Skip to main content
×
Home

The epidemiology and global burden of autism spectrum disorders

  • A. J. Baxter (a1) (a2), T. S. Brugha (a3), H. E. Erskine (a1) (a2), R. W. Scheurer (a2), T. Vos (a1) (a4) and J. G. Scott (a2) (a5) (a6)...
Abstract
Background

Autism spectrum disorders (ASDs) are persistent disabling neurodevelopmental disorders clinically evident from early childhood. For the first time, the burden of ASDs has been estimated for the Global Burden of Disease Study 2010 (GBD 2010). The aims of this study were to develop global and regional prevalence models and estimate the global burden of disease of ASDs.

Method

A systematic review was conducted for epidemiological data (prevalence, incidence, remission and mortality risk) of autistic disorder and other ASDs. Data were pooled using a Bayesian meta-regression approach while adjusting for between-study variance to derive prevalence models. Burden was calculated in terms of years lived with disability (YLDs) and disability-adjusted life-years (DALYs), which are reported here by world region for 1990 and 2010.

Results

In 2010 there were an estimated 52 million cases of ASDs, equating to a prevalence of 7.6 per 1000 or one in 132 persons. After accounting for methodological variations, there was no clear evidence of a change in prevalence for autistic disorder or other ASDs between 1990 and 2010. Worldwide, there was little regional variation in the prevalence of ASDs. Globally, autistic disorders accounted for more than 58 DALYs per 100 000 population and other ASDs accounted for 53 DALYs per 100 000.

Conclusions

ASDs account for substantial health loss across the lifespan. Understanding the burden of ASDs is essential for effective policy making. An accurate epidemiological description of ASDs is needed to inform public health policy and to plan for education, housing and financial support services.

