Abstract
Previous studies reported that the prevalence of Autism Spectrum Conditions (ASC) in mainland China is much lower than estimates from developed countries (around 1%). The aim of the study is to apply current screening and standardized diagnostic instruments to a Chinese population to establish a prevalence estimate of ASC in an undiagnosed population in mainland China. We followed the design development used previously in the UK published in 2009 by Baron‐Cohen and colleagues. The Mandarin Childhood Autism Spectrum Test (CAST) was validated by screening primary school pupils (n = 737 children age 6–10 years old) in Beijing and by conducting diagnostic assessments using the Autism Diagnostic Observation Schedule and the Autism Diagnostic Interview‐Revised. The prevalence estimate was generated after adjusting and imputing for missing values using the inverse probability weighting. Response was high (97%). Using the UK cutoff (≥15), CAST performance has 84% sensitivity and 96% specificity (95% confidence interval [CI]: 46, 98, and 96, 97, respectively). Six out of 103 children, not previously diagnosed, were found to the meet diagnostic criteria (8.5 after adjustment, 95% CI: 1.6, 15.4). The preliminary prevalence in an undiagnosed primary school population in mainland China was 119 per 10,000 (95% CI: 53, 265). The utility of CAST is acceptable as a screening instrument for ASC in large epidemiological studies in China. Using a comparable method, the preliminary prevalence estimate of ASC in mainland China is similar to that of those from developed countries. Autism Res 2015, 8: 250–260. © 2015 The Authors. Autism Research published by Wiley Periodicals, Inc. on behalf of International Society for Autism Research
Highlights
Autism spectrum conditions (ASC) are characterized by impairments in social interaction and communication, and the presence of repetitive and stereotyped behavior, interests, and activities [World Health Organization, 1993]
The results indicate that a cutoff of 15 is a suitable preliminary cutoff for the Mandarin Childhood Autism Spectrum Test (CAST)
This study suggests that applying international standardized diagnostic instruments and similar epidemiological methods used in developed countries to Chinese primary school age children results in prevalence estimates similar to developed countries
Summary
Autism spectrum conditions (ASC) are characterized by impairments in social interaction and communication, and the presence of repetitive and stereotyped behavior, interests, and activities [World Health Organization, 1993]. The International Classification of Disease, 10th revision (ICD-10) [World Health Organization, 1993] describes ASC as including four subgroups: childhood autism, atypical autism, Asperger’s syndrome (AS) and pervasive developmental disorders—not otherwise specified (PDD-NOS). Population-based epidemiological studies in a number of developed countries have reported an increase in the prevalence estimates of ASC, from 30.8 per 10,000 in 2000 [Baron-Cohen et al, 2000] to approximately 100 per 10,000 (1%) [Baron-Cohen et al, 2009]. A recent prevalence estimate of ASC is 113 per 10,000 in the US in 2012 [Centres of Disease Control and Prevention, 2012]. The most recent worldwide prevalence review suggested the prevalence of ASC is 62 per 10,000 (range 30–116), the no geographic differences were found among population samples in reviewed studies. The most recent worldwide prevalence review suggested the prevalence of ASC is 62 per 10,000 (range 30–116), the no geographic differences were found among population samples in reviewed studies. [Elsabbagh et al, 2012]
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