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Multicenter Study
. 2015 Apr 28:350:h1961.
doi: 10.1136/bmj.h1961.

Autism phenotype versus registered diagnosis in Swedish children: prevalence trends over 10 years in general population samples

Sebastian Lundström  1 , Abraham Reichenberg  2 , Henrik Anckarsäter  3 , Paul Lichtenstein  4 , Christopher Gillberg  5
Affiliations
Multicenter Study

Autism phenotype versus registered diagnosis in Swedish children: prevalence trends over 10 years in general population samples

Sebastian Lundström et al. BMJ. .

Abstract

Objective: To compare the annual prevalence of the autism symptom phenotype and of registered diagnoses for autism spectrum disorder during a 10 year period in children.

Design: Population based study.

Setting: Child and Adolescent Twin Study and national patient register, Sweden.

Participants: 19, 993 twins (190 with autism spectrum disorder) and all children (n=1,078,975; 4620 with autism spectrum disorder) born in Sweden over a 10 year period from 1993 to 2002.

Main outcome measures: Annual prevalence of the autism symptom phenotype (that is, symptoms on which the diagnostic criteria are based) assessed by a validated parental telephone interview (the Autism-Tics, ADHD and other Comorbidities inventory), and annual prevalence of reported diagnoses of autism spectrum disorder in the national patient register.

Results: The annual prevalence of the autism symptom phenotype was stable during the 10 year period (P=0.87 for linear time trend). In contrast, there was a monotonic significant increase in prevalence of registered diagnoses of autism spectrum disorder in the national patient register (P<0.001 for linear trend).

Conclusions: The prevalence of the autism symptom phenotype has remained stable in children in Sweden while the official prevalence for registered, clinically diagnosed, autism spectrum disorder has increased substantially. This suggests that administrative changes, affecting the registered prevalence, rather than secular factors affecting the pathogenesis, are important for the increase in reported prevalence of autism spectrum disorder.

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Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at http://www.icmje.org/coi_disclosure.pdf and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years, no other relationships or activities that could appear to have influenced the submitted work.

Figures

None
Annual prevalence of autism spectrum disorder in Child and Adolescent Twin Study in Sweden (CATSS), national patient register (NPR), and NPR diagnoses in Swedish twins. *Prevalence calculated on 19 993 people responding in twin study born 1993-2002. †Prevalence calculated on all twins, irrespective of response in CATTS (n=26 953). Diagnosis in NPR was ascribed before the children’s 10th birthday. ‡Prevalence calculated on all births in Sweden 1993-2002 (n=1 078 975). Diagnosis in NPR was ascribed before the children’s 10th birthday. Regression lines are depicted within 95% confidence intervals
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References

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