The epidemiology of autism: a review

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<jats:p><jats:bold>Background.</jats:bold> There is some uncertainty about the rate and correlates of autism.</jats:p><jats:p><jats:bold>Method.</jats:bold> Twenty-three epidemiological surveys of autism published in the English language between 1966 and 1998 were reviewed.</jats:p><jats:p><jats:bold>Results.</jats:bold> Over 4 million subjects were surveyed; 1533 subjects with autism were identified. The methodological characteristics of each study are summarized, including case definition, case-finding procedures, participation rates and precision achieved. Across surveys, the median prevalence estimate was 5·2/10000. Half the surveys had 95% confidence intervals consistent with population estimates of 5·4–5·5/10000. Prevalence rates significantly increased with publication year, reflecting changes in case definition and improved recognition; the median rate was 7·2/10000 for 11 surveys conducted since 1989. The average male/female ratio was 3·8[ratio ]1, varying according to the absence or presence of mental retardation. Intellectual functioning within the normal range was reported in about 20% of subjects. On average, medical conditions of potential causal significance were found in 6% of subjects with autism, with tuberous sclerosis having a consistently strong association with autism. Social class and immigrant status did not appear to be associated with autism. There was no evidence for a secular increase in the incidence of autism. In eight surveys, rates for other forms of pervasive developmental disorders were two to three times higher than the rate for autism.</jats:p><jats:p><jats:bold>Conclusion.</jats:bold> Based on recent surveys, a minimum estimate of 18·7/10000 for all forms of pervasive developmental disorders was derived, which outlines the needs in special services for a large group of children.</jats:p>

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