Copyright
Corresponding author
* Address for correspondence: A. J. Baxter, M.P.H., Queensland Centre for Mental Health Research, University of Queensland, Brisbane, QLD 4074, Australia. (Email: amanda_baxter@qcmhr.uq.edu.au)
References
Hide All
Ahmad O, Boschi-Pinto C, Lopez A, Murray C, Lozano R, Inoue M (2001). Age Standardization of Rates: A New WHO Standard. World Health Organization: Geneva.
APA (1994). Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). American Psychiatric Association: Washington, DC.
APA (2000). Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR). American Psychiatric Association: Washington, DC.
APA (2013). Desk Reference to the Diagnostic Criteria from DSM-5. American Psychiatric Publishing: Arlington, VA.
Baird G, Simonoff E, Pickles A, Chandler S, Loucas T, Meldrum D, Charman T (2006). Prevalence of disorders of the autism spectrum in a population cohort of children in South Thames: the Special Needs and Autism Project (SNAP). Lancet 368, 210215.
Baxter AJ, Patton G, Degenhardt L, Scott KM, Whiteford HA (2013). Global epidemiology of mental disorders: what are we missing? PLoS One 8, e65514.
Billstedt E, Gillberg C, Gillberg C (2005). Autism after adolescence: population-based 13- to 22-year follow-up of 120 individuals with autism diagnosed in childhood. Journal of Autism and Developmental Disorders 33, 351360.
Blaxill M, Baskin D, Spitzer W (2003). Commentary: Blaxill, Baskin, and Spitzer on Croen et al (2002), the changing prevalence of autism in California. Journal of Autism and Developmental Disorders 33, 223226.
Boyle CA, Boulet S, Schieve LA, Cohen RA, Blumberg SJ, Yeargin-Allsopp M, Visser S, Kogan MD (2011). Trends in the prevalence of developmental disabilities in US children, 1997-2008. Pediatrics 127, 10341042.
Brugha T, Cooper S, McManus S, Purdon S, Smith J, Scott FJ, Spiers N, Tyrer F; the NHS Information Centre Community and Mental Health Team (2012). Estimating the Prevalence of Autism Spectrum Conditions in Adults – Extending the 2007 Adult Psychiatric Morbidity Survey. Health and Social Care Information Centre: London.
Brugha TS, McManus S, Bankart J, Scott F, Purdon S, Smith J, Bebbington P, Jenkins R, Meltzer H (2011). Epidemiology of autism spectrum disorders in adults in the community in England. Archives of General Psychiatry 68, 459466.
Brugha T, McManus S, Meltzer H, Smith J, Scott F, Purdon S, Harris J, Bankart J (2009). Autism Spectrum Disorders in Adults Living in Households Throughout England. Report from the Adult Psychiatric Morbidity Survey 2007. The NHS Information Centre: London.
Cantwell DP, Baker L (1989). Stability and natural history of DSM-III childhood diagnoses. Journal of the American Academy of Child and Adolescent Psychiatry 28, 691700.
Cederlund M, Hagberg B, Billstedt E, Gillberg IC, Gillberg C (2008). Asperger syndrome and autism: a comparative longitudinal follow-up study more than 5 years after original diagnosis. Journal of Autism and Developmental Disorders 38, 7285.
Chakrabarti S, Fombonne E (2005). Pervasive developmental disorders in preschool children: confirmation of high prevalence. American Journal of Psychiatry 162, 11331141.
Charman T, Pickles A, Chandler S, Wing L, Bryson S, Simonoff E, Loucas T, Baird G (2009). Commentary: effects of diagnostic thresholds and research vs service and administrative diagnosis on autism prevalence. International Journal of Epidemiology 38, 12341238.
Croen L, Grether J (2003). Response: a response to Blaxill, Baskin, and Spitzer on Croen et al (2002), ‘The changing prevalence of autism in California’. Journal of Autism and Developmental Disorders 33, 227229.
Croen LA, Grether JK, Hoogstrate J, Selvin S (2002). The changing prevalence of autism in California. Journal of Autism and Developmental Disorders 32, 207215.
