Prevalence and Onset of Regression within Autism Spectrum Disorders: A Meta-analytic Review

Abstract

Rates and onset of regression were meta-analyzed from 85 articles representing 29,035 participants with autism spectrum disorders (ASD). Overall prevalence rate for regression was 32.1, 95 % CI [29.5, 34.8] occurring at mean of 1.78 years, 95 % CI [1.67, 1.89]. Regression prevalence rates differed according to four types of regression: language regression, 24.9 %; language/social regression, 38.1 %; mixed regression, 32.5 %; and unspecified regression, 39.1 %. Regression prevalence also differed according to sampling method: population-based prevalence was 21.8 %, clinic-based prevalence was 33.6 %, and parent survey-based prevalence was 40.8 %. Risk of regression was equal for males and females, but higher for individuals diagnosed with autism versus another ASD. Later age of regression onset was predicted by older age of child.

This is a preview of subscription content, log in to check access.

Fig. 1

References

  1. American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders, 4th edn., text revision Washington, DC; Author.

  2. Ashwood, P., Kwong, C., Hansen, R., Hertz-Picciotto, I., Croen, L., Krakowiak, P., et al. (2008). Brief report: Plasma leptin levels are elevated in autism: Association with early onset phenotype? Journal of Autism and Developmental Disorders, 38, 169–175.

    PubMed  Article  Google Scholar 

  3. Autism and Developmental Disabilities Monitoring Network 2006 Principal Investigators. (2009). Prevalence of autism spectrum disorders—Autism and developmental disabilities monitoring network, United States, 2006. Morbidity and Mortality Weekly Report, 58(SS-10). http://www.cdc.gov/mmwr/preview/mmwrhtml/ss5810a1.htm.

  4. Autism and Developmental Disabilities Monitoring Network Year 2000 Principal Investigators. (2007). Prevalence of autism spectrum disorders—Autism and developmental disabilities monitoring network, six sites, United States, 2000. Morbidity and Mortality Weekly Report, 56(SS-1). http://www.cdc.gov/mmwr/preview/mmwrhtml/ss5601a1.htm.

  5. Baird, G., Charman, T., Pickles, A., Chandler, S., Loucas, T., Meldrum, D., et al. (2008a). Regression, developmental trajectory and associated problems in disorders in the autism spectrum: The SNAP study. Journal of Autism and Developmental Disorders, 38, 1827–1836.

    PubMed  Article  Google Scholar 

  6. Baird, G., Pickles, A., Simonoff, E., Charman, T., Sullivan, P., Chandler, S., et al. (2008b). Measles vaccination and antibody response in autism spectrum disorders. Archives of Disability in Childhood, 93, 832–837.

    Article  Google Scholar 

  7. Bernabei, P., Cerquiglini, A., Cortesi, F., & D’Ardia, C. (2007). Regression versus no regression in autistic disorder: Developmental trajectories. Journal of Autism and Developmental Disorders, 37, 580–588.

    PubMed  Article  Google Scholar 

  8. Borenstein, M., Hedges, L., Higgins, J., & Rothstein H. (2005). Comprehensive meta-analysis version 2. [Computer software]. Engelwood, NJ: Biostat.

  9. Cicchetti, D. V. (1994). Guidelines, criteria, and rules of thumb for evaluating normed and standardized assessment instruments in psychology. Psychological Assessment, 6, 284–290.

    Article  Google Scholar 

  10. Creak, M. (1963). Childhood psychosis: A review of 100 cases. British Journal of Psychiatry, 109, 84–89.

    PubMed  Article  Google Scholar 

  11. Davidovitch, M., Glick, L., Holtzman, G., Tirosh, E., & Safir, M. P. (2000). Developmental regression in autism: Maternal perception. Journal of Autism and Developmental Disorders, 30, 113–119.

    PubMed  Article  Google Scholar 

  12. De Giacomo, A., & Fombonne, E. (1998). Parental recognition of developmental abnormalities in autism. European Child and Adolescent Psychiatry, 7, 131–136.

    PubMed  Article  Google Scholar 

  13. First, M. B. (2008). Report from the autism and other pervasive developmental disorders conference, February 3–5, 2008. http://www.dsm5.org/Research/Pages/AutismandOtherPervasiveDevelopmentalDisordersConference%28February3-5,2008%29.aspx.

  14. Fombonne, E., & Chakrabarti, S. (2001). No evidence for a new variant of measles-mumps-rubella-induced autism. Pediatrics, 108, e58.

