with very low birthweight was selected from the Spanish population at 7-10 years old. Families were contacted from the hospital, and they were offered an appointment to conduct a neuropsychological assessment. The children who showed signs of ASD were referred to the diagnostic unit for differential diagnosis.

Results

A total of 57 children completed full assessments, with 4 confirmed ASD diagnoses. The estimated prevalence was 7.02%. There were statistically significant weak correlations between ASD and gestational age (τb = -0.23), and birthweight (τb = -0.25), suggesting there is a higher likelihood of developing ASD for those born smaller or earlier in their gestation.

Conclusion

These results could improve ASD detection and outcomes for this vulnerable population while also supporting and enhancing previous findings.

A systematic review and meta-analysis on the prevalence of mental disorders among children and adolescents in Europe

Most mental disorders appear by age 14, but in most cases, they remain undiagnosed and untreated well into adulthood. A scoping review showed an absence of systematic reviews that address prevalence rates of mental disorders among children and adolescents in Europe that are based on community studies conducted between 2015 and 2020. To estimate the updated pooled prevalence of Anxiety Disorder, Depressive Disorder, Attention Deficit Hyperactivity Disorder (ADHD), Conduct Disorder (CD), Oppositional Defiant Disorder (ODD), Autism Spectrum Disorder, Eating Disorders, Substance Use Disorders (SUD), among children and adolescents living in Europe, a search strategy was conducted using MEDLINE, Embase and Psych Info and studies were also identified from reference lists and gray literature. Eligible studies were evaluated for reliability, validity, and bias. Trends of prevalence rates for each mental disorder were calculated. Almost one in five young people in Europe were found to suffer from a mental disorder, with a pooled prevalence rate of 15.5%. Anxiety disorders had the highest pooled prevalence rate (7.9% (95% CI 5.1-11.8%, I2: 98.0%)), followed by ADHD (2.9% (95% CI 1.2-6.9%, I2 = 94.3%)), ODD (1.9% (95% CI 1.0-3.7%, I2 = 98.4%)), depressive disorder (1.7% (95% CI 1.0-2.9%, I2 = 97.7%)), CD (1.5% (95% CI 0.6-3.8%, I2 = 98.8%)) and ASD (1.4% (95% CI 0.4-5.4%, I2 = 99.7%). No studies on SUD were identified. The mental health of children and adolescents may be improved by introducing routine screening, refining diagnostic sensitivity, raising awareness of mental disorders, minimizing stigma and socioeconomic inequality, as well as developing early intervention services. These facilitators of good mental health need to be prioritized, especially at a time of unprecedented risk factors for poor mental health.

Attitudes Towards Evidence-Based Practice of Professionals Working with Children and Adolescents with Autism Spectrum Disorder in Bangladesh

Like in many lower-middle-income countries (LMIC), progress in implementing evidence-based practices (EBPs) for children with autism spectrum disorder (ASD) has been slow in Bangladesh. This cross-sectional study examined professionals' attitudes towards evidence-based practice (EBP) for children and adolescents with ASD and explored how providers' demographic factors are related to attitudes to and adoption of EBPs in Bangladesh. The sample consisted of 150 mental health professionals and special teachers from the urban area of Dhaka. Attitudes were assessed by the Evidence-based Practice Attitude Scale-36. Findings indicated that professionals have favorable attitudes towards EBP. Their attitudes varied depending on service settings (public clinical, private clinical, and special school) and caseload per year. Professionals who work in private and special school settings claimed to be more willing to adopt an EBP when required and perceived a higher fit of EBPs and their work than those in public clinical settings. The number of different EBPs used also differed by service setting. Every type of intervention (except medication) was used by more professionals in special schools than in private and public clinical settings. Many professionals reported few barriers to the implementation of EBPs. These findings indicate conditions that are often conducive to the implementation of EBPs. However, these results do not reflect the situation in rural areas, in which poverty is more widespread and the number of specialized professionals is low.

Effectiveness of interventions for children and adolescents with autism spectrum disorder in high-income vs. lower middle-income countries: An overview of systematic reviews and research papers from LMIC

Background

There is a multitude of systematic reviews of interventions for children and adolescents with autism spectrum disorder (ASD). However, most reviews seem to be based on research conducted in High-Income Countries (HIC). Thus, summary findings may not directly apply to Lower Middle-Income Countries (LMIC). Therefore, we conducted a Meta-Review analyzing systematic reviews on the effectiveness of interventions for target outcomes in children and adolescents with ASD to find out whether there are differences in effectiveness between HIC and LMIC and which interventions can be considered evidence-based in LMIC.

