Background: Prospective population-based follow-up study of 120 individuals with autism followed from childhood to adulthood. Methods: Individuals with autism, diagnosed in childhood, were followed prospectively for a period of 13–22 years and re-evaluated at ages 17–40 years. The instruments used at follow-up were the DISCO, WAIS-R, WISC-III, Vineland Adaptive Behavior Scales, psychiatric-medical examination and GAF-scale. A set of criteria was used for the classification of outcomes, taking into consideration employment, higher education/vocational training, independent living and peer relations. Results: Six of the 120 (5%) had died at the time of follow-up, and six declined participation. Overall outcome was poor in 78% of cases. Only four individuals were independent albeit leading fairly isolated lives. Childhood IQ-level was positively correlated with better adult outcome, as was the existence of some communicative phrase speech at age six years. Conclusions: Children with autism as diagnosed in the 1960s, 1970s, and 1980s may have an even worse psychosocial outcome than previously believed.

Autism after adolescence: population-based 13- to 22-year follow-up study of 120 individuals with autism diagnosed in childhood

For decades after Kanner's original paper on the subject was published in 1943, autism was generally considered to be a rare condition with a prevalence of around 2-4 per 10,000 children. Then, studies carried out in the late 1990s and the present century reported annual rises in incidence of autism in pre-school children, based on age of diagnosis, and increases in the age-specific prevalence rates in children. Prevalence rates of up to 60 per 10,000 for autism and even more for the whole autistic spectrum were reported. Reasons for these increases are discussed. They include changes in diagnostic criteria, development of the concept of the wide autistic spectrum, different methods used in studies, growing awareness and knowledge among parents and professional workers and the development of specialist services, as well as the possibility of a true increase in numbers. Various environmental causes for a genuine rise in incidence have been suggested, including the triple vaccine for measles, mumps and rubella (MMR]. Not one of the possible environmental causes, including MMR, has been confirmed by independent scientific investigation, whereas there is strong evidence that complex genetic factors play a major role in etiology. The evidence suggests that the majority, if not all, of the reported rise in incidence and prevalence is due to changes in diagnostic criteria and increasing awareness and recognition of autistic spectrum disorders. Whether there is also a genuine rise in incidence remains an open question.

The epidemiology of autistic spectrum disorders: is the prevalence rising?

Background: The Diagnostic Interview for Social and Communication Disorders (DISCO) is a schedule for the diagnosis of autistic spectrum and related disorders and assessment of individual needs. It enables information to be recorded systematically for a wide range of behaviours and developmental skills and is suitable for use with all ages and levels of ability. In addition to helping the clinician to obtain a profile of each individual's pattern of development and behaviour, the DISCO also enables identification of specific features found in autistic spectrum disorders that are relevant for use with established diagnostic systems. Method: This paper describes the historical background of the DISCO, outlines its structure and reports the results of an inter-rater reliability study with parents of 82 children aged 3 to 11 years with autistic spectrum disorder, learning disability, language disorder or typical development. Results: Inter-rater reliability for the items in the interview was high (kappa coefficient or intra-class correlation at .75 or higher). This level of agreement was achieved for over 80% of the interview items.

The Diagnostic Interview for Social and Communication Disorders: background, inter-rater reliability and clinical use.

Although several studies have investigated the occurrence of medical and neurological conditions in persons with autism, relatively few reports have focused on the phenomenology and treatment of psychiatric disorders in this population. There is emerging evidence that depression is probably the most common psychiatric disorder that occurs in autistic persons. In this review, we examine the factors that influence the presence of depression in this population, such as the level of intelligence, age, gender, associated medical conditions, and the role of genetic factors and life events. We discuss the various forms of treatment available and highlight the need for early detection.

/pdf/depression-in-persons-with-autism-implications-for-research-20lpueh6x3.pdf

Depression in persons with autism: implications for research and clinical care.

Objective: To provide a clinically useful analysis of the extent to which autism and Asperger syndrome coexist with other disorders.

Method: Selective review of the literature detailing data pertaining to symptoms and disorders sometimes encountered in connection with autism or Asperger syndrome.

Results: A large number of medical conditions, psychiatric disorders and behavioural and motor dyscontrol symptoms are associated with autism and Asperger syndrome.

Conclusion: Comorbidity is to be expected in autism spectrum disorders — directly or indirectly. Comorbid conditions may be markers for underlying pathophysiology and suggest a more varied treatment approach. There is a great need for in-depth research into this area, meaning that the exclusion criteria of current diagnostic manuals, i.e. those that rule out a diagnosis of autism in some disorders, and a diagnosis of certain other disorders in autism may have to be revised.

Autism and Asperger syndrome: coexistence with other clinical disorders

Background The clinical pictures of autistic spectrum disorders include features described in catatonia.

Aims To examine the severe exacerbation of the catatonic features of autistic disorders in adolescence or early adult life, which occurs in some individuals.

Method A semi-structured interview schedule was used to collect information from parents or other care-givers concerning 506 referrals to a specialist clinic for autistic spectrum disorders. Individuals with severe exacerbation of catatonic features were compared with a same-age group of referrals without this type of deterioration in skills and behaviour.

Results Seventeen per cent of referrals aged 15 or over had severe exacerbation of catatonic features. They were significantly more likely than the comparison group to have had, before the onset of the change in behaviour, impaired language and passivity in social interaction.

Conclusions Catatonia is a later complication of autistic spectrum disorders, which adds considerably to the burden of caring. More research is needed to identify causes, neuropathology, and early signs of vulnerability.

/pdf/catatonia-in-autistic-spectrum-disorders-59g2im00ga.pdf

Catatonia in autistic spectrum disorders.

BACKGROUND The hypothesis that Asperger's syndrome (AS) may go unrecognised in forensic populations was examined by ascertaining the prevalence in Broadmoor Special Hospital.

METHOD The entire male patient population was screened by examination of case notes. Identified cases were subject to the next stage of the study, which involved observation and interviewing of patients, and a semi-structured interview of key staff.

RESULTS A prevalence of 1.5% (0.6% to 3.3%, 95% CI) was found. The addition of equivocal cases increased the prevalence to 2.3%.

CONCLUSION The prevalence of AS in Broadmoor Hospital is greater than that reported for the general population.

Amitta Shah

Papers

Catatonia in autistic spectrum disorders.

Prevalence of Asperger's syndrome in a secure hospital.