    PubMed  Article  Google Scholar 

  15. Fombonne, E., Heavey, L., Smeeth, L. Rodrigues, L., Cook, C., Smith, P., et al. (2004). Validation of the diagnosis of autism in general practitioner records. BMC Public Health, 4, 5. Retrieved from: http://www.biomedcentral.com/1471-2458/4/5.

  16. Goldberg, W. A., Osann, K., Filipek, P. A., Laulhere, T., Jarvis, K., Modahl, C., et al. (2003). Language and other regression: Assessment and timing. Journal of Autism and Developmental Disorders, 33, 607–616.

    PubMed  Article  Google Scholar 

  17. Hansen, R. L., Ozonoff, S., Krakowiak, P., Angkustsiri, K., Jones, C., Deprey, L. J., et al. (2008). Regression in autism: Prevalence and associated factors in the CHARGE study. Ambulatory Pediatrics, 8, 25–31.

    PubMed  Article  Google Scholar 

  18. Hoshino, Y., Kaneko, M., Yashima, Y., Kumashiro, H., Volkmar, F. R., & Cohen, D. J. (1987). Clinical features of autistic children with setback course in their infancy. The Japanese Journal of Psychiatry and Neurology, 41, 237–246.

    PubMed  Google Scholar 

  19. Hozo, S. P., Djulbegovic, B., & Hozo, I. (2005). Estimating the mean and variance from the median, range, and the size of a sample. BMC Medical Research Methodology, 5, 13. doi: 10.1186/1471-2288-5-13. Retrieved from: http://www.biomedcentral.com/147-22885/13.

  20. Jones, L. A., & Campbell, J. M. (2010). Clinical characteristics associated with language regression for children with autism spectrum disorders. Journal of Autism and Developmental Disorders, 40, 54–62.

    PubMed  Article  Google Scholar 

  21. Kobayashi, R., & Murata, T. (1998). Setback phenomenon in autism and long-term prognosis. Acta Psychiatrica Scandinavica, 98, 296–303.

    PubMed  Article  Google Scholar 

  22. Kurita, H. (1985). Infantile autism with speech loss before the age of thirty months. Journal of the American Academy of Child Psychiatry, 24, 191–196.

    PubMed  Article  Google Scholar 

  23. Lainhart, J. E., Ozonoff, S., Coon, H., Krasny, L., Dinh, E., Nice, J., et al. (2002). Autism, regression and the broader autism phenotype. American Journal of Medical Genetics, 113, 231–237.

    PubMed  Article  Google Scholar 

  24. Lipsey, M. W., & Wilson, D. B. (2001). Practical meta-analysis. Thousand Oaks, CA: Sage.

    Google Scholar 

  25. Lord, C., Shulman, C., & DiLavore, P. (2004). Regression and word loss in autistic spectrum disorders. Journal of Child Psychology and Psychiatry, 45, 936–955.

    PubMed  Article  Google Scholar 

  26. Luyster, R., Richler, J., Risi, S., Hsu, W. L., Dawson, G., Bernier, R., et al. (2005). Early regression in social communication in autism spectrum disorders: A CPEA study. Developmental Neuropsychology, 27, 311–336.

    PubMed  Article  Google Scholar 

  27. Maestro, S., Muratori, F., Cesari, A., Pecini, C., Apicella, F., & Stern, D. A. (2006). A view to regressive autism through home movies. Is early development really normal? Acta Psychiatrica Scandinavica, 113, 68–72.

    PubMed  Article  Google Scholar 

  28. Matson, J. L., & Kozlowski, A. M. (2010). Autistic regression. Research in Autism Spectrum Disorders, 4, 340–345.

    Article  Google Scholar 

  29. Meilleur, A. S., & Fombonne, E. (2009). Regression of language and non-language skills in pervasive developmental disorders. Journal of Intellectual Disability Research, 52, 115–124.

    Article  Google Scholar 

  30. Moher, D., Liberati, A., Tetzlaff, J., Altman, D. G., & The PRISMA Group. (2009). Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. PLoS Med, 6, e1000097. doi:10.1371/journal.pmed.1000097.

    PubMed  Article  Google Scholar 

  31. Molloy, C. A., Keddache, M., & Martin, L. J. (2005). Evidence for linkage on 21q and 7q in a subset of autism characterized by developmental regression. Molecular Psychiatry, 10, 741–746.

    PubMed  Article  Google Scholar 

  32. Ozonoff, S., Heung, K., Byrd, R., Hansen, R., & Hertz-Picciotto, I. (2008). The onset of autism: Patterns of symptom emergence in the first years of life. Autism Research, 1, 320–328.