Methods

Electronic databases (PsycINFO, PubMed, Cochrane database of systematic reviews) were searched for reviews on interventions for ASD in children and adolescents from January 2011 through December 2021, which included studies not coming from HIC. Systematic reviews with qualitative and quantitative syntheses of findings were included. Two investigators independently assessed studies against predetermined inclusion/exclusion criteria and extracted relevant data including quality and evidence assessments. Evidence for different types of interventions in HIC vs. LMIC was planned to be compared, but none of the reviews assessed potential differences. Therefore, a narrative review of the studies from LMIC was conducted including an assessment of quality and evidence.

Results

Thirty-five reviews fulfilled the inclusion criteria. Eleven considered findings from HIC and LMIC. Sixty-nine percent included studies with various research designs; 63% provided a qualitative synthesis of findings; 77% percent assessed the quality of studies; 43% systematically assessed the level of evidence across studies. No review compared evidence from HIC and LMIC. A review of the studies from LMIC found some promising results, but the evidence was not sufficient due to a small number of studies, sometimes poor quality, and small sample sizes.

Conclusion

Systematic reviews on interventions for children and adolescents with ASD did not look for potential differences in the effectiveness of interventions in HIC and LMIC. Overall, there is very little evidence from LMIC. None of the interventions can be considered evidence-based in LMIC. Hence, additional research and mutually agreed methodological standards are needed to provide a more secure basis for evidence-based treatments in LMIC trying to establish evidence-based practices.

The global prevalence of autism spectrum disorder: a comprehensive systematic review and meta-analysis

Background

Autism spectrum disorder (ASD) is one of the serious developmental disorders that is usually diagnosed below the age of three years. Although the severity of the disease’s symptoms varies from patient to patient, the ability to communicate with others is affected in all forms of ASD. This study aimed to determine the prevalence of ASD in high-risk groups by continent.

Methods

The present study was conducted by systematic review and meta-analysis from 2008 to July 2021. Databases such as Science Direct, PubMed, Scopus, SID, Magiran, Web of Science (WoS), and Google Scholar from 2008 to July 2021 were searched to find related studies. Data were analysed using Comprehensive Meta-Analysis software (Version 2).

Results

A total of 74 studies with 30,212,757 participants were included in this study. The prevalence of ASD in the world was 0.6% (95% confidence interval: 0.4–1%). Subgroup analyses indicated that the prevalence of ASD in Asia, America, Europe, Africa and Australia was 0.4% (95% CI: 0.1–1), 1% (95% CI: 0.8–1.1), 0.5% (95% CI: 0.2–1), 1% (95% CI: 0.3–3.1), 1.7% (95% CI: 0.5–6.1) respectively.

Conclusion

ASD imposes a heavy health burden on communities around the world. Early detection of ASD can reduce the incidence of developmental disorders and improve patients’ communication skills. Therefore, health policymakers need to be aware of the prevalence and increasing trend of ASD to implement appropriate planning and interventions to reduce its consequences.

Autism spectrum disorder in older adults with intellectual disability: a scoping review

INTRODUCTION

Ireland has an ageing population of persons with intellectual disability (ID), autism spectrum disorder (ASD) and both (ID/ASD). Despite this, little is known about the prevalence of ASD and its effect on functional outcomes, psychiatric comorbidity or diagnostic issues in an older population with ID. This article reviews the literature on older adults with ID/ASD and identifies opportunities for future research in this population.

METHOD

The authors searched the Medline, Pubmed, Embase, CINAHL and PsychInfo databases using the search terms using key words: (older adults) AND (ID OR mental retardation OR learning disability) AND (autism OR ASD). After excluding articles for relevance, a scoping review was carried out on the results retrieved.

RESULTS

Of the 1227 articles retrieved from the literature on ID and autism/ASD in older adults, 85 articles were relevant to an adult population with ID/ASD. The data were collated and are presented covering domains of diagnosis, prevalence, psychiatric comorbidities and functional outcomes.

CONCLUSIONS

Despite increased prevalence in childhood ASD in the last 20 years, there is a lack of research regarding adults, especially older adults, with ASD, up to half of whom will have some level of ID. The existing literature suggests that older adults with ID/ASD may have reduced functional independence, increased psychiatric comorbidity and psychotropic prescribing and more behavioural presentations than the older population generally or those with ID only. There is a need for longitudinal data to be collected on this ageing population so that care and management needs can be met in the future.