de Bildt A, Sytema S, Ketelaars C, Kraijer D, Mulder E, Volkmar F, Minderaa R (2004). Interrelationship between Autism Diagnostic Observation Schedule-Generic (ADOS-G), Autism Diagnostic Interview Revised (ADI-R), and the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) classification in children and adolescents with mental retardation. Journal of Autism and Developmental Disorders 34, 129137.
Dilavore PC, Lord C, Rutter M (1995). The pre-linguistic autism diagnostic observation schedule. Journal of Autism and Developmental Disorders 25, 355379.
Erskine HE, Ferrari AJ, Polanczyk GV, Moffitt TE, Murray CJL, Vos T, Whiteford HA, Scott JG (2014). The global burden of conduct disorder and attention-deficit/hyperactivity disorder in 2010. Journal of Child Psychology and Psychiatry 55, 328336.
Faraone SV, Biederman J, Mick E (2006). The age-dependent decline of attention deficit hyperactivity disorder: a meta-analysis of follow-up studies. Psychological Medicine 36, 159165.
Fombonne E (2008). Thimerosal disappears but autism remains. Archives of General Psychiatry 65, 1516.
Gillberg C, Steffenburg S, Schaumann H (1991). Is autism more common now than 10 years ago? British Journal of Psychiatry 158, 403409.
Howlin P, Goode S, Hutton J, Rutter M (2004). Adult outcome for children with autism. Journal of Child Psychology and Psychiatry 45, 212229.
Kim YS, Leventhal BL, Koh YJ, Fombonne E, Laska E, Lim EC, Cheon KA, Kim SJ, Kim YK, Lee H, Song DH, Grinker RR (2011). Prevalence of autism spectrum disorders in a total population sample. American Journal of Psychiatry 168, 904912.
King M, Bearman P (2009). Diagnostic change and the increased prevalence of autism. International Journal of Epidemiology 38, 12241234.
Kogan MD, Strickland BB, Blumberg SJ, Singh GK, Perrin JM, van Dyck PC (2008). A national profile of the health care experiences and family impact of autism spectrum disorder among children in the United States, 2005-2006. Pediatrics 122, e1149e1158.
Laidler JR (2005). US Department of Education data on ‘autism’ are not reliable for tracking autism prevalence. Pediatrics 116, e120e124.
Lauritsen MB, Pedersen CB, Mortensen PB (2004). The incidence and prevalence of pervasive developmental disorders: a Danish population-based study. Psychological Medicine 34, 13391346.
Mattila M-L, Kielinen M, Jussila K, Linna S-L, Bloigu R, Ebeling H, Moilanen I (2007). An epidemiological and diagnostic study of Asperger syndrome according to four sets of diagnostic criteria. Journal of the American Academy of Child and Adolescent Psychiatry 46, 636646.
Montiel-Nava C, Pena JA (2008). Epidemiological findings of pervasive developmental disorders in a Venezuelan study. Autism 12, 191202.
Mouridsen SE, Bronnum-Hansen H, Rich B, Isager T (2008). Mortality and causes of death in autism spectrum disorders: an update. Autism 12, 403414.
Murray CJL, Ezzati M, Flaxman AD, Lim S, Lozano R, Michaud C, Naghavi M, Salomon JA, Shibuya K, Vos T, Wikler D, Lopez AD (2012). GBD 2010: design, definitions, and metrics. Lancet 380, 20632066.
Newschaffer CJ, Croen LA, Daniels J, Giarelli E, Grether JK, Levy SE, Mandell DS, Miller LA, Pinto-Martin J, Reaven J, Reynolds AM, Rice CE, Schendel D, Windham GC (2007). The epidemiology of autism spectrum disorders. Annual Review of Public Health 28, 235258.
Park A (2009). Autism numbers are rising. The question is why? Time (http://content.time.com/time/health/article/0,8599,1948842,00.html). Accessed 30 June 2014.
Powell JE, Edwards A, Edwards M, Pandit BS, Sungum-Paliwal SR, Whitehouse W (2000). Changes in the incidence of childhood autism and other autistic spectrum disorders in preschool children from two areas of the West Midlands, UK. Developmental Medicine and Child Neurology 42, 624628.
