Autism Spectrum Disorder (ASD) is more common than previously believed. ASD is increasingly diagnosed at very young ages. We report estimated ASD prevalence rates from a population study of 2-year-old children conducted in 2010 in Gothenburg, Sweden. Screening for ASD had been introduced at all child health centers at child age 21/2 years. All children with suspected ASD were referred for evaluation to one center, serving the whole city of Gothenburg. The prevalence for all 2-year-olds referred in 2010 and diagnosed with ASD was 0.80%. Corresponding rates for 2-year-olds referred to the center in 2000 and 2005 (when no population screening occurred) were 0.18 and 0.04%. Results suggest that early screening contributes to a large increase in diagnosed ASD cases.
Autism spectrum disorders (ASDs) are among the most common of the severe developmental disabilities, yet little is known about older adults with ASDs—in particular, how the disabilities and dependencies that result from aging interact with those resulting from ASDs. The aging of the population in Western countries, the increasing rate of diagnosis of ASDs, and the burgeoning use of services for ASDs are converging to create a large, growing influx of older adults with ASDs that could impose tremendous humanistic and economic burdens on the healthcare system and society. An understanding of the epidemiological, biological, psychological, and social aspects of ASDs in older adults is essential for preparing to meet their needs, but studies on ASDs in these individuals are practically nonexistent. This article outlines observations and recommendations of a multidisciplinary expert group convened in March 2010 to characterize gaps in knowledge regarding ASDs in older adults and defines research directions to help individuals, the healthcare system, and society prepare for meeting the needs of this population. The proposed research agenda could help improve the lives of older adults with ASDs and inform research and clinical practice involving younger individuals with ASDs.
Among their recommendations:
- Develop diagnostic criteria and instruments for diagnosis and assessment of the needs of older adults with ASDs. Current diagnostic practice relies on early life history, which is less likely to be available in older adults suspected of having an ASD. Diagnostic criteria will therefore need to take into account adult manifestations of autistic symptoms and the specificity of adult symptom profiles for the diagnosis of an ASD. The development of reliable and valid diagnostic and assessment tools is a prerequisite for conducting descriptive studies of individual and convenience samples and epidemiological population-based samples (#2 and #3 below). Based on recent findings suggesting stable rates of ASD across the life span, it seems likely that there exists a large population of older adults with ASD who have not been identified. No instruments are currently available to geriatricians for screening or diagnosis of this population.
- Conduct cross-sectional descriptive studies in adults of phenomenology, including current symptoms and behaviors, neuropsychiatric features, associated medical conditions, and descriptions of available service and support networks. These studies will be critical in elucidating the magnitude and specificity of problems and suggest potential interventions at individual (e.g., specific behavioral or medical strategies, the importance of screening for selected conditions) and societal (e.g., new approaches to vocational training, development of skilled long term care facilities) levels.