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Epidemiology of autism in adults across age groups and ability levels

  • Traolach S. Brugha (a1), Nicola Spiers (a1), John Bankart (a2), Sally-Ann Cooper (a3), Sally McManus (a4), Fiona J. Scott (a5), Jane Smith (a5) and Freya Tyrer (a5)...
Abstract
Background

The epidemiology of autism in adults has relied on untested projections using childhood research.

Aims

To derive representative estimates of the prevalence of autism and key associations in adults of all ages and ability levels.

Method

Comparable clinical diagnostic assessments of 7274 Adult Psychiatric Morbidity Survey participants combined with a population case-register survey of 290 adults with intellectual disability.

Results

The combined prevalence of autism in adults of all ages in England was 11/1000 (95% CI 3–19/1000). It was higher in those with moderate to profound intellectual disability (odds ratio (OR) = 63.5, 95% CI 27.4–147.2). Male gender was a strong predictor of autism only in those with no or mild intellectual disability (adjusted OR = 8.5, 95% CI 2.0–34.9; interaction with gender, P = 0.03).

Conclusions

Few adults with autism have intellectual disability; however, autism is more prevalent in this population. Autism measures may miss more women with autism.

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Copyright
Corresponding author
Traolach S. Brugha, Department of Health Sciences, University of Leicester, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, UK. Email: tsb@le.ac.uk
Footnotes
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Findings from this project were presented to: the Annual Meeting of the Royal College of Psychiatrists, Birmingham, July 2015; IMFAR Conference, at Donostia, San Sebastian, Spain, 2013. Summary findings and methods of the IDCR study have appeared in the HSCIC Government Report: Brugha T, Cooper SA, McManus S, Purdon S, Scott FJ, Spiers NA, et al. Estimating the Prevalence of Autism Spectrum Conditions in Adults: Extending the 2007 Adult Psychiatric Morbidity Survey. Leeds: The NHS Information Centre, 2012, which is cited in this article. Tables in the present article do not duplicate tables in that report.

Researchers and clinicians using the ADOS-Mod4 in clinical populations should note certain differences in the method we have been using to calculate ADOS-Mod4 total score (all scores available for secondary analysis in the data archive; see Acknowledgements). The published ADOS-Mod4 algorithm protocol that was developed in clinical populations includes subdomain rules (e.g. a threshold of 10 or greater (10+) on the ADOS-Mod4 total score for identifying cases of autism, only if there are scores of 3+ on the Communication subdomain and 6+ on the Reciprocal Social Interaction subdomain). However, calibration by us of the ADOS-Mod4 score for general population research was performed across ADOS-Mod4 score thresholds ranging from 5+ to 13+; for all but two of these thresholds (7+ and 10+) no subdomain rules exist. Therefore, no subdomain rules were used in calibrating the ADOS-Mod4 total score, which we based on the sum total of the subdomain ratings of Communication and Reciprocal Social Interaction. However, the subdomain rule for identifying cases of ‘autism spectrum’ (7+) (scores of 2+ on the Communication subdomain and 4+ on the Reciprocal Social Interaction subdomain) does apply to all cases of ‘autism’ (10+ threshold) in our general population studies using the ADOS.

Declaration of interest

None.

Footnotes
References
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Epidemiology of autism in adults across age groups and ability levels

  • Traolach S. Brugha (a1), Nicola Spiers (a1), John Bankart (a2), Sally-Ann Cooper (a3), Sally McManus (a4), Fiona J. Scott (a5), Jane Smith (a5) and Freya Tyrer (a5)...
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