Attention deficit hyperactivity disorder (ADHD) symptoms, comorbid psychopathology, behaviour problems and gastrointestinal symptoms in children and adolescents with autism spectrum disorder

OBJECTIVES

The study aims to investigate attention deficit hyperactivity disorder (ADHD) symptoms, gastrointestinal (GI) symptoms, comorbid psychopathology and behaviour problems in children and adolescents with autism spectrum disorder (ASD).

METHODS

Parents of 147 children and adolescents with ASD aged 6-18 years completed the Conners 3 Parent-Short Form, Gastrointestinal Symptom Inventory, Behavior Problems Inventory-Short Form and Autism Spectrum Disorder-Comorbid for Children.

RESULTS

Fifty-six per cent of children and adolescents had a comorbid diagnosis of ADHD, yet over 70% presented with clinically significant ADHD symptoms. Forty per cent of participants received a diagnosis of ADHD before ASD and 25.6% received a diagnosis of ASD first. Relationships were found between ADHD symptoms and comorbid psychopathology, GI symptoms, and behaviour problems.

CONCLUSIONS

The outcomes suggest that ADHD is being underestimated as a comorbid disorder of ASD. This may have implications on treatment and interventions for children and adolescents who have a diagnosis of both ASD and ADHD.

Epidemiological surveys of ASD: advances and remaining challenges

Recent worldwide epidemiological surveys of autism conducted in 37 countries are reviewed; the median prevalence of autism is .97% in 26 high-income countries. Methodological advances and remaining challenges in designing and executing surveys are discussed, including the effects on prevalence of variable case definitions and nosography, of reliance on parental reports only, case ascertainment through mainstream school surveys, innovative approaches to screen school samples more efficiently, and consideration of age in interpreting surveys. Directions for the future of autism epidemiology are discussed, including the need to systematically examine cross-cultural variation in phenotypic expression and developing surveillance programs.

Inclusion at a Crossroads: Dismantling Ireland’s System of Special Education

Ireland’s system of special education has undergone unprecedented change over the last three decades. Following major policy developments in the mid-2000s which emphasised inclusive education, there have been changes to special education school personnel and funding structures which seek to include greater numbers of students with disabilities in mainstream education. There is one anomaly however: Ireland continues to operate a parallel system of special schools and classes with an emphasis on special class provision for students with disabilities. The aim of this paper is to examine the evolution of Ireland’s special education policy over the past three decades and explore the extent to which it is compatible with its obligations under the United Nations Convention for People with Disabilities (UNCRPD) and more recent discussions around moving to inclusive education. It uses a systematic investigation of policy and administrative data on special class growth over time to highlight anomalies between the policy narrative around inclusive education in Ireland and the continued use of segregated settings. The current system, therefore, suggests confused thinking at a policy level which has resulted in the implementation of special education grafted on to the general education system. Any move to an inclusive system therefore, in order to be successful, would require a root and branch overhaul of existing policies.

The ASDEU autism prevalence study in northern Spain

The prevalence of autism spectrum disorders (ASD) was studied in children in the County of Gipuzkoa (Basque Country, Spain) as part of the European Union's Autism Spectrum Disorder in Europe project (ASDEU- https://asdeu.eu ). To identify cases in a total community sample of 7- to 9-year-old pupils (N = 14,734), a multistage approach was adopted: in the first stage, a teacher nomination (TN) form was completed by school teachers; and in the second stage, all families with a child nominated by their teachers were invited to complete the Social Communication Questionnaire (SCQ). A total of 108 (59%) schools participated fully, yielding a final sample of 9177 of 14.734 (61.9%) pupils. A total of 212 (2.3%) children were nominated via the TN form, and of these, 105 (49.5%) returned the completed SCQ. Twenty-five (23.8%) cases with SCQ scores ≥ 15 were invited to undergo a free clinical assessment, and 10 (40%) new cases of ASD were identified. The prevalence estimate included the 55 cases already being supported by the Gipuzkoa's only ASD association, the Gipuzkoa Autism Society (Asociación Guipuzcoana de Autismo/GAUTENA)), as well as the 10 new subjects identified by the ASDEU field diagnostic process. A sensitivity analysis was performed to estimate new potential ASD cases among the non-participant schools, leading to a final figure of 87 cases of ASD in this age-bracket at the date of the study. This global probabilistic estimate, including non-participating schools, would thus provide a population prevalence of 0.59% (95% CI 0.48-0.73), a result lower than those reported by some other studies. Attrition rates in cross-sectional studies are challenging and support the need for developing longitudinal ASD incidence surveillance study areas (ASD observatories).

