Epidemiology of Pervasive Developmental Disorders

Department of Psychiatry, Montreal Children's Hospital of the McGill University Health Centre, Montreal, Quebec, Canada.
Pediatric Research (Impact Factor: 2.31). 03/2009; 65(6):591-8. DOI: 10.1203/PDR.0b013e31819e7203
Source: PubMed


This article reviews the results of 43 studies published since 1966 that provided estimates for the prevalence of pervasive developmental disorders (PDDs), including autistic disorder, Asperger disorder, PDD not otherwise specified, and childhood disintegrative disorder. The prevalence of autistic disorder has increased in recent surveys and current estimates of prevalence are around 20/10,000, whereas the prevalence for PDD not otherwise specified is around 30/10,000 in recent surveys. Prevalence of Asperger disorder is much lower than that for autistic disorder and childhood disintegrative disorder is a very rare disorder with a prevalence of about 2/100,000. Combined all together, recent studies that have examined the whole spectrum of PDDs have consistently provided estimates in the 60-70/10,000 range, making PDD one of the most frequent childhood neurodevelopmental disorders. The meaning of the increase in prevalence in recent decades is reviewed. There is evidence that the broadening of the concept, the expansion of diagnostic criteria, the development of services, and improved awareness of the condition have played a major role in explaining this increase, although it cannot be ruled out that other factors might have also contributed to that trend.

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Available from: Eric Fombonne, Apr 01, 2015
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    • "This sample differs from autism in the sighted by sex distribution and preponderant etiology. Whereas a world survey of children with ASD confirms its expected strong male preponderance (81 %) (Fombonne 2009), in this small sample, in which the major cause of blindness (53 %) was ROP, the sex difference between ASD Ever (67 % boys) and ASD Never (43 % boys) did not reach statistical significance. Lack of significant male preponderance (59 %) was also documented in 17 blind children with acquired ASD, congenital rubella (Chess 1977). "
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    ABSTRACT: Autism spectrum disorders affected 19 of 38 unselected children at a school for the blind in Cordoba, Argentina. Autism was linked to total congenital blindness, not blindness' etiology, acquired or incomplete blindness, sex, overt brain damage, or socioeconomic status. Autism "recovery," had occurred in 4 verbal children. Congenital blindness causes profoundly deviant sensory experience and massive reorganization of brain connectivity. Its ≥30 times greater prevalence than in sighted children suggests a distinct pathogenesis. Unawareness of autism's high prevalence in blind individuals includes blindness' rarity, misunderstanding of autism as "disease" rather than dimensional behavioral diagnosis, reluctance to diagnose it in blind children, and ignorance of its potentially more favorable outcome. Future investigation may suggest interventions to prevent or mitigate it.
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    • "The relevance of accurate diagnosis of autism has become greater than ever, particularly in view of the increasing prevalence [26], elevated costs for both family and society [27], and accepted importance of early identification and intervention in individuals with autism. The classification systems used strongly affect prevalence studies, and it is important to consider the changes that have occurred at this level when analyzing the possible causes of the increase in pervasive developmental disorders [28]. "
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    ABSTRACT: Symptoms of inattention and hyperactivity, features of attention-deficit/hyperactivity disorder (ADHD), have been frequently documented in children with autism spec‐ trum disorders (ASDs) and often co-occur. Evidence indicates that 20-50% of children with ADHD meet criteria for ASD, and 30-80% of ASD children meet criteria for ADHD. According to the DSM-IV, the essential features of Autistic Disorder (AD) are " the presence of markedly abnormal or impaired development in social interaction and communication and a markedly restricted repertoire of activity and interests ". Differ‐ ential diagnosis of " Pervasive Developmental Disorder " (PDD: Autistic Disorder, Re‐ tt's Disorder, Childhood Disintegrative Disorder, Asperger's Disorder) and " Pervasive Developmental Disorder-Not Otherwise Specified " (PDD-NOS) is often difficult in the preschool child. This is particularly true when assessing verbal and nonverbal com‐ munication since both expressive and cognitive language are not yet established and there are many differences in their acquisition period among these children (before the age of three). As a result, many of these children are diagnosed with PDD-NOS not meeting the criteria for a specific type of PDD; this category includes "atypical au‐ tism" presentations that do not meet the criteria for AD. As a result, the concept of PDD-NOS has become a mixed bag. Often, diagnosis cannot be established before age three, delaying therapeutic interventions. Moreover, differential diagnosis between ADHD and PDD-NOS can be especially difficult, mainly in infant and young chil‐ dren. However, and following the recommendations of the DSM-IV, the ASDs diag‐ nosis has been included among the exclusion criteria for the ADHD. Such exclusion has generated considerable controversy regarding the necessity and benefits of main‐ taining these separations. At present, a new edition of the DSM has been published: DSM-5® (Fifth Edition, 2013). Among the advantages that this new manual provides are: i) further categoriza‐ tion of the persons affected and ii) the possibility of diagnosis before the age of three. The DSM-5 takes into account that limitations in language are not specific to autism. The new diagnostic category " Social Communication Disorder " appears separate from ASD, which does not seek to create a new subcategory. In light of the new DSM-V criteria which allow a dual diagnosis of ASD and ADHD behaviors, in this chapter we will review the clinical overlap of these two conditions, particularly regarding their comorbidities in community pre-schoolers (generally categorized as PDD-NOS). We will also look into possible future research directions necessary to enhance our understanding of the etiology/genetics factors as well as the appropriate sequence of therapeutic interventions and pharmacological treatment (psychostimulant and nonstimulant medications) for the co-occurrence of these disor‐ ders.
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    • "Le TSA est associé à une incidence plus élevée pour certains problèmes de santé. Des études estiment que 40 % de ces personnes auraient une déficience intellectuelle associée (Baird, et al. 2006 ; Fombonne, 2009) et que 70 % présenteraient une comorbidité (Simonoff et al., 2008). Près de 30 % de ces individus souffriraient aussi d'épilepsie (Tuchman, Cuccaro, & Alessandri, 2010). "

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