Department of Neuropsychiatry, Graduate School of Medicine, Hirosaki University, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan.
Department of Psychiatry, Langley Porter Psychiatric Institute, University of California San Francisco, 401 Parnassus Avenue, San Francisco, CA, 94143, USA.
Mol Autism. 2020 May 14;11(1):35. doi: 10.1186/s13229-020-00342-5.
Whether there is a true increase in autism spectrum disorder (ASD) frequency or not remains unclear. Additionally, the rates of co-existing neurodevelopmental disorders (NDD) in a total population sample has not been fully examined before. Therefore, using a total population sample in Japan, we aimed to estimate the prevalence and cumulative incidence of autism spectrum disorder (ASD) annually, to determine whether there is a true increase in ASD prevalence by estimating the cumulative incidence of ASD annually, and to examine the rates of co-existing neurodevelopmental disorders (NDD).
In this cross-sectional sequential design study, all 5-year-old children in the catchment area underwent the screening annually from the year 2013-2016. Screen-positive children were invited to participate in a comprehensive assessment, including child and parent interview, behavioral observation, and cognitive and motor function testing. All cases were reviewed by a multidisciplinary research team.
Caregivers of 3954 children returned the screening, among which 559 children underwent the assessment with 87 children receiving an ASD diagnosis. Adjusted ASD prevalence was 3.22% (95% confidence interval (CI) 2.66-3.76%). The male to female ratio of the crude prevalence was 2.2:1. The cumulative incidence of ASD up to 5 years of age for the total study years was 1.31% (95% CI 1.00-1.62%). A generalized linear model revealed no significant linear trends in 5-year cumulative incidence over the study years. Only 11.5% of children had ASD alone; the remaining 88.5% were found to have at least one co-existing NDD.
Modest sample size for a total population study.
Our findings demonstrate the stability of the 5-year cumulative incidence of ASD, implying no true rise in ASD incident cases over the 4-year study period in the study catchment area. High rates of co-existing NDDs reflect the importance of investigating broad developmental challenges in children with ASD.
自闭症谱系障碍（ASD）的发病率是否真的增加仍不清楚。此外，之前尚未全面研究总人口样本中并存的神经发育障碍（NDD）的发生率。因此，我们使用日本的总人口样本，旨在估算自闭症谱系障碍（ASD）的患病率和累积发病率，通过估算 ASD 的年度累积发病率来确定 ASD 的患病率是否真的增加，并检查并存的神经发育障碍（NDD）的发生率。
在这项横断面连续设计研究中，从 2013 年至 2016 年，该流域的所有 5 岁儿童每年都进行筛查。对筛查阳性的儿童进行邀请参加全面评估，包括儿童和家长访谈、行为观察以及认知和运动功能测试。所有病例均由多学科研究团队进行审查。
3954 名儿童的照顾者返回了筛查，其中 559 名儿童接受了评估，其中 87 名儿童被诊断为 ASD。调整后的 ASD 患病率为 3.22%（95%置信区间[CI] 2.66-3.76%）。男女比例为 2.2:1。整个研究年的 ASD 累积发病率为 1.31%（95%CI 1.00-1.62%）。广义线性模型显示，研究年内 5 年累积发病率没有显著的线性趋势。只有 11.5%的儿童患有单纯 ASD；其余 88.5%的儿童被发现至少有一个并存的 NDD。
总人口研究的样本量不大。
我们的研究结果表明 ASD 的 5 年累积发病率稳定，表明在研究流域的 4 年研究期间，ASD 的发病率没有真正增加。并存的 NDD 发生率高反映了在 ASD 儿童中广泛调查发育挑战的重要性。