    PubMed  Article  Google Scholar 

  33. Ozonoff, S., Iosif, A., Baguio, F., Cook, I. C., Hill, M. M., Hutman, T., et al. (2010). A prospective study of the emergence of early behavioral signs of autism. Journal of the American Academy of Child and Adolescent Psychiatry, 49, 256–266.

    PubMed  Google Scholar 

  34. Plioplys, A. (1998). Intravenous immunoglobin treatment of children with autism. Journal of Child Neurology, 13, 79–82.

    PubMed  Article  Google Scholar 

  35. Rapin, I. (2006). Language heterogeneity and regression in the autism spectrum disorders—Overlaps with other language regression syndromes. Clinical Neuroscience Research, 6, 209–218.

    Article  Google Scholar 

  36. Richler, J., Luyster, R., Risi, S., Hsu, W. L., Dawson, G., Bernier, R., et al. (2006). Is there a ‘regressive phenotype’ of autism spectrum disorder associated with the measles-mumps-rubella vaccine? A CPEA study. Journal of Autism and Developmental Disorders, 36(3), 299–316.

    PubMed  Article  Google Scholar 

  37. Rogers, S. J. (2004). Developmental regression in autism spectrum disorders. Mental Retardation and Developmental Disabilities, 10, 139–143.

    Article  Google Scholar 

  38. Shattuck, P. T., Durkin, M., Maenner, M., Newschaffer, C., Mandell, D. S., Wiggins, L., et al. (2009). Timing and identification among children with an autism spectrum disorder: Findings from a population-based surveillance study. Journal of the American Academy of Child and Adolescent Psychiatry, 48, 474–483.

    PubMed  Article  Google Scholar 

  39. Siperstein, R., & Volkmar, F. (2004). Brief report: Parental reporting of regression in children with pervasive developmental disorders. Journal of Autism and Developmental Disorders, 34, 731–734.

    PubMed  Article  Google Scholar 

  40. Stefanatos, G. A. (2008). Regression in autistic spectrum disorders. Neuropsychology Review, 18, 305–319.

    PubMed  Article  Google Scholar 

  41. Taylor, B., Miller, E., Lingam, R., Andrews, N., Simmons, A., & Stowe, J. (2002). Measles, mumps, and rubella vaccination and bowel problems or developmental regression in children with autism: Population study. British Medical Journal, 324, 393–396.

    PubMed  Article  Google Scholar 

  42. Tuchman, R. F., & Rapin, I. (1997). Regression in pervasive developmental disorders: Seizures and epileptiform electroencephalogram correlates. Pediatrics, 99, 560–566.

    PubMed  Article  Google Scholar 

  43. Wakefield, A. J., Murch, S. H., Anthony, A., Linnell, J., Casson, D. M., Malik, M., et al. (1998). Ileal-lymphoid-nodular hyperplasia, nonspecific colitis, and pervasive developmental disorder in children. Lancet, 351, 637–641.

    PubMed  Article  Google Scholar 

  44. Webb, S. J., Nalty, T., Munson, J., Brock, R., Abbott, R., & Dawson, G. (2007). Rate of head circumference growth as a function of autism diagnosis and history of autistic regression. Journal of Child Neurology, 22, 1182–1190.

    PubMed  Article  Google Scholar 

  45. Werner, E., & Dawson, G. (2005). Validation of the phenomenon of autistic regression using home videotapes. Archives of General Psychiatry, 62, 889–895.

    PubMed  Article  Google Scholar 

  46. Werner, E., Dawson, G., Munson, G., & Osterling, J. (2005). Variation in early developmental course in autism and its relation with behavioral outcome at 3–4 years of age. Journal of Autism and Developmental Disorders, 35, 337–350.

    PubMed  Article  Google Scholar 

  47. Wiggins, L. D., Rice, C. E., & Baio, J. (2009). Developmental regression in children with an autism spectrum disorder identified by a population-based surveillance system. Autism, 13, 357–374.

    PubMed  Article  Google Scholar 

  48. Wolff, S., & Chess, S. (1964). A behavioral study of schizophrenic children. Acta Psychiatrica Scandinavica, 40, 438–466.

    PubMed  Article  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to Jonathan M. Campbell.

Additional information

Authorship determined by alphabetical order. Brian D. Barger and Jonathan M. Campbell have contributed equally to all aspects of the study.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOC 52 kb)

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Barger, B.D., Campbell, J.M. & McDonough, J.D. Prevalence and Onset of Regression within Autism Spectrum Disorders: A Meta-analytic Review. J Autism Dev Disord 43, 817–828 (2013). https://doi.org/10.1007/s10803-012-1621-x

Download citation

Keywords

  • Autism spectrum disorders
  • Regression
  • Meta-analysis