Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.
Steno Diabetes Center, Aarhus University Hospital, Aarhus, Denmark.
JAMA Pediatr. 2021 Jun 1;175(6):601-608. doi: 10.1001/jamapediatrics.2021.0124.
Population-based data on educational and employment outcomes in adulthood among individuals diagnosed with autism spectrum disorder (ASD) in childhood are currently limited.
To evaluate educational attainment and employment among individuals with and without a diagnosis of ASD before age 12 years in Denmark.
DESIGN, SETTING, AND PARTICIPANTS: This nationwide cross-sectional prevalence study was conducted using data from Danish registers. Individuals with a diagnosis of ASD recorded before age 12 years were identified among all individuals born in Denmark between January 1, 1989, and December 31, 1991, who were alive at age 25 years. Individuals with ASD were then matched on a 10:1 ratio by age, sex, and region of residence with a comparison population of individuals without a diagnosis of ASD at age 12 years. Data were analyzed from March 2019 to December 2020.
Autism spectrum disorder diagnosis and diagnostic subtype recorded before age 12 years.
Adjusted prevalence ratios (aPRs) with 95% CIs for the completion of compulsory primary and lower secondary school (grade 9), upper secondary school (grades 10-12 or vocational), and tertiary school (university) and for employment by age 25 years were estimated using log-binomial regression analysis.
A total of 810 individuals with a diagnosis of ASD before age 12 years were matched with a comparison population of 8100 individuals without ASD. The prevalence of ninth-grade completion was similar among those with and without ASD (785 individuals [96.9%] and 7982 individuals [98.5%], respectively; aPR, 0.98; 95% CI, 0.97-1.00). Compared with those without ASD, persons with ASD had a lower prevalence of completing upper secondary school (6338 individuals [78.2%] vs 286 individuals [35.3%], respectively; aPR, 0.46; 95% CI, 0.42-0.50) and tertiary school (2185 individuals [27.0%] vs 70 individuals [8.6%]; aPR, 0.33; 95% CI, 0.26-0.41) and obtaining employment (4284 individuals [77.7%] vs 177 individuals [27.2%]; aPR, 0.35; 95% CI, 0.31-0.40) at age 25 years. A ninth-grade final examination score was available for 394 individuals (48.6%) with ASD and 7417 individuals (91.6%) without ASD. In an analysis stratified by ASD subtype, individuals diagnosed with childhood autism had lower educational attainment and employment than those diagnosed with Asperger syndrome or pervasive developmental disorder not otherwise specified. A total of 461 individuals (56.9%) with ASD were receiving public assistance or a pension (ie, disability benefits) at age 25 years compared with 1094 individuals (13.5%) without ASD in the comparison population.
In this population-based cross-sectional study, a diagnosis of ASD in childhood was not associated with the completion of compulsory primary and lower secondary education (ninth grade). An ASD diagnosis before age 12 years was associated with a lower prevalence of attaining education beyond ninth grade and obtaining employment by age 25 years, indicating a substantially higher risk of reliance on public assistance in young adulthood.
目前，关于儿童期被诊断为自闭症谱系障碍（ASD）的个体在成年后的教育和就业结果的基于人群的数据有限。
评估丹麦在 12 岁之前被诊断为 ASD 和未被诊断为 ASD 的个体的教育程度和就业情况。
设计、地点和参与者：这是一项全国性的横断面患病率研究，使用丹麦登记处的数据进行。在丹麦出生于 1989 年 1 月 1 日至 1991 年 12 月 31 日之间，且在 25 岁时仍存活的所有个体中，确定了在 12 岁之前被诊断为 ASD 的个体。然后，通过年龄、性别和居住地，将 ASD 个体与未在 12 岁时被诊断为 ASD 的个体进行 10:1 的匹配，形成一个对照人群。数据于 2019 年 3 月至 2020 年 12 月进行分析。
在 12 岁之前被诊断为 ASD 及诊断亚型。
使用对数二项式回归分析估计了 25 岁时完成义务教育（9 年级）、高中（10-12 年级或职业）和高等教育（大学）以及就业的调整后患病率比（aPR）。
共有 810 名在 12 岁之前被诊断为 ASD 的个体与 8100 名未患有 ASD 的个体进行了匹配。具有和不具有 ASD 的个体完成 9 年级的比例相似（分别为 785 名[96.9%]和 7982 名[98.5%]；aPR，0.98；95%CI，0.97-1.00）。与未患有 ASD 的个体相比，患有 ASD 的个体完成高中（分别为 6338 名[78.2%]和 286 名[35.3%]；aPR，0.46；95%CI，0.42-0.50）和高等教育（分别为 2185 名[27.0%]和 70 名[8.6%]；aPR，0.33；95%CI，0.26-0.41）的比例较低，且在 25 岁时获得就业（分别为 4284 名[77.7%]和 177 名[27.2%]；aPR，0.35；95%CI，0.31-0.40）的比例较低。有 394 名（48.6%）患有 ASD 的个体和 7417 名（91.6%）未患有 ASD 的个体提供了 9 年级期末考试成绩。在按 ASD 亚型分层的分析中，被诊断为儿童自闭症的个体与被诊断为阿斯伯格综合征或未特定的广泛发育障碍的个体相比，其教育程度和就业水平较低。在被诊断为 ASD 的 810 名个体中，有 461 名（56.9%）在 25 岁时接受公共援助或养老金（即残疾福利），而在未患有 ASD 的 8100 名对照人群中，有 1094 名（13.5%）接受公共援助或养老金。
在这项基于人群的横断面研究中，儿童期被诊断为 ASD 与完成义务教育（9 年级）无关。在 12 岁之前被诊断为 ASD 与获得高于 9 年级的教育程度和在 25 岁时获得就业的比例较低有关，这表明在青年时期依赖公共援助的风险显著增加。
