Prevalence of Asperger's syndrome in a secure hospital.
TL;DR: The prevalence of AS in Broadmoor Hospital is greater than that reported for the general population, and the addition of equivocal cases increased the prevalence to 2.3%.
Abstract: 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.
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TL;DR: The evidence suggests that the majority, if not all, of the reported rise in incidence and prevalence of autism in pre-school children is due to changes in diagnostic criteria and increasing awareness and recognition of autistic spectrum disorders.
Abstract: 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.
645 citations
TL;DR: An analysis of the extent to which autism and Asperger syndrome coexist with other disorders is provided to provide a clinically useful analysis.
Abstract: 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.
535 citations
Cites background from "Prevalence of Asperger's syndrome i..."
...There is also some limited evidence that Asperger syndrome may be overrepresented among mentally ill convicted violent offenders (77)....
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TL;DR: In this paper, the authors reviewed what is known about outcome in adult life for more able individuals within the autistic spectrum and combined the results of studies involving high-functioning people with autism and Asperger syndrome.
Abstract: The paper reviews what is known about outcome in adult life for more able individuals within the autistic spectrum. Because of the problems associated with differential diagnosis, the results of studies involving high-functioning people with autism and Asperger syndrome are combined. The review focuses predominantly on long-term follow-up research and covers outcome in terms of cognitive, linguistic, academic and adaptive functioning; educational and employment history; independence and social relationships; and behavioural and psychiatric problems. The stability of IQ and other measures over time, and variables related to outcome, are also investigated.
456 citations
Cites background from "Prevalence of Asperger's syndrome i..."
...The only relatively large-scale study of offending by people with Asperger syndrome or autism was conducted by Scragg and Shah (1994), who assessed the entire male population of Broadmoor Special Hospital in the UK....
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...As Scragg and Shah (1994) suggest, there may well be more people with autism in prisons or secure accommodation than is realized, and it is clearly important that such individuals are correctly identified and treated....
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TL;DR: Given the heterogeneity of autism spectrum disorder (ASD), approaches based on studying heritable components of the disorder, or endophenotypes, such as language or social cognition, provide promising avenues for genetic and neurobiological investigations.
Abstract: Autism is a common childhood neurodevelopmental disorder with strong genetic liability. It is not a unitary entity but a clinical syndrome, with variable deficits in social behavior and language, restrictive interests, and repetitive behaviors. Recent advances in the genetics of autism emphasize its etiological heterogeneity, with each genetic susceptibility locus accounting for only a small fraction of cases or having a small effect. Therefore, it is not surprising that no unifying structural or neuropathological features have been conclusively identified. Given the heterogeneity of autism spectrum disorder (ASD), approaches based on studying heritable components of the disorder, or endophenotypes, such as language or social cognition, provide promising avenues for genetic and neurobiological investigations. Early intensive behavioral and cognitive interventions are efficacious in many cases, but autism does not remit in the majority of children. Therefore, development of targeted therapies based on pathophysiologically and etiologically defined subtypes of ASD remains an important and achievable goal of current research.
442 citations
TL;DR: It appears likely that the current true prevalence of ASD is considerably greater than previously recognised, which has significant implications for the scientific understanding of ASD and for families and services.
Abstract: Background: Until recently best estimate prevalence rates for autism spectrum disorders (ASD) were 0.5/1,000 for autism and 2.0/1,000 for the broader spectrum. Three recent studies have suggested a significantly higher prevalence rate for ASD of 6.0/1,000 (mean 95 % CI = 4.8–8.0). Method: Possible determinants of the apparent increase in the prevalence of ASD are outlined. Methodological aspects of the three recent studies are examined. Findings: Increased recognition, the broadening of the diagnostic concept over time and methodological differences across studies may account for most or all of the apparent increase in prevalence, although this cannot be quantified. Conclusions: Findings from ongoing studies should help confirm or disconfirm the putative rate of 6.0/1,000 for all ASD. The possibility that autism has been over-diagnosed in recent studies needs to be ruled out. Notwithstanding these outstanding questions, it appears likely that the current true prevalence of ASD is considerably greater than previously recognised. This has significant implications for our scientific understanding of ASD and for families and services. Future directions for epidemiological research are outlined.
370 citations
References
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TL;DR: A total population study of Asperger syndrome using a two-stage procedure and findings obtained using Szatmari et al.'s and ICD-10 draft criteria for the disorder are described.