Study protocol for autism specific transition resources (T-Res Study): developing a flexible resource package for dealing with the loosening and/or lifting of COVID-19 related restrictions

Autism specific transition resources (T-Res) aims to develop a flexible resource package to support children and young people with a diagnosis of autism spectrum disorder (ASD), as well as their families and educators, during the loosening and/or lifting of coronavirus disease 2019 (COVID-19) related restrictions on movement. A secondary aim is to determine the current and long-term impacts of the COVID-19 related restrictions on the wellbeing of individuals with autism spectrum disorders and their parents/caregivers. Measuring and addressing the psychosocial impact of the COVID-19 pandemic and related restrictions in movement is of prime importance at this time.  The impacts of this crisis will be far reaching and many may not be realised for many years. The proposed research will focus on children and young people with a diagnosis of ASD, their families and educators.  The ASD population alone is sizable with 14,000 (or 1.55%) of students in schools holding a diagnosis. When parents, teachers, tutors and special needs assistants (SNAs) are also considered this is a considerable group. The proposed research has the potential to have impacts that are social, psychological, educational and economic. This will be achieved through development of an online transition package to guide parents and educators in preparing children and young people for the resumption of regular daily routines following the lifting of COVID-19 restrictions.  This resource will be developed based on the needs of families and young people, as measured through surveys, as well as expert consensus on the targets and means of intervention.  This ambitious project can be commenced quickly and is designed to produce outputs quickly, which will in turn be disseminated to key stakeholders.

Spanish Cultural Validation of the Modified Checklist for Autism in Toddlers, Revised

The Modified Checklist for Autism in Toddlers-revised/follow-up (M-CHAT-R/F) was developed to reduce the number of cases requiring telephone verification. The aim of this study was to validate a Spanish version of the M-CHAT-R/F in the Spanish public health system. The M-CHAT-R/F was translated, culturally adapted, and then administered to 6625 children. Of the 39 positive screening cases, 15 children were diagnosed with autism spectrum disorder (ASD) and 24 with non-ASD disorders or delays. The sensitivity was 0.79 and specificity of 0.99. Positive and negative predictive values were 0.39 and 0.99, respectively. These results are similar to the English equivalent, though observed prevalence was lower. This study supports Spanish National Health System policy makers to consider a universal ASD screening program.

Explaining Age at Autism Spectrum Diagnosis in Children with Migrant and Non-Migrant Background in Austria

This study explored (i) differences in age at Autism Spectrum Disorder (ASD) diagnosis between children with and without a migrant background in the main diagnostic centre for ASD in Upper Austria (ii) factors related to the age at diagnosis and (iii) whether specific factors differed between the two groups. A retrospective chart analysis included all children who received their first diagnosis before the age of 10 years (n = 211) between 2013 and 2018. Children with a migrant background were diagnosed 13 months earlier than those without (r = 0.278, p < 0.001), and had more severe delays in language, more severe autism, no Asperger’s syndrome, lower parental educational level and more frequent referrals by paediatricians. For the total sample, expressive language delay, severity of restricted and repetitive behaviours, higher nonverbal development, and paediatric referrals explained earlier diagnoses. There was a stronger effect of parental education and weaker effect of language impairment on age at ASD diagnosis in children with a migrant background. In conclusion, no delay in diagnosing ASD in children with a migrant background in a country with universal health care and an established system of paediatric developmental surveillance was found. Awareness of ASD, including Asperger’s syndrome, should be raised among families and healthcare professionals.

Autism Spectrum Disorders in Greece: Nationwide Prevalence in 10-11 Year-Old Children and Regional Disparities

Autism spectrum disorders (ASD) constitute a public health concern with increasing prevalence worldwide. We aimed to estimate prevalence and age at diagnosis in Greece, where no large-scale prevalence study has ever been conducted. Aggregate data were collected on ASD diagnoses by gender and calendar year of diagnosis up to 2019, for children born in 2008 and 2009, from the Centers for Educational and Counseling Support, which evaluate children to receive special educational support in school. Coverage was 87.1% of centers and 88.1% of schoolchildren born in 2008–9. ASD prevalence overall was 1.15% (1.83% males, 0.44% females; ratio 4.14:1), ranging from 0.59% to 1.50% in Greece’s 13 regions. In five regions, prevalence differed significantly between centers. Overall, only 3.8% of diagnoses were made before the fourth year after birth and 42.7% before the sixth year, with considerable variation between regions. Approximate mean age at diagnosis was six years and one month, and about three months earlier for girls than for boys. Our results provide evidence-based information to guide service planning and development at national and regional levels. Particular attention should be paid to smoothing out inequalities regarding service accessibility and provision. Emphasis should be given to earlier identification and diagnosis of ASD.

