European Child & Adolescent Psychiatry

, Volume 2, Issue 1, pp 61–74 | Cite as

The definition and prevalence of autism: A review

  • Lorna Wing
Article

Abstract

Sixteen studies of the prevalence of autism in childhood, using epidemiological methods in defined populations in Europe, the USA and Japan, in English or with English summaries, were found in the published literature. Age specific rates varied from 3.3 to 16.0 per 10,000. Eight studies gave rates for a sub-group of ‘typical’ autism varying from 1.2 to 8.4. Reasons for variations were sought by examining geographic and demographic details of the populations screened, methods for initial screening and final examination of possibly autistic children, demographic and clinical details of children identified as autistic, and criteria used for diagnosis. There was evidence, independent of diagnostic criteria, of a higher prevalence among children of first generation immigrants to Europe from ‘exotic’ countries. Apart from this, all differences could be due to variations in diagnostic practice and increasing awareness of the manifestations of autistic conditions throughout the range of intelligence, from severely retarded to average and above. However, it remains possible, though not proven, that rates do vary over place and/or time. The problems of defining a sub-group with ‘typical’ autism among the wide spectrum of children with the triad of impairments of social interaction, communication and imagination are discussed and the value of such a sub-grouping questioned.

Résumé

16 études de prévalence de l'autisme dans l'enfance faisant appel à des méthodes épidémiologiques sur populations définies en Europe, aux U.S.A., Canada et au Japon, en anglais ou avec des résumés anglais ont été relevées dans la littérature publiée. Les taux varient de 3.3 à 16.0 pour 10.000. 8 études donnent des taux pour un sous-groupe d'autisme typique de 1.2 à 8.4. Les raisons de ces variations ont été recherchées en examinant les données geographiques et démographiques de la population concernée, les méthodes de repérage initial et d'examen final des enfants possiblement autistes, les données démographiques et cliniques des enfants identifiés comme autistes, et les critères utilisés pour le diagnostic. Il y avait à l'évidence, indépendamment des critères diagnostiques, une prévalence plus élevée parmi les enfants de première génération émigrant en Europe depuis des pays “exotiques”. A part cela toutes les différences pouvaient être dues aux variations dans la pratique diagnostique et la prise de conscience croissante des manifestations des conditions autistiques au travers des écarts d'intelligence, depuis les formes sévèrement retardées jusqu'à la moyenne et au-dessus. Cependant, il reste possible, bien que non prouvé, que les taux varient selon les lieux et l'époche. Les problèmes de définition d'un sous-groupe avec autisme typique parmi le spectre large des enfants avec la triade de défauts d'interaction sociale, de communication et d'imagination sont discutés ainsi que la valeur d'un tel sous-groupe.

Zusammenfassung

In der englischsprachigen Fachliteratur (mindestens die Zusammenfassung in englischer Sprache) fanden sich 16 Prävalenzstudien zum Autismus im Kindesalter unter Anwendung von epidemiologischen Methoden in definierten Bevölkerungsstichproben aus Europa, USA, Kanada und Japan; die altersspezifischen Raten variierten zwischen 3,3 und 16,0/10.000. Acht Studien gaben Raten für “typischen” Autismus an: 1,2 bis 8,4/10.000. Nach Ursachen für die unterschiedlichen Prävalenzangaben wurden kritisch gesucht unter Prüfung der geographischen und demographischen Details der gescreenten Bevölkerungsstichproben, der Methoden des initialen Screenings und der endgültigen Untersuchung von möglicherweise autistischen Kindern, der demographischen und klinischen Details von Kindern, die aus autistisch identifiziert wurden, und der diagnostischen Kriterien. Es fanden sichunabhängig von diagnostischen Kriterien. Es fanden sichunabhängig von diagnostischen Kriterien-Hinweise für eine höhere Prävalenz unter Kindern von Eltern, die aus “exotischen” Ländern nach Europa eingewandert waren. Hiervon abgesehen, könnten alle Prävalenzunterschiede auf verschiedenen diagnostischen Vorgehensweisen und einem erhöhten Bewußtsein für die Manifestationen autistischer Störungen über die gesamte IQ-Verteilung (von schwer geistig behindert bis durchschnittlich bzw. überdurchschnittlich) beruhen. Es ist jedoch möglich, obgleich bislang nicht bewiesen, daß die Raten von der Zeit bzw. dem Ort abhängen. Die Probleme, die sich aus der Definition der Untergruppe “typischer Autismus” ergeben, werden diskutiert angesichts eines weiten Spektrums von Kindern mit Beeinträchtigungen der sozialen Interaktion, der Kommunikation und der Phantasie. Der Sinn dieser Untergruppenbildung wird in Frage gestellt.