Abstract: This paper describes a total population study of Asperger syndrome using a two-stage procedure. All school children in an outer Goteborg borough were screened. Final case selection based on clinical work-up showed a minimum prevalence of 3.6 per 1.000 children (7-16 years of age) using Gillberg and Gillberg's criteria and a male to female ratio of 4:1. Including suspected and possible Asperger syndrome cases, the prevalence rose to 7.1 per 1.000 children and the male:female ratio dropped to 2.3:1. These findings are discussed as they relate to previously published results in the field and to findings obtained using Szatmari et al.'s and ICD-10 draft criteria for the disorder.
730 citations
TL;DR: It is concluded that among children with normal intelligence, rates of 10-26 per 10,000 children are minimum figures and the combination of Asperger syndrome and mild mental retardation is shown.
Abstract: Asperger syndrome has so far been the subject at very little systematic empirical inquiry. This paper reviews those few studies in the literature and some data from a new Swedish study which has reported findings pertinent to estimations of Asperger syndrome prevalence. It is concluded that among children with normal intelligence, rates of 10–26 per 10,000 children are minimum figures. Another 0.4 per 10,000 Swedish teenagers showed the combination of Asperger syndrome and mild mental retardation.
603 citations
01 Oct 1991
TL;DR: In this paper, a twelve-year-old boy with Asperger syndrome wrote a letter to his mother to explain his quite unprecedented emotional distress when the family cat died, describing the feeling of being trapped in a "vicious circle".
Abstract: It's only by logic and lack of emotions that I get through. Hiding feelings came after I became the victim. All emotions are a sign of weakness. I'm about as flexible as a thick bar of metal in a barrel of nitrogen … I shall turn out a mechanical, inflexible person who [sic] nobody likes, nobody loves and who everyone will be glad about when I'm in my grave. I'd only be concerned with money … It's a vicious circle. i. I get teased 2. I make myself miserable and cynical 3. I get teased again … The best school would be one where I spent my time working with machines – remove the human factor. If the people were very nice I could probably do very well. What I find difficult about learning, as well as the teasing, is that there's a massive great group of us and they're all unruly … I can break out of the vicious circle, but I can't take down the barriers. The clay has set – I've moulded my personality. The wall's there for good. I'm no good at changing. My flexibility was one of the first things I lost – lost completely. So wrote a twelve-year-old boy with Asperger syndrome to his mother to explain his quite unprecedented emotional distress when the family cat died.
239 citations
01 Oct 1991
TL;DR: A year before Asperger's first on ‘autistic psychopathy’ appeared, Kanner (1943) published his famous first account of eleven children with a pattern of abnormal behaviour that he decided to call ‘early infantile autism’.
Abstract: A year before Asperger's first on ‘autistic psychopathy’ appeared, Kanner (1943) published his famous first account of eleven children with a pattern of abnormal behaviour that he decided to call ‘early infantile autism’. He began as follows: ‘Since 1938, there have come to our attention a number of children whose condition differs so markedly and uniquely from anything reported so far, that each case merits – and I hope will eventually receive – a detailed consideration of its fascinating peculiarities’. The characteristics of Kanner's syndrome Kanner pointed out that these children had a number of characteristics in common. Kanner and Eisenberg (1956) selected five diagnostic criteria from Kanner's descriptions. Kanner's own words are given in quotation marks. The expansions and examples are based on his descriptions and my clinical experience. ‘A profound lack of affective contact with other people’. When young, the children appear aloof and indifferent to other people, especially other children. Kanner wrote: ‘There is, from the start, an extreme autistic aloneness that, wherever possible, disregards, ignores, shuts out anything that comes to the child from outside’. Their parents describe them as ‘self-sufficient’, ‘like in a shell’, ‘acting as if people weren't there’, ‘happiest when alone’. […]
213 citations
TL;DR: The design, administration, and scoring of the first edition of the Children's Handicaps, Behavior & Skills (HBS) structured interview schedule, intended to elicit information concerning mentally retarded or psychotic children, are described.
Abstract: The design, administration, and scoring of the first edition of the Children's Handicaps, Behavior & Skills (HBS) structured interview schedule, intended to elicit information concerning mentally retarded or psychotic children, are described. A high level of reliability was achieved with experienced interviewers and good informants. In a study of 104 such children, the levels of overall agreement between parent and professional informants on the 62 sections of the schedule were, in general, 7O% or above. Agreement was better for rating absence of skills or behavioral abnormalities than for rating their presence. This tendency was particularly marked for the behavioral abnormalities. Parents, when compared with professional workers, tended to describe their children as having higher developmental skills, more social contact but also more repetitive and difficult behavior.
201 citations