Secular changes in the symptom level of clinically diagnosed autism
Secular changes in the symptom level of clinically diagnosed autism
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DOI：
10.1111/jcpp.12864
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发表时间：
2018-07-01
影响因子：
7.6
通讯作者：
Lundstrom, Sebastian
中科院分区：
文献类型：
--
作者：
Arvidsson, Olof;Gillberg, Christopher;Lundstrom, Sebastian
背景：据报道，自闭症的患病率在世界范围内有所增加。随着时间的推移，临床自闭症诊断所需的自闭症症状数量减少，这在一定程度上有助于解释这种增加。这项研究旨在确定13岁以下临床诊断的自闭症病例的症状水平是否随时间而变化。研究方法：瑞典9岁双胞胎（n = 28，118）的父母参加了一项电话调查，其中在10年的时间内评估了他们孩子与神经发育障碍[包括自闭症，但也包括注意力缺陷/多动障碍（ADHD），发育协调障碍（DCD）和学习障碍（LD）]相关的症状和功能障碍/痛苦。调查数据与包含临床登记的自闭症诊断的国家患者登记册（n = 271）合并。结果如下：在13岁之前被临床诊断为自闭症的个体中，在1992-2002年的出生队列中，自闭症的症状评分平均下降了30%。从2004年到2014年，在7-12岁被诊断患有自闭症的人中，自闭症症状评分平均下降了50%，但在0-6岁被诊断出的人中没有下降。结论：随着时间的推移，自闭症的临床诊断似乎需要相当少的自闭症症状，至少对于那些在学龄前几年后被诊断出来的人来说。这些发现进一步支持了这样一种观点，即观察到的自闭症诊断的增加至少部分是临床实践变化的副产品，并强调了与最佳实践指南达成一致的必要性。
Background: The prevalence of autism has been reported to have increased worldwide. A decrease over time in the number of autism symptoms required for a clinical autism diagnosis would partly help explain this increase. This study aimed to determine whether the symptom level of clinically diagnosed autism cases below age 13 had changed over time. Methods: Parents of Swedish 9-year old twins (n = 28,118) participated in a telephone survey, in which symptoms and dysfunction/suffering related to neurodevelopmental disorders [including autism, but also attentiondeficit/ hyperactivity disorder (ADHD), Developmental Coordination Disorder (DCD), and Learning Disabilities (LD)] in their children were assessed over a 10-year period. Survey data was merged with the National Patient Register containing clinically registered autism diagnoses (n = 271). Results: In individuals who had been clinically diagnosed with autism before the age of 13, the symptom score for autism decreased on average 30% over more than a decade in birth cohorts 1992-2002. There was an average decrease of 50% in the autism symptom score from 2004 to 2014 in individuals who were diagnosed with autism at ages 7-12, but there was no decrease in those diagnosed at ages 0-6. Conclusions: Over time, considerably fewer autism symptoms seemed to be required for a clinical diagnosis of autism, at least for those diagnosed after the preschool years. The findings add support for the notion that the observed increase in autism diagnoses is, at least partly, the by-product of changes in clinical practice, and flag up the need for working in agreement with best practice guidelines.