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References

  1. American Psychiatric Association (1980).Diagnostic and Statistical Manual of Mental Disorders (3rd ed.); Washington: APAGoogle Scholar
  2. American Psychiatric Association (1987).Diagnostic and Statistical Manual of Mental Disorders (3rd ed., revised). Washington: APA.Google Scholar
  3. Asperger, H. (1944). Die autistischen Psychopathen im Kindesalter.Archiv für Psychiatrie und Nervenkrankheiten, 17, 76–136.CrossRefGoogle Scholar
  4. Aussilloux, Ch., Collery, F. & Roy, J. (1989). Épidémiologie de l'autisme infantile dans le département de l'Hérault.Revue Française de Psychiatrie, 7, 24–28.Google Scholar
  5. Bohman, M., Bohman, I., Björck, P. & Sjöholm, E. (1983): Childhood psychosis in a northern Swedish county: some preliminary findings from an epidemiological survey. In M. Schmidt and H. Remschmidt (Eds.),Epidemiological Approaches in Child Psychiatry II (pp. 164–173). New York: Thieme-Stratton.Google Scholar
  6. Brask, B. H. (1972). A prevalence investigation of childhood psychoses. InNordic Symposium on the Comprehensive Care of the Psychotic Children (pp. 145–153). Oslo: Barnepsykiatrist Forening.Google Scholar
  7. Bryson, S. E., Clark, B. S. & Smith, I. M. (1988). First report of a Canadian epidemiological study of autistic syndromes.Journal of Child Psychology and Psychiatry, 29, 433–446.PubMedCrossRefGoogle Scholar
  8. Burd, L., Fisher, W. & Kerbeshian, J. (1987). A prevalance study of pervasive developmental disorders in North Dakota.Journal of the American Academy of Child and Adolescent Psychiatry, 26, 704–710.PubMedCrossRefGoogle Scholar
  9. Cialdella, P. & Mamelle, N. (1989). An epidemiological study of infantile autism in a French Department (Rhône): A research note.Journal of Child Psychology and Psychiatry, 30, 165–176.PubMedCrossRefGoogle Scholar
  10. Denckla, M. B. (1986). Editorial: New diagnostic criteria for autism and related behaviour disorders: Guidelines for research protocols.Journal of the American Academy of Child and Adolescent Psychiatry, 25, 221–224.CrossRefGoogle Scholar
  11. Frith, U. (Ed.). (1991).Autism and Asperger Syndrome. Cambridge: Cambridge University Press.Google Scholar
  12. Fombonne, E. & du Mazaubran, C. (1992). Prevalence of infantile autism in four French regions.Social Psychiatry and Psychiatric Epidemiology, 27, 203–209.PubMedCrossRefGoogle Scholar
  13. Gillberg, C. (1984). Infantile autism and other childhood psychoses in a Swedish urban region: Epidemiological aspects.Journal of Child Psychology and Psychiatry, 25, 35–43.PubMedCrossRefGoogle Scholar
  14. Gillberg, C. (1992). The Emmanuel Miller Memorial Lecture 1991. Autism and autistic-like conditions; Subclasses among disorders of empathy.Journal of Child Psychology and Psychiatry, 33, 813–842.PubMedCrossRefGoogle Scholar
  15. Gillberg, I. & Gillberg, C. (1989). Asperger syndrome: Some epidemiological considerations.Journal of Child Psychology and Psychiatry, 30, 631–638.PubMedCrossRefGoogle Scholar