Salomon JA, Vos T, Hogan DR, Gagnon M, Naghavi M, Mokdad A, Begum N, Shah R, Karyana M, Kosen S, Farje MR, Moncada G, Dutta A, Sazawal S, Dyer A, Seiler J, Aboyans V, Baker L, Baxter A, Benjamin EJ, Bhalla K, Abdulhak AB, Blyth F, Bourne R, Braithwaite T, Brooks P, Brugha TS, Bryan-Hancock C, Buchbinder R, Burney P, Calabria B, Chen H, Chugh SS, Cooley R, Criqui MH, Cross M, Dabhadkar KC, Dahodwala N, Davis A, Degenhardt L, Díaz-Torné C, Dorsey ER, Driscoll T, Edmond K, Elbaz A, Ezzati M, Feigin V, Ferri CP, Flaxman AD, Flood L, Fransen M, Fuse K, Gabbe BJ, Gillum RF, Haagsma J, Harrison JE, Havmoeller R, Hay RJ, Hel-Baqui A, Hoek HW, Hoffman H, Hogeland E, Hoy D, Jarvis D, Karthikeyan G, Knowlton LM, Lathlean T, Leasher JL, Lim SS, Lipshultz SE, Lopez AD, Lozano R, Lyons R, Malekzadeh R, Marcenes W, March L, Margolis DJ, McGill N, McGrath J, Mensah GA, Meyer A-C, Michaud C, Moran A, Mori R, Murdoch ME, Naldi L, Newton CR, Norman R, Omer SB, Osborne R, Pearce N, Perez-Ruiz F, Perico N, Pesudovs K, Phillips D, Pourmalek F, Prince M, Rehm JT, Remuzzi G, Richardson K, Room R, Saha S, Sampson U, Sanchez-Riera L, Segui-Gomez M, Shahraz S, Shibuya K, Singh D, Sliwa K, Smith E, Soerjomataram I, Steiner T, Stolk WA, Stovner LJ, Sudfeld C, Taylor HR, Tleyjeh IM, van der Werf MJ, Watson WL, Weatherall DJ, Weintraub R, Weisskopf MG, Whiteford H, Wilkinson JD, Woolf AD, Zheng Z-J, Murray CJL (2012). Common values in assessing health outcomes from disease and injury: disability weights measurement study for the Global Burden of Disease Study 2010. Lancet 380, 21292143.
Scott FJ, Baron-Cohen S, Bolton P, Brayne C (2002). Brief report: prevalence of autism spectrum conditions in children aged 5–11 years in Cambridgeshire, UK. Autism 6, 231237.
Scott JG, Duhig M, Hamlyn J, Norman R (2013). Environmental contributions to autism: explaining the rise in incidence of autistic spectrum disorders. Journal of Environmental Immunology and Toxicology 1, 7579.
Shavelle RM, Strauss DJ, Pickett J (2001). Causes of death in autism. Journal of Autism and Developmental Disorders 31, 569576.
Sponheim E, Skjeldal O (1998). Autism and related disorders: epidemiological findings in a Norwegian study using ICD-10 diagnostic criteria. Journal of Autism and Developmental Disorders 28, 217227.
Vos T, Flaxman AD, Naghavi M, Lozano R, Michaud C, Ezzati M, Shibuya K, Salomon JA, Abdalla S, Aboyans V, Abraham J, Ackerman I, Aggarwal R, Ahn SY, Ali MK, Alvarado M, Anderson HR, Anderson LM, Andrews KG, Atkinson C, Baddour LM, Bahalim AN, Barker-Collo S, Barrero LH, Bartels DH, Basáñez M-G, Baxter A, Bell ML, Benjamin EJ, Bennett D, Bernabé E, Bhalla K, Bhandari B, Bikbov B, Abdulhak AB, Birbeck G, Black JA, Blencowe H, Blore JD, Blyth F, Bolliger I, Bonaventure A, Boufous S, Bourne R, Boussinesq M, Braithwaite T, Brayne C, Bridgett L, Brooker S, Brooks P, Brugha TS, Bryan-Hancock C, Bucello C, Buchbinder R, Buckle G, Budke CM, Burch M, Burney P, Burstein R, Calabria B, Campbell B, Canter CE, Carabin H, Carapetis J, Carmona L, Cella C, Charlson F, Chen H, Cheng AT-A, Chou D, Chugh SS, Coffeng LE, Colan SD, Colquhoun S, Colson KE, Condon J, Connor MD, Cooper LT, Corriere M, Cortinovis M, de Vaccaro KC, Couser W, Cowie BC, Criqui MH, Cross M, Dabhadkar KC, Dahiya M, Dahodwala N, Damsere-Derry J, Danaei G, Davis A, De Leo D, Degenhardt L, Dellavalle R, Delossantos A, Denenberg J, Derrett S, Des Jarlais DC, Dharmaratne SD, Dherani M, Diaz-Torne C, Dolk H, Dorsey ER, Driscoll T, Duber H, Ebel B, Edmond K, Elbaz A, Ali SE, Erskine H, Erwin PJ, Espindola P, Ewoigbokhan SE, Farzadfar F, Feigin V, Felson DT, Ferrari A, Ferri CP, Fèvre EM, Finucane MM, Flaxman S, Flood L, Foreman K, Forouzanfar MH, Fowkes FGR, Franklin R, Fransen M, Freeman MK, Gabbe BJ, Gabriel SE, Gakidou E, Ganatra HA, Garcia B, Gaspari F, Gillum RF, Gmel G, Gosselin R, Grainger R, Groeger J, Guillemin F, Gunnell D, Gupta R, Haagsma J, Hagan H, Halasa YA, Hall W, Haring D, Haro JM, Harrison JE, Havmoeller R, Hay RJ, Higashi H, Hill C, Hoen B, Hoffman H, Hotez PJ, Hoy D, Huang JJ, Ibeanusi SE, Jacobsen KH, James SL, Jarvis D, Jasrasaria R, Jayaraman S, Johns N, Jonas JB, Karthikeyan G, Kassebaum N, Kawakami N, Keren A, Khoo J-P, King CH, Knowlton LM, Kobusingye O, Koranteng A, Krishnamurthi R, Lalloo R, Laslett