Time Magazine->For The First Time, A Census of Autistic Adults

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For the First Time, a Census of Autistic Adults

By Wallis

(From http://www.time.com/time/health/article/0,8599,1927415,00.html)

Among the many great mysteries of autism is this: Where are all the

adults with the disorder? In California, for instance, about 80% of

people identified as having an autism spectrum disorder (ASD) are 18 or

under. Studies by the Centers for Disease Control and Protection (CDC)

indicate that about 1 in 150 children in the U.S. have autism, but

despite the fact that autism is by definition a lifelong condition, the

agency doesn't have any numbers for adults. Neither has anyone else.

Until now.

On Sept. 22, England's National Health Service (NHS) released the first

study of autism in the general adult population. The findings confirm

the intuitive assumption: that ASD is just as common in adults as it is

in children. Researchers at the University of Leicester, working with

the NHS Information Center found that roughly 1 in 100 adults are on the

spectrum — the same rate found for children in England, Japan, Canada

and, for that matter, New Jersey.

This finding would also appear to contradict the commonplace idea that

autism rates have exploded in the two decades. Researchers found no

significant differences in autism prevalence among people they surveyed

in their 20s, 30s, 40s, right up through their 70s. " This suggests that

the factors that lead to developing autism appear to be constant, " said

Dr. Terry Brugha, professor of psychiatry at the University of Leicester

and lead author of the study. " I think what our survey suggests doesn't

go with the idea that the prevalence is rising. "

In England, where there is widespread suspicion that the childhood

vaccine for measles, mumps and rubella has led to an explosion in autism

cases, the study was hailed as part of a growing body of evidence that

the vaccine, which was introduced in the 1988, is not to blame.

Brugha's study was part of a larger national survey of psychiatric

disorders among adults. In the first phase, researchers conducted

90-minute interviews with 7,461 people in 4,000 randomly selected

British households; the interview included a 20-item questionnaire

designed to screen for autism. (Sample yes-or-no questionnaire items: I

find it easy to make friends. I would rather go to a party than the

library. I particularly enjoy reading fiction.) Based on their answers

in the first phase, investigators further assessed 618 individuals,

using a battery of psychiatric measures, including a state-of-the art

autism diagnostic tool. (About 200 of these participants had been

selected for scoring high on the autism screen; the rest had been

selected to sample for other disorders.) In the second phase,

researchers identified 19 adults with ASD. But had they been able to

evaluate all 7,461 in the survey, they estimate that they would have

found 72 cases, or roughly 1% of the total.

One limitation of the study is its relatively small size, says Brugha.

Being the first of its kind, it also needs to be confirmed by other

studies. Another issue, notes Roy Grinker, an autism researcher

and professor of anthropology at Washington University, who was

not involved in the work, is that the study looked only at adults in the

general population. Had it included people living in institutions, which

is where the most severely autistic adults are likely to be, the

estimated rate of ASD may have been even higher than 1%.

noff, an epidemiology specialist with Autism Speaks,

emphasizes that " the small sample size for estimating prevalence

requires caution about interpreting this finding on a population-based

scale. "

Despite its limits, the new study does begin to fill in the profile of

high-functioning adults who are on the spectrum but living in an

ordinary home in the community. Researchers found that they are

primarily male and unmarried: about 1.8% of men surveyed were on the

spectrum — among never-married, single men, an estimated 4.5% had ASD —

compared with just 0.2% of women. (Brugha notes, however, that autism

screening tools may be poorly adapted for identifying autism in adult

females.) People with autism are less likely than average to have

finished college but about as likely to be employed. Only 0.2% of adults

who had finished college were on the spectrum, but the rate was 10 times

higher among those without a high school degree. And, in contrast with

people with depression or anxiety disorders, autistic adults were

unlikely be receiving any sort of mental health services.

Why has it taken so long to do a study of this sort? For one thing, you

need an enormous sample size — at an enormous cost — to find significant

numbers of people with autism. Second, it's more difficult to detect

autism in adults than in children. Children often have glaring symptoms,

like delays in learning to speak, extreme social withdrawal and terrible

tantrums. Less is known about how autism looks in adults. " To diagnose

autism, you need to have good information on people's behavior, " says

Brugha. " It's much more straightforward to get that with children

because you've got parents and teachers as observers. Adults with autism

are not the best people to describe their own behavior. "

The Irish-born psychiatrist and epidemiologist says he sees a lot of

adults with ASD in his own clinical practice, and " they have so much

difficulty saying what their own difficulties are. " He suspects that

this lack of insight and inability to communicate emotional issues also

reduces their ability to seek professional help.

Efforts to identify and help adults with ASD have lagged far behind

efforts to help children. And yet, Brugha notes that just having an ASD

diagnosis to explain their troubles can be enormously beneficial to his

adult patients, who often struggle with relationships at home and at

work because of difficulty reading social cues. " Once you help them to

understand that they are not the only person on the planet who is like

this, and help their families understand, it can be a breakthrough.

People also have a better chance of staying in their work, if their

employer understands why they are the way they are. " Moreover, Brugha

says it is not expensive to provide services to adults with relatively

mild autism. " The cost of treating a child with autism is phenomenally

high. We are not talking about this. We are talking about support,

helping people adapt their lives " with help from a social worker.

Grinker, who has a teenage daughter with autism, finds the study to be

in some ways comforting. " I would think that a study like this would

encourage people that children with autism could grow up and have

futures that are meaningful and that they are not going to end up in

institutions. "