Predictors of unmet needs and family debt among children and adolescents with an autism spectrum disorder: Evidence from Ireland

Autism Spectrum Disorders (ASDs) are a life-long neurodevelopmental condition where individuals affected and their families require varying intensities of services and supports. A growing body of evidence provides consensus that early intervention may improve long-term outcomes. The purpose of the paper is to identify the factors that explain variations between families raising a child/children with an ASD in their experience of specific unmet needs and/or experience of debt. Analysis was based on data collected as part of a larger study that examined the economics of autism spectrum disorder in Ireland among 195 families with 222 children aged between 2-18 years of age in 2014/2015. The findings from parental reported responses show over 74 % of children did not receive one or more services in the previous 12 months. Average debt per year per family was €3259. Regression analyses showed that families that had two or more children with an ASD were more likely to experience unmet needs and incur debt specifically because of the child's condition than families with one child with an ASD. The study shows there is a significant level of unmet need and economic hardship, as evident in the level of ASD related debt which may make current met needs unsustainable in the future. Issues of capacity and geographic inequity that warrant a policy response were also evident.

Exploring diagnostic validity of the autism diagnostic observation schedule-2 in South Korean toddlers and preschoolers

This study aims to provide the initial validity of the Autism Diagnostic Observation Schedule-2 (ADOS-2) Toddler Module and Module 1-2 for South Korean toddlers and preschoolers. Based on 143 children, the ASD group (n = 68) showed significantly higher ADOS-2 item and algorithm total scores as well as social affect and repetitive and restricted behaviors domain scores compared with children with nonspectrum (NS; n = 42) disorders and typically developing (TD; n = 33) children. Using lower algorithm cutoffs, sensitivities were excellent for the ASD versus NS/TD comparisons, ranging from 94% to 100% across different Modules. Specificities varied more, ranging from 82% to 100%. Internal consistency was strong with high item-total correlations (r of 0.6-0.9) and Cronbach's Alphas (all above 0.7). Results demonstrated promising, initial evidence for the validity of the ADOS-2 for South Korean toddlers and preschoolers from 1 to 4 years of age. The ADOS-2 could be implemented, with minimal adaptations, in research and clinical settings in South Korea. This study is one of the first steps toward validating the ADOS-2 in other Eastern countries that are in great need for a valid instrument for the detection of ASD. Autism Res 2019, 12: 1356-1366. © 2019 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: Results of this study demonstrated promising, initial evidence for the validity of a gold standard measure for the diagnosis of autism, the Autism Diagnostic Observation Schedule-2 (ADOS-2), for South Korean toddlers and preschoolers. The ADOS-2 could be implemented, with minimal adaptations, in research and clinical settings in South Korea. This study is one of the first steps toward validating the ADOS-2 in other Eastern countries that are in great need of a valid instrument for the detection of ASD.

A case of mistaken diagnoses: diagnostic and management challenges in a case of adult autism spectrum disorder

Autism spectrum disorder (ASD) is frequently identified in children but is often unrecognised in adults. ASD is characterised by difficulties in social interaction, communication and restricted interests, but other presentations are common, especially in adults. This report describes a 34-year-old man with a history of multiple psychiatric diagnoses including generalised anxiety disorder, major depressive disorder and panic disorder. He was diagnosed with ASD in his early 30s and engaged in a targeted treatment plan, including rationalisation of medications, supportive therapy and occupational therapy, which successfully facilitated discharge from mental health services. This case illustrates the atypical presentation of ASD in adults, which is diagnostically challenging. Such cases often present to community mental health services and may be misdiagnosed as treatment resistant cases of depressive, anxiety or personality disorders. Accurate diagnosis and targeted management is more likely to yield a successful outcome.

Maternal Alcohol Consumption During Pregnancy and the Risk of Autism Spectrum Disorders in Offspring: A Retrospective Analysis of the Millennium Cohort Study

The objective of this retrospective analysis of the longitudinal Millennium Cohort Study was to examine whether maternal alcohol consumption in pregnancy (MACP) is associated with the development of childhood autism spectrum disorders (ASD). Data on MACP and ASD were obtained from parental questionnaires. There were 18,168 singleton mother–child pairs with data on MACP, and 12,595 answered the question on ASD when the children were 11 years old. No statistically significant association was found between MACP and ASD for light (OR 0.78, 95% CI 0.48–1.29), moderate (OR 0.89, 95% CI 0.35–2.27), or heavy (OR 1.54, 95% CI 0.56–4.21) MACP. Alcohol consumption during pregnancy was not associated with the risk of developing ASD in this study cohort.