LL, Lathlean T, Leasher JL, Lee YY, Leigh J, Lim SS, Limb E, Lin JK, Lipnick M, Lipshultz SE, Liu W, Loane M, Ohno SL, Lyons R, Ma J, Mabweijano J, MacIntyre MF, Malekzadeh R, Mallinger L, Manivannan S, Marcenes W, March L, Margolis DJ, Marks GB, Marks R, Matsumori A, Matzopoulos R, Mayosi BM, McAnulty JH, McDermott MM, McGill N, McGrath J, Medina-Mora ME, Meltzer M, Mensah GA, Merriman TR, Meyer A-C, Miglioli V, Miller M, Miller TR, Mitchell PB, Mocumbi AO, Moffitt TE, Mokdad AA, Monasta L, Montico M, Moradi-Lakeh M, Moran A, Morawska L, Mori R, Murdoch ME, Mwaniki MK, Naidoo K, Nair MN, Naldi L, Narayan KMV, Nelson PK, Nelson RG, Nevitt MC, Newton CR, Nolte S, Norman P, Norman R, O'Donnell M, O'Hanlon S, Olives C, Omer SB, Ortblad K, Osborne R, Ozgediz D, Page A, Pahari B, Pandian JD, Rivero AP, Patten SB, Pearce N, Padilla RP, Perez-Ruiz F, Perico N, Pesudovs K, Phillips D, Phillips MR, Pierce K, Pion S, Polanczyk GV, Polinder S, Pope CA, Popova S, Porrini E, Pourmalek F, Prince M, Pullan RL, Ramaiah KD, Ranganathan D, Razavi H, Regan M, Rehm JT, Rein DB, Remuzzi G, Richardson K, Rivara FP, Roberts T, Robinson C, De Leòn FR, Ronfani L, Room R, Rosenfeld LC, Rushton L, Sacco RL, Saha S, Sampson U, Sanchez-Riera L, Sanman E, Schwebel DC, Scott JG, Segui-Gomez M, Shahraz S, Shepard DS, Shin H, Shivakoti R, Singh D, Singh GM, Singh JA, Singleton J, Sleet DA, Sliwa K, Smith E, Smith JL, Stapelberg NJC, Steer A, Steiner T, Stolk WA, Stovner LJ, Sudfeld C, Syed S, Tamburlini G, Tavakkoli M, Taylor HR, Taylor JA, Taylor WJ, Thomas B, Thomson WM, Thurston GD, Tleyjeh IM, Tonelli M, Towbin JA, Truelsen T, Tsilimbaris MK, Ubeda C, Undurraga EA, van der Werf MJ, van Os J, Vavilala MS, Venketasubramanian N, Wang M, Wang W, Watt K, Weatherall DJ, Weinstock MA, Weintraub R, Weisskopf MG, Weissman MM, White RA, Whiteford H, Wiersma ST, Wilkinson JD, Williams HC, Williams SRM, Witt E, Wolfe F, Woolf AD, Wulf S, Yeh P-H, Zaidi AKM, Zheng Z-J, Zonies D, Lopez AD, Murray CJL (2012). Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 380, 21632196.
Wazana A, Bresnahan M, Kline J (2007). The autism epidemic: fact or artifact? Journal of the American Academy of Child and Adolescent Psychiatry 46, 721730.
Whiteford HA, Degenhardt L, Rehm J, Baxter AJ, Ferrari AJ, Erskine HE, Charlson FJ, Norman RE, Flaxman AD, Johns N, Burstein R, Murray CJL, Vos T (2013). Global burden of disease attributable to mental and substance use disorders: findings from the Global Burden of Disease Study 2010. Lancet 382, 15751586.
WHO (1993). The ICD-10 Classification of Mental and Behavioural Disorders: Diagnostic Criteria for Research. World Health Organization: Geneva.
Williams K, Glasson EJ, Wray J, Tuck M, Helmer M, Bower CI, Mellins CM (2005). Incidence of autism spectrum disorders in children in two Australian states. Medical Journal of Australia 182, 108111.
Wing L (1997). The autistic spectrum. Lancet 350, 17611766.
Wing L, Potter D (2002). The epidemiology of autistic spectrum disorders – is the prevalence rising? Mental Retardation and Developmental Disabilities Research and Reviews 8, 151161.
Wong VC, Hui SL (2008). Epidemiological study of autism spectrum disorder in China. Journal of Child Neurology 23, 6772.
World Bank (1993). World Development Report 1993: Investing in Health. Oxford University Press: New York.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Psychological Medicine
  • ISSN: 0033-2917
  • EISSN: 1469-8978
  • URL: /core/journals/psychological-medicine
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Keywords:

Type Description Title
WORD
Supplementary Materials

Baxter Supplementary Material
Appendix

 Word (268 KB)
268 KB

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 274
Total number of PDF views: 2057 *
Loading metrics...

Abstract views

Total abstract views: 5637 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 24th November 2017. This data will be updated every 24 hours.