Abstract
Objective: 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.Methods: 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).Results: 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 US 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).Conclusion: 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.
Highlights
Autism Spectrum Disorder (1) is defined as a lifelong neurodevelopmental disorder characterized by two key symptoms: persistent deficits in social communication/interaction and restricted, repetitive patterns of behavior and abnormal sensory responses (2)
This study looked at how age and gender were linked to the prevalence estimates of Autism Spectrum Disorder (ASD) and its co-morbidities
Studies reporting on the prevalence of co-morbidities in ASD were retrieved from a second systematic literature review (SLR) on the clinical burden of ASD which considered the same population and geographic scope
Summary
Autism Spectrum Disorder (1) is defined as a lifelong neurodevelopmental disorder characterized by two key symptoms: persistent deficits in social communication/interaction and restricted, repetitive patterns of behavior and abnormal sensory responses (2). The severity of these symptoms varies extensively from one patient to another, leading to a multitude of clinical presentations. As a consequence, estimating the prevalence of ASD is challenging, as illustrated by Chiarotti and Venerosi (5) who recently conducted a worldwide narrative review on this topic (except for the African and Latin American regions) and confirmed the high variability in reported prevalence across regions. The authors reported high inter and intra variability across regions, with estimates ranging from 0.42 and 3.13% in Europe, 0.11 and 1.53% in Middle-East, 0.08 and 9.3% in Asia, and 0.87 and 1.85% in North America (5)
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