  16. Gillberg, C., Persson, E., Grufman, M. & Themner, U. (1986). Psychiatric disorders in mildly and severely mentally retarded urban children and adolescents: Epidemiological aspects.British Journal of Psychiatry, 149, 68–74.PubMedCrossRefGoogle Scholar
  17. Gillberg, C. & Schaumann, H. (1982). Social class and infantile autism.Journal of Autism and Developmental Disorders, 12, 223–228.PubMedCrossRefGoogle Scholar
  18. Gillberg, C., Steffenburg, S., Börjesson, B. & Andersson, L. (1987). Infantile autism in children of immigrant parents: A population-based study from Göteborg, Sweden.British Journal of Psychiatry, 150, 856–857.PubMedCrossRefGoogle Scholar
  19. Gillberg, C., Steffenburg, S. & Schaumann, H. (1991). Is autism more common now than ten years ago?British Journal of Psychiatry, 158, 403–409.PubMedCrossRefGoogle Scholar
  20. Haga, H. & Miyamoyo, Y. (1971). A survey on the actual state of so-called autistic children in Kyoto prefecture.Japanese Journal of Child Psychiatry, 12, 160–167.Google Scholar
  21. Hoshino, Y., Yashima, Y., Ishige, K., Tachibana, R., Watanabe, M., Kancko, M., Kumashiro, H., Ueno, B., Takahashi, E. & Furukawa, H. (1982). The epidemiological study of autism in FukushimaKen.Folia Psychiatrica et Neurologica Japonica 36, 115–124.PubMedGoogle Scholar
  22. Ishii, T. & Takahashi, O. (1983). The epidemiology of autistic children in Toyota, Japan: Prevalence.Japanese Journal of Child and Adolescent Psychiatry, 24, 311–321.Google Scholar
  23. Kanner, L. (1943). Autistic disturbances of affective contact.Nervous Child, 2, 217–250.Google Scholar
  24. Kanner, L. (1973).Childhood Psychosis: Initial Studies and New Insights. New York: Winston/Wiley.Google Scholar
  25. Kanner, L. & Eisenberg, L. (1956). Early infantile autism 1943–1955.American Journal of Orthopsychiatry, 26, 55–65.Google Scholar
  26. Lane, H. (1977).The Wild Boy of Aveyron. London: Allen and Unwin.Google Scholar
  27. Lotter, V. (1966). Epidemiology of autistic conditions in young children: I. Prevalence.Social Psychiatry, 1, 124–137.CrossRefGoogle Scholar
  28. Lotter, V. (1967a): Epidemiology of autistic conditions in young children: II. Some characteristics of the parents and children.Social Psychiatry, 1, 163–173.CrossRefGoogle Scholar
  29. Lotter, V. (1967b).The prevalence of the autistic syndromes in children. Unpublished PhD thesis, University of London.Google Scholar
  30. McCarthy, P., Fitzgerald, M., and Smith, M. (1984). Prevalence of childhood autism in Ireland.Irish Medical Journal, 77, 129–130.PubMedGoogle Scholar
  31. Matsuishi, T., Shiotsuki, Y., Yoshimura, K., Shoji, H., Imuta, F. & Yamashita, F. (1987). High prevalence of infantile autism in Kurume City, Japan.Journal of Child Neurology, 2, 268–271.PubMedCrossRefGoogle Scholar
  32. Mises, R. (1990). Classification Française des troubles mentaux de l'enfant et de l'adolescent.Neuropsychiatrie de l'Enfance, 38, 523–539.Google Scholar
  33. Nakai, M. (1971). Epideniology of autistic children in Gifu-ken.Japanese Journal of Child Psychiatry, 12, 262–266.Google Scholar
