Bougeard Clémence, Picarel-Blanchot Françoise, Schmid Ramona, Campbell Rosanne, Buitelaar Jan
Syneos Health, Value Access & HEOR, Montrouge, France (Bougeard); Servier Global Medical and Patients Affairs, Suresnes, France (Picarel-Blanchot); Servier, Global Value & Access, Suresnes, France (Schmid); Syneos Health, Value Access & HEOR, London, United Kingdom (Campbell); Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, Netherlands (Buitelaar).
Focus (Am Psychiatr Publ). 2024 Apr;22(2):212-228. doi: 10.1176/appi.focus.24022005. Epub 2024 Apr 10.
Individuals with autism spectrum disorder often present somatic and/or psychiatric co-morbid disorders. The DSM-5 allows for consideration of additional diagnoses besides ASD and may have impacted the prevalence of co-morbidities as well as being limited in capturing the true differences in prevalence observed between males and females. We describe the prevalence of ASD and frequently observed co-morbidities in children and adolescents (<18 years) in the United States and five European countries.
Two systematic literature reviews were conducted in PubMed and Embase for the period 2014-2019 and focusing on the prevalence of ASD and nine co-morbidities of interest based on their frequency and/or severity: Attention Deficit Hyperactivity Disorder (ADHD), anxiety, depressive disorders, epilepsy, intellectual disability (ID), sleep disorders, sight/hearing impairment/loss, and gastro-intestinal syndromes (GI).
Thirteen studies on prevalence of ASD and 33 on prevalence of co-morbidities were included. Prevalence of ASD was 1.70 and 1.85% in U.S children aged 4 and 8 years respectively, while prevalence in Europe ranged between 0.38 and 1.55%. Additionally, current evidence is supportive of a global increase in ASD prevalence over the past years. Substantial heterogeneity in prevalence of co-morbidities was observed: ADHD (0.00-86.00%), anxiety (0.00-82.20%), depressive disorders (0.00-74.80%), epilepsy (2.80-77.50%), ID (0.00-91.70%), sleep disorders (2.08-72.50%), sight/hearing impairment/loss (0.00-14.90%/0.00-4.90%), and GI syndromes (0.00-67.80%). Studies were heterogeneous in terms of design and method to estimate prevalence. Gender appears to represent a risk factor for co-morbid ADHD (higher in males) and epilepsy/seizure (higher in females) while age is also associated with ADHD and anxiety (increasing until adolescence).
Our results provide a descriptive review of the prevalence of ASD and its co-morbidities in children and adolescents. These insights can be valuable for clinicians and parents/guardians of autistic children. Prevalence of ASD has increased over time while co-morbidities bring additional heterogeneity to the clinical presentation, which further advocates for personalized approaches to treatment and support. Having a clear understanding of the prevalence of ASD and its co-morbidities is important to raise awareness among stakeholders.Appeared originally in 2021; 12:744709.
自闭症谱系障碍患者常伴有躯体和/或精神共病。《精神疾病诊断与统计手册》第5版（DSM - 5）允许在自闭症谱系障碍（ASD）之外考虑其他诊断，这可能影响了共病的患病率，并且在捕捉男性和女性患病率的真实差异方面存在局限性。我们描述了美国和五个欧洲国家儿童及青少年（<18岁）中ASD的患病率以及常见共病情况。
于2014 - 2019年期间在PubMed和Embase数据库进行了两项系统文献综述，重点关注ASD的患病率以及基于其发生频率和/或严重程度的九种感兴趣的共病：注意力缺陷多动障碍（ADHD）、焦虑症、抑郁症、癫痫、智力残疾（ID）、睡眠障碍、视力/听力损害/丧失以及胃肠道综合征（GI）。
纳入了13项关于ASD患病率的研究和33项关于共病患病率的研究。美国4岁和8岁儿童中ASD的患病率分别为1.70%和1.85%，而欧洲的患病率在0.38%至1.55%之间。此外，现有证据支持过去几年全球ASD患病率呈上升趋势。共病患病率存在显著异质性：ADHD（0.00% - 86.00%）、焦虑症（0.00% - 82.20%）、抑郁症（0.00% - 74.80%）、癫痫（2.80% - 77.50%）、ID（0.00% - 91.70%）、睡眠障碍（2.08% - 72.50%）、视力/听力损害/丧失（0.00% - 14.90%/0.00% - 4.90%）以及胃肠道综合征（0.00% - 67.80%）。在估计患病率的设计和方法方面，各研究存在异质性。性别似乎是共病ADHD（男性更高）和癫痫/癫痫发作（女性更高）的危险因素，而年龄也与ADHD和焦虑症相关（直至青春期患病率增加）。
我们的结果提供了对儿童及青少年中ASD及其共病患病率的描述性综述。这些见解对临床医生以及自闭症儿童的家长/监护人可能有价值。随着时间推移，ASD的患病率有所增加，而共病给临床表现带来了更多异质性，这进一步提倡采用个性化的治疗和支持方法。清楚了解ASD及其共病的患病率对于提高利益相关者的认识很重要。最初发表于2021年；12:744709。
