Secular changes in the symptom level of clinically diagnosed autism

Arvidsson, Olof; Gillberg, Christopher; Lichtenstein, Paul; Lundström, Staffan

doi:10.1111/jcpp.12864

Cited by 69 publications

(59 citation statements)

References 36 publications

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“…The increases in the frequencies of some criteria in this dataset contrasts with results from a study in Sweden which found fewer autism symptoms among children diagnosed in 2014 than among children diagnosed in 2004 [38]. Arvidsson et al suggest that clinical diagnoses of autism are being made in the year 2014 for cases that are less severe and would not have been given that diagnosis in 2004.…”

Section: Discussioncontrasting

confidence: 83%

Automated Extraction of Diagnostic Criteria From Electronic Health Records for Autism Spectrum Disorders: Development, Evaluation, and Application (Preprint)

Leroy¹,

Gu²,

Pettygrove³

et al. 2018

Preprint

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Background: Electronic health records (EHR) bring many opportunities for information utilization. One such use is the surveillance conducted by the Centers for Disease Control and Prevention (CDC) to track cases of Autism Spectrum Disorders (ASD). This process currently comprises the manual collection and review of EHR of 4-and 8-year old children in 11 U.S. states for the presence of ASD criteria. The work is time-consuming and expensive.

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Section: Discussioncontrasting

confidence: 83%

Automated Extraction of Diagnostic Criteria From Electronic Health Records for Autism Spectrum Disorders: Development, Evaluation, and Application (Preprint)

Leroy¹,

Gu²,

Pettygrove³

et al. 2018

Preprint

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“…For example, Gillberg and colleagues reported no increase in levels of (parent‐reported) autistic traits (at 9 or 12 years) in a Swedish population‐based sample of children born from 1993 to 2003, but a significant increase in the rates of autism diagnosis over this 10‐year period (Lundström et al, ). They also found a decrease in level of parent‐reported autism (and related) symptoms and impairment for children receiving an autism diagnosis at age 7–13 years, over the period 2004–2014 (Arvidsson et al, ). The authors suggest the bar for diagnosis is now significantly lower – perhaps too low.…”

Section: The Changing Concept Of Autism: 2 From Rare To Commonmentioning

confidence: 97%

Annual Research Review: Looking back to look forward – changes in the concept of autism and implications for future research

Happé

Frith

2020

Child Psychology Psychiatry

238

158

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The concept of autism is a significant contribution from child psychiatry that has entered wider culture and public consciousness, and has evolved significantly over the last four decades. Taking a rather personal retrospective, reflecting on our own time in autism research, this review explores changes in the concept of autism and the implications of these for future research. We focus on seven major changes in how autism is thought of, operationalised, and recognised: (1) from a narrow definition to wide diagnostic criteria; (2) from a rare to a relatively common condition, although probably still under‐recognised in women; (3) from something affecting children, to a lifelong condition; (4) from something discreet and distinct, to a dimensional view; (5) from one thing to many ‘autisms’, and a compound or ‘fractionable’ condition; (6) from a focus on ‘pure’ autism, to recognition that complexity and comorbidity is the norm; and finally, (7) from conceptualising autism purely as a ‘developmental disorder’, to recognising a neurodiversity perspective, operationalised in participatory research models. We conclude with some challenges for the field and suggestions for areas currently neglected in autism research.

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“…There has been an increase in the prevalence of autism from less than 0.05% in 1966 3 to 1.47% among children aged 8 years in the United States 4 and to more than 2% in studies 5 measuring lifetime prevalence through less stringent case ascertainment. In the absence of a reliable biomarker for the diagnosis of autism, this statistic may reflect multiple factors, such as a true increase in autism in the population, greater public awareness of autism, 6 diagnostic substitution, 7 a link between diagnosis and support, greater tendency to diagnose individuals with an IQ in the normal range, 8 a diminished threshold for clinical diagnosis, 9 the use of checklist diagnoses, 10 or low specificity of standardized diagnostic instruments in clinical settings. 11 , 12 Possible changes in diagnostic practices may have resulted in empirical studies assessing an increasingly heterogeneous population, including individuals with less profound deviations from normal that would not have previously been classified as autistic.…”

Section: Introductionmentioning

confidence: 99%

Temporal Changes in Effect Sizes of Studies Comparing Individuals With and Without Autism

et al. 2019

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IMPORTANCE The definition and nature of autism have been highly debated, as exemplified by several revisions of the DSM (DSM-III, DSM-IIIR, DSM-IV, and DSM-5) criteria. There has recently been a move from a categorical view toward a spectrum-based view. These changes have been accompanied by a steady increase in the prevalence of the condition. Changes in the definition of autism that may increase heterogeneity could affect the results of autism research; specifically, a broadening of the population with autism could result in decreasing effect sizes of group comparison studies. OBJECTIVE To examine the correlation between publication year and effect size of autism-control group comparisons across several domains of published autism neurocognitive research. DATA SOURCES This meta-analysis investigated 11 meta-analyses obtained through a systematic search of PubMed for meta-analyses published from January 1, 1966, through January 27, 2019, using the search string autism AND (meta-analysis OR meta-analytic). The last search was conducted on January 27, 2019. STUDY SELECTION Meta-analyses were included if they tested the significance of group differences between individuals with autism and control individuals on a neurocognitive construct. Meta-analyses were only included if the tested group difference was significant and included data with a span of at least 15 years. DATA EXTRACTION AND SYNTHESIS Data were extracted and analyzed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline using fixed-effects models. MAIN OUTCOMES AND MEASURES Estimated slope of the correlation between publication year and effect size, controlling for differences in methods, sample size, and study quality. RESULTS The 11 meta-analyses included data from a total of 27 723 individuals. Demographic data such as sex and age were not available for the entire data set. Seven different psychological and neurologic constructs were analyzed based on data from these meta-analyses. Downward temporal trends for effect size were found for all constructs (slopes:-0.067 to-0.003), with the trend being significant in 5 of 7 cases: emotion recognition (slope:-0.028 [95% CI,-0.048 to-0.007]), theory of mind (-0.045 [95% CI,-0.066 to-0.024]), planning (-0.067 [95% CI,-0.125 to-0.009]), P3b amplitude (-0.048 [95% CI,-0.093 to-0.004]), and brain size (-0.047 [95% CI,-0.077 to-0.016]). In contrast, 3 analogous constructs in schizophrenia, a condition that is also heterogeneous but with no reported increase in prevalence, did not show a similar trend. CONCLUSIONS AND RELEVANCE The findings suggest that differences between individuals with autism and those without the diagnosis have decreased over time and that possible changes in the definition of autism from a narrowly defined and homogenous population toward an inclusive and heterogeneous population may reduce our capacity to build mechanistic models of the condition.

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Secular changes in the symptom level of clinically diagnosed autism

Cited by 69 publications

References 36 publications

Automated Extraction of Diagnostic Criteria From Electronic Health Records for Autism Spectrum Disorders: Development, Evaluation, and Application (Preprint)

Automated Extraction of Diagnostic Criteria From Electronic Health Records for Autism Spectrum Disorders: Development, Evaluation, and Application (Preprint)

Annual Research Review: Looking back to look forward – changes in the concept of autism and implications for future research

Temporal Changes in Effect Sizes of Studies Comparing Individuals With and Without Autism

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