  34. Ritvo, E. R., Freeman, B. J., Pingree, C., Mason-Brothers, A., Jorde, L., Jenson, W. R., McMahon, W. M., Peterson, P. B., Mo, A. & Ritvo, A. (1989). The UCLA-University of Utah epidemiological study of autism: Prevalence.American Journal of Psychiatry, 146, 194–245.PubMedGoogle Scholar
  35. Rutter, M. (1970). Autistic children: Infancy to adulthood.Seminars in Psychiatry, 2, 435–450.PubMedGoogle Scholar
  36. Rutter, M. (1978). Diagnosis and definition. In M. Rutter & E. Schopler (Eds.),Autism: A Reappraisal of Concepts and Treatment (pp. 1–25). New York: Plenum Press.Google Scholar
  37. Steffenburg, S. & Gillberg, C. (1986). Autism and autisticlike conditions in Swedish rural and urban areas: A population study.British Journal of Psychiatry, 149, 81–87.PubMedCrossRefGoogle Scholar
  38. Steinhausen, H., Göbel, D., Breinlinger, M. & Wohlleben, B. (1986). A community survey of infantile autism.Journal of the American Academy of Child Psychiatry, 25, 189–189.Google Scholar
  39. Sugiyama, T. & Abe, T. (1989) The prevalence of autism in Nagoya, Japan: A total population study.Journal of Autism and Developmental Disorders, 19, 87–96.PubMedCrossRefGoogle Scholar
  40. Tanino, Y. (1971). An investigation into infantile autism and autistic children in Toyama prefecture.Japanese Journal of Child Psychiatry, 12, 150–159.Google Scholar
  41. Tanoue, Y., Oda, S., Asano, F. & Kawashima, K. (1988). Epidemiology of infantile autism in the Southern Ibaraki, Japan.Journal of Autism and Developmental Disorders, 18, 155–167.PubMedCrossRefGoogle Scholar
  42. Treffert, D. A. (1970). Epidemiology of infantile autism.Archives of General Psychiatry, 22, 431–438.PubMedGoogle Scholar
  43. Wing, L. (1979). Mentally retarded children in Camberwell (London). In H. Hafner (Ed.),Estimating Needs for Mental Health Care (pp. 107–112). Berlin: Springer Verlag.Google Scholar
  44. Wing, L. (1980). Childhood autism and social class: A question of selection.British Journal of Psychiatry, 137, 410–417.PubMedCrossRefGoogle Scholar
  45. Wing, L. (1981a). Asperger's syndrome: A clinical account.Psychological Medicine, 11, 115–130.PubMedCrossRefGoogle Scholar
  46. Wing, L. (1981b). Sex ratios in early childhood autism and related conditions.Psychiatry Research, 5, 129–137.PubMedCrossRefGoogle Scholar
  47. Wing, L. (1988). The continuum of autistic disorders. In E. Schopler & G. M. Mesibov (Eds.)Diagnosis and Assessment in Autism (pp. 91–110). New York: Plenum.Google Scholar
  48. Wing, L. & Gould, J. (1979). Severe impairments of social interaction and associated abnormalities in children: Epidemiology and classification.Journal of Autism and Childhood Schizophrenia, 9, 11–29.CrossRefGoogle Scholar
  49. Yamazaki, K., Yamashita, I., Suwa, N., Kuroda, T., Iwabuchi, J., Imamura, S., Miyamoto, M., Fujino, T., Ito, N. & Sugaya, K. (1971). Survey on the morbidity rate of “autistic children” in the Hokkaido district.Japanese Journal of Child Psychiatry, 12, 141–149.CrossRefGoogle Scholar

Copyright information

© Hogrefe & Huber Publishers 1993

Authors and Affiliations

  • Lorna Wing
    • 1
  1. 1.The Centre for Social and Communication DisordersBromleyUK

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