The economic costs and its predictors for childhood autism spectrum disorders in Ireland: How is the burden distributed?

Autism spectrum disorders are associated with a substantial economic burden; although little is known about the relationship between state and family out-of-pocket expenditure. The objective of this study is to estimate the societal cost of childhood autism spectrum disorders and explain the variation in costs between state and family out-of-pocket expenditure. A bottom-up prevalence based cost-of-illness methodology was implemented using data from a combination of multiple convenience samples in Ireland of 195 parents of 222 children aged between 2 and 18 years of age with a clinically diagnosed autism spectrum disorder collected in 2014/2015. The findings show the average annual cost per child for families amounted to €28,464.89 related to private autism spectrum disorder services, lost income and informal care. By comparison, annual state expenditure per child on autism spectrum disorder-related health, social and educational resources was €14,192. Regression analyses indicate that autism spectrum disorder severity is significantly associated with higher out of pocket expenditures but not state health expenditures. The results suggest that parents are central to meeting the needs of young people with autism spectrum disorders in Ireland. Policy implications of these findings suggest that significant investment and commitment is needed to address the needs of individuals living with autism spectrum disorders and their families.

Prevalence of Autism Spectrum Disorder in a large Italian catchment area: a school-based population study within the ASDEU project

AIMS

This study aims to estimate Autism Spectrum Disorders (ASD) prevalence in school-aged children in the province of Pisa (Italy) using the strategy of the ASD in the European Union (ASDEU) project.

METHODS

A multistage approach was used to identify cases in a community sample (N = 10 138) of 7-9-year-old children attending elementary schools in Pisa - Italy. First, the number of children with a disability certificate was collected from the Local Health Authority and an ASD diagnosis was verified by the ASDEU team. Second, a Teacher Nomination form (TN) to identify children at risk for ASD was filled in by teachers who joined the study and the Social Communication Questionnaire (SCQ) was filled in by the parents of children identified as positive by the TN; a comprehensive assessment, which included the Autism Diagnostic Observation Schedule-Second Edition, was performed for children with positive TN and SCQ⩾9.

RESULTS

A total of 81 children who had a disability certificate also had ASD (prevalence: 0.79%, i.e. 1/126). Specifically, 66 children (57 males and nine females; 62% with intellectual disability -ID-) were certified with ASD, whereas another 15 (11 males and four females; 80% with ID) were recognised as having ASD among those certified with another neurodevelopmental disorder. Considering the population of 4417 (children belonging to schools which agreed to participate in the TN/SCQ procedure) and using only the number of children certified with ASD, the prevalence (38 in 4417) was 0.86%, i.e. one in 116. As far as this population is concerned, the prevalence rises to 1% if we consider the eight new cases (six males and two females; no subject had ID) identified among children with no pre-existing diagnoses and to 1.15%, i.e., one in 87, if probabilistic estimation is used.

CONCLUSIONS

This is the first population-based ASD prevalence study conducted in Italy so far and its results indicate a prevalence of ASD in children aged 7-9 years of about one in 87. This finding may help regional, national and international health planners to improve ASD policies for ASD children and their families in the public healthcare system.

A review of prevalence studies of Autism Spectrum Disorder by latitude and solar irradiance impact

Autism Spectrum Disorder (ASD) is a lifelong disability with no known cause or cure. Among the suggested etiologies, is Cannell's hypothesis of a deficiency in Vitamin D the main natural source of which is Solar Ultraviolet-B (UVB) radiation. The aim in this paper is to build on this hypothesis and explore the relationship of solar irradiance of which UVB is a component, by latitude with the prevalence rates of ASD. Twenty-five reports published between 2011 and 2016 using comparable diagnostic criteria were reviewed. The results suggest a tendency for the prevalence rates of ASD to be lowest in countries near the equator and for this rate to increase as the latitude increases. These findings provide some support not just for the Vitamin D hypothesis, but also for a new proposition that along with UVB radiation, the entire solar radiation spectrum which reaches the earth, may play a role in ASD. While these results are both novel and encouraging in terms of the potential efficacy of exposure to natural sunlight, further research is warranted before results can be considered definitive, and before the implications of the findings can be implemented clinically.