Prevalence of Autism Spectrum Disorders among Children in China: A Systematic Review

By Wan, Yumei; Hu, Qiang et al. | Shanghai Archives of Psychiatry, April 2013 | Go to article overview

Prevalence of Autism Spectrum Disorders among Children in China: A Systematic Review


Wan, Yumei, Hu, Qiang, Li, Ting, Jiang, Lijuan, Du, Yasong, Feng, Lei, Wong, John Chee-Meng, Li, Chunbo, Shanghai Archives of Psychiatry


1. Introduction

Autism is a developmental disorder with an onset during earlychildhoodthat results insocialdeficits, communication deficits, stereotyped interests, and repetitive behaviors. [1] Recently the term 'autism spectrum disorders' (ASD) has been used to describe a group of disorders that include autism and similar types of disorders. [2] The conditions included under the ASD label vary slightly between the three diagnostic systems commonly used in China -the 3rd edition of the Chinese Classification and Diagnostic Criteria of Mental Disorders; [3] the 10th edition of the International Classification of Diseases (ICD-10) [4] and the 4th edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) [5] In all three diagnostic systems, ASD includes autism, atypical autism, Rett syndrome, childhood disintegrative disorder, Asperger syndrome, and pervasive developmental disorder not otherwise specified (PDD-NOS). The ASD diagnosis in ICD-10 also includes 'overactive disorder associated with mental retardation and stereotyped movements'. Rett syndrome will be excluded from the ASD diagnosis in the forthcoming DSM-5. [6]

Prevalence studies conducted by the United States Centers for Disease Control and Prevention [7-9] and others Centers [10-12] have documented a rapid increase in the prevalence of ASD. A meta-analysis conducted by Williams and colleagues in 2006 [13] reported a pooled estimate of prevalence of 7.1 per 10 000 for autism, and 20.0 per 10 000 for ASD among individuals under the age of 18. Another meta-analysis conducted by Fombonne and colleagues in 2009[141 summarized data from 57 studies and yielded a pooled prevalence of 22 per 10 000 for autism and 60 to 70 per 10 000 for ASD. Elsabbagh and colleagues [15] reviewed studies conducted after the year 2000 and found a median prevalence of 17 per 10000 for autism and 62 per 10000 for ASD.

Information from China has not figured prominently in these prevalence estimates for autism and ASD: the 2006 analysis by Williams [13] included no data from China; the 2009 analysis by Fombonne [14] included one study from Hong Kong; and the 2012 report from Elsabbagh [15] combined data from China and Japan together as the 'Western Pacific region'. Most studies on the prevalence of ASD in mainland China have been provincial studies with relatively small sample sizes that report wide variations in prevalence. [16-18] The only national study, a study conducted by Li and colleagues in 2011,[191 reported a very low prevalance of autism (2.4 per 10 000). The current report is a systematic review and meta-analysis of prevalance studies on autism and ASD from mainland China, Hong Kong and Taiwan.

2. Methods

2.1 Identification of studies for inclusion in the meta-analysis

The process of identifying studies for inclusion in the meta-analysis is shown in Figure 1. Two authors (YW and Q.H) first conducted electronic searches in the following databases: the Chinese National Knowledge Infrastructure database (CNKI, 1979-2013), the Chongqing VIP database for Chinese Technical Periodicals (1989-2013), the WAN FANG DATA database (1990-2013), the Chinese Biological Medical Literature Database (1978-2013), Pubmed (1966-2013), and Web of Science (1950-2013). All reports published by 28 February 2013 were included in the search. All articles in which any word denoting autism (including 'autism spectrum disorders', 'pervasive developmental disorders', 'autism', 'autism disorder', 'zi bi zheng' [an older term for autism in Chinese], 'Asperger' 'Asperger syndrome') in either Chinese or English occurred with any word denoting prevalence (including 'prevalence' 'detectable rate', 'incidence rate', and 'epidemiology') in either Chinese or English were identified. Reference lists of identified studies were hand-searched.

Included studies were epidemiological studies about the prevalence of autism or ASD (as defined by CCMD [3],ICD [4] or DSMPI diagnostic criteria) among Chinese individuals (including those from mainland China, Hong Kong, Macau, and Taiwan) under the age of 18 who were identified from the general population, from clinical populations, or from student populations. …

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