Study supports theory that rise in autism is

related to changes in diagnosis

8 April 2008

Research funded by the Wellcome Trust 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.

Professor Dorothy Bishop, a Wellcome Trust Principal Research Fellow at the University of
Oxford, led a study that revisited 38 adults, aged 15-31, who had been diagnosed with having
developmental language disorders as children rather than being autistic. Professor Bishop and
colleagues looked at whether they now met current diagnostic criteria for autistic spectrum
disorders, either through reports of their childhood behaviour or on the basis of their current
behaviour. The results are published this month in the journal ‘Developmental Medicine and
Child Neurology’ (see point 1 below).

Developmental language disorders, which include specific language impairment, are diagnosed
when a child has unusual difficulty in his or her 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 does speak in long and complex
utterances but nevertheless has a problem communicating effectively because of problems in
conveying a point or grasping what others mean.

Autistic spectrum disorders, which include autism and Asperger’s 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
studies of developmental language disorder conducted during the period 1986 to 2003 and
about whose conditions detailed information was known. All attended special schools or
classes for children with language impairments, and would have been diagnosed by educational
psychologists, paediatricians or speech therapists as having developmental language disorders;
none had previously been diagnosed as autistic. However, when reassessed by Professor
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 (see point 2 below), the figure until the 1990s was
widely accepted as being about 5 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 the true prevalence of the disorder is constant but that changes in diagnostic
criteria mean that more children are being diagnosed as autistic. The latter theory is supported
by a UK study (see point 3 below) 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 Professor Bishop's study.

"Our study shows pretty direct evidence to support the theory that changes in diagnosis may
contribute towards the rise in autism," says Professor 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.

"Criteria for diagnosing autism were much more stringent in the 1980s than nowadays 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, Professor Bishop 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," she 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."

Contact
Craig Brierley
Media Officer
Wellcome Trust
T +44 (0)20 7611 7329
E c.brierley@wellcome.ac.uk

Notes for editors

1. Bishop D et al. Autism and diagnostic substitution: Evidence from a study of adults with a
history of developmental language disorder. Developmental Medicine and Child Neurology,
published in advance online 31 March 2008.

2. Baird G et al. Prevalence of disorders of the autism spectrum in a population cohort of

children in South Thames: the Special Needs and Autism Project (SNAP). Lancet 2006; 368
(9531): 210-215.

3. Jick H et al. (2003) Epidemiology and possible causes of autism. Pharmacotherapy; 23:
1524-1530.

About the Wellcome Trust

The Wellcome Trust is the largest charity in the UK. It funds innovative biomedical research, in
the UK and internationally, spending around £650 million each year to support the brightest
scientists with the best ideas. The Wellcome Trust supports public debate about biomedical
research and its impact on health and wellbeing.

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