New research suggests that many children diagnosed with severe language disorders in the 1980s and 1990s would today be diagnosed as having autism. The research supports the theory that the rise in the number of cases of autism may be related to changes in how it is diagnosed.

Dorothy Bishop, PhD, a professor of developmental neuropsychology and a Wellcome Trust Principal Research Fellow at the England-based University of Oxford, led a study that revisited 38 adults, between the ages of 15 to 31, who were diagnosed with developmental language disorders as children, rather than autism.

Bishop and colleagues looked at whether they now met current diagnostic criteria for autistic spectrum disorders, either through reports of their childhood behavior or on the basis of their current behavior. The results are published in a recent issue of the journal Developmental Medicine & Child Neurology.

Developmental language disorders, which include specific language impairment, are diagnosed when a child has unusual difficulty in their grasp of the spoken language, despite normal development in other areas. This may range from a child who has very limited ability to produce or understand spoken sentences, to one who speaks in long and complex utterances, but nevertheless has trouble communicating effectively due to problems comprehending what others mean.

Autistic spectrum disorders, which include autism and Asperger syndrome, are developmental disorders affecting how a person communicates with and relates to other people and how they make sense of the world around them.

Participants in the study were drawn from a pool of children who had participated in a series of developmental language disorder studies conducted from 1986 to 2003 and about whose conditions detailed information was known.

All subjects attended special schools or classes for children with language impairments and would have been diagnosed by speech therapists as having developmental language disorders; none were previously diagnosed as autistic.

However, when reassessed by Bishop and colleagues using current criteria, around a quarter were identified as having autistic spectrum disorder.

In recent years, the criteria for diagnosing developmental language disorders and autism have changed. This has coincided with a marked rise in the rates of diagnosis of autism. According to the Special Needs and Autism Project, until the 1990s, the statistics for autism prevalence were about five people per 10,000; even using the narrowest definition of autism, this rose to almost 40 in 10,000 by 2006

There are two main hypotheses to explain this rise: the “autism epidemic” hypothesis and the “diagnostic substitution” hypothesis. While the former says that the rise is genuine, the latter maintains that although the true prevalence of the disorder is constant, changes in diagnostic criteria mean that more children are being diagnosed with the disorder.

The latter theory is supported by a United Kingdom study using the General Practice Research Database, which found that the rise in autism was mirrored by a decline in frequency of language disorders, and now by Bishop’s study.

“Our study shows pretty direct evidence to support the theory that changes in diagnosis may contribute toward the rise in autism,” says Bishop. “These were children that people were saying were not autistic in the 1980s, but when we talk to their parents now about what they were like as children, it’s clear that they would be classified as autistic now.”

In addition, Bishop says, “Criteria for diagnosing autism were much more stringent in the 1980s than [today], and a child wouldn’t be classed as autistic unless he or she was very severe. Now, children are being identified who have more subtle characteristics and who could in the past easily have been missed.”

However, she cautions against using the results to suggest that the prevalence of autism is not genuinely rising. “We can’t say that genuine cases of autism are not on the increase as the numbers in our study are very small,” Bishop says. “However, this is the only study to date where direct evidence has been found of people who would have had a different diagnosis today than they were given 15 or 20 years ago.”


Source: Wellcome Trust