Trends in Autism Spectrum Disorder Diagnoses: 1994–2007
We analyzed predictors of parent-reported initial diagnosis (autistic disorder [AD], pervasive developmental disorder-not otherwise specified [PDD-NOS], pervasive developmental disorder [‘PDD’] and autism spectrum disorder [‘ASD’], and Asperger syndrome [AS]), among 6,176 individuals with autism spectrum disorders diagnosed from 1994 through 2007. Overall, distribution of diagnoses was influenced by a secular time trend factor; other significant factors included ethnicity, white race, geographic location, urbanicity, and initial evaluator. Since 2001, most initial diagnoses of AD and AS have remained steady while ‘PDD’ and PDD-NOS have decreased. ‘ASD’ diagnoses have increased, especially among school-based teams; AS diagnoses also increased uniquely among these evaluators. Findings from this study suggest that current diagnostic guidelines may not be meeting all community evaluator needs.
KeywordsAutism Asperger syndrome Pervasive developmental disorder Health disparity Classification
This study was supported by Autism Speaks. The funder had no role in determining content. We thank Ms Teresa Foden for proofreading assistance. We gratefully acknowledge the contributions of IAN families without which this research would not be possible.
- American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders: DSM-IV Washington. DC: American Psychiatric Association.Google Scholar
- American Psychiatric Association. (2000). Disorders usually first diagnosed in infancy, childhood, or adolescence. Diagnostic and statistical manual of mental disorders, fourth edition, text revision (DSM-IV-TR) (Fourth, Text Revision ed.,). Arlington, VA: American Psychiatric Association. doi: 10.1176/appi.books.9780890423349.
- Bitsika, V., Sharpley, C. F., Orapeleng, S. (2008). An exploratory analysis of the use of cognitive, adaptive and behavioural indices for cluster analysis of ASD subgroups. Journal of Intellectual Disability Research: JIDR, 52(11 Special Issue: Mental Health and Intellectual Disability: XXIV), 973–985.Google Scholar
- Cath, D. C., Ran, N., Smit, J. H., van Balkom, A. J., & Comijs, H. C. (2008). Symptom overlap between autism spectrum disorder, generalized social anxiety disorder and obsessive-compulsive disorder in adults: A preliminary case-controlled study. Psychopathology, 41(2), 101–110. doi: 10.1159/000111555.PubMedCrossRefGoogle Scholar
- Charman, T., Taylor, E., Drew, A., Cockerill, H., Brown, J. A., & Baird, G. (2005). Outcome at 7 years of children diagnosed with autism at age 2: Predictive validity of assessments conducted at 2 and 3 years of age and pattern of symptom change over time. Journal of Child Psychology and Psychiatry and Allied Disciplines, 46(5), 500–513. doi: 10.1111/j.1469-7610.2004.00377.x.CrossRefGoogle Scholar
- Filipek, P. A., Accardo, P. J., Ashwal, S., Baranek, G. T., Cook, E. H., Jr, Dawson, G., et al. (2000). Practice parameter: Screening and diagnosis of autism: Report of the quality standards subcommittee of the American academy of neurology and the child neurology society. Neurology, 55(4), 468–479.PubMedGoogle Scholar
- Fombonne, E. (2005). Epidemiologic studies of pervasive developmental disorders. In F. Volkmar, R. Paul, A. Klin, & D. J. Cohen (Eds.), Handbook of autism and pervasive developmental disorders, diagnosis, development, neurobiology, and behavior (3rd ed., pp. 42–69). New York: Wiley.Google Scholar
- Kanner, L. (1943). Autistic disturbances of affective contact. Nervous Child, 2, 217–250.Google Scholar
- Klin, A., Lang, J., Cicchetti, D. V., & Volkmar, F. R. (2000). Brief report: Interrater reliability of clinical diagnosis and DSM-IV criteria for autistic disorder: Results of the DSM-IV autism field trial. Journal of Autism and Developmental Disorders, 30(2), 163–167. doi: 10.1023/A:1005415823867.PubMedCrossRefGoogle Scholar
- Mahoney, W. J., Szatmari, P., MacLean, J. E., Bryson, S. E., Bartolucci, G., Walter, S. D., et al. (1998). Reliability and accuracy of differentiating pervasive developmental disorder subtypes. Journal of the American Academy of Child and Adolescent Psychiatry, 37(3), 278–285. doi: 10.1097/00004583-199803000-00012.PubMedCrossRefGoogle Scholar
- National Research Council Committee on Educational Interventions for Children with Autism. (2001). Educating children with autism. Washington, DC: National Academy Press.Google Scholar
- University of Washington. (2008). RHRC rural urban commuting area codes. Retrieved 12/12/2008, from http://depts.washington.edu/uwruca/download2006.html.
- Walker, D. R., Thompson, A., Zwaigenbaum, L., Goldberg, J., Bryson, S. E., Mahoney, W. J., et al. (2004). Specifying PDD-NOS: A comparison of PDD-NOS, asperger syndrome, and autism. Journal of the American Academy of Child and Adolescent Psychiatry, 43(2), 172–180. doi: 10.1097/00004583-200402000-00012.PubMedCrossRefGoogle Scholar
- World Health Organization. (1992). International classification of diseases—10, (http://www.who.int/classifications/apps/icd/icd10online/ed.), Geneva.
- Zhao, X., Leotta, A., Kustanovich, V., Lajonchere, C., Geschwind, D. H., Law, K., et al. (2007). A unified genetic theory for sporadic and inherited autism. Proceedings of the National Academy of Sciences of the United States of America, 104(31), 12831–12836. doi: 10.1073/pnas.0705803104.PubMedCrossRefGoogle Scholar