Focus on the Social Aspect of Autism

Journal of Autism and Developmental Disorders, Nov 2017

Autism spectrum disorder (ASD) describes a set of neurodevelopmental disorders. Despite extensive ASD research lasting more than 60 years, its causes are still unknown. Without indicating the etiology, its development cannot be stopped. Over the years, both the definition and diagnostic criteria have developed. The number of ASD incidence is rising. The economical aspect should also be highlighted. This disorder presents particular challenges to affected children, their parents and physicians. The research of ASD, physician activities, policy making and raising the level of awareness must be coordinated. Special attention should be paid to the problem among adults with ASD.

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Focus on the Social Aspect of Autism

Journal of Autism and Developmental Disorders https://doi.org/10.1007/s10803 Focus on the Social Aspect of Autism Joanna Kałużna‑Czaplińska 0 1 2 4 Ewa Żurawicz 0 1 2 4 Jagoda Jóźwik‑Pruska 0 1 2 4 0 Department of Chemistry, Institute of General and Ecological Chemistry, Lodz University of Technology , Żeromskiego 116 Street, 90-924 Lodz , Poland 1 Jagoda Jóźwik-Pruska 2 Ewa Żurawicz 3 Joanna Kałużna-Czaplińska 4 CONEM Poland Chemistry and Nutrition Research Group , Lodz , Poland Autism spectrum disorder (ASD) describes a set of neurodevelopmental disorders. Despite extensive ASD research lasting more than 60 years, its causes are still unknown. Without indicating the etiology, its development cannot be stopped. Over the years, both the definition and diagnostic criteria have developed. The number of ASD incidence is rising. The economical aspect should also be highlighted. This disorder presents particular challenges to affected children, their parents and physicians. The research of ASD, physician activities, policy making and raising the level of awareness must be coordinated. Special attention should be paid to the problem among adults with ASD. Autism spectrum disorder; Prevalence; Expenditures; Costs - Introduction The more we understand autism spectrum disorder and how it affects patients and their families, the easier it is to determine the support and resources required by each individual case. To understand what ASD is, in the current approach we should refer to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5). Autism spectrum disorder is a set of neurodevelopmental disorders, which includes autistic disorder, Asperger’s disorder and pervasive developmental disorder. It is characterized by the presence of deficits in social communication and social interaction across multiple contexts, and restricted, repetitive patterns of behavior, interests, or activities (APA 2013) . Diagnosis of ASD is based on comprehensive behavioral evaluations. Despite numerous studies, the etiology of ASD is unknown and remains the subject of speculations and misconceptions. Nevertheless, there is evidence of a strong influence of genes on the pathogenesis of ASD. Twin studies show that if one of a pair of identical twins meets the diagnostic criteria for ASD, the probability that the other will have the disorder is as high as 58% for boys and 60% for girls, while in the case of fraternal twins the probability falls to 21% for boys and 27% for girls (Hallmayer et al. 2011) . In order to get a thorough understanding of causes of ASD, numerous factors and their interactions have been examined (Szatmari et al. 2012) , including a number of genetic disorders (Xu et al. 2012) , anatomical brain abnormalities (cerebellum, brain stem, hippocampus, amygdale, and frontal lobes) (Belmonte et al. 2004) and the comorbidities such as psychiatric, neurological, metabolic and gastrological disorders (Żurawicz et al. 2013; Kałużna-Czaplińska et al. 2013 , 2014; McElhanon et al. 2014). Literature reports that parents of children with ASD experience increased psychological distress, including depression, anxiety, obsession-compulsion, interpersonal sensitivity, hostility, schizoid traits, paranoia, and schizophrenia (Karst and Van Hecke 2012) . Stressors refer to both family and social life and include emotional aspects of having a child with a disability, understanding a child’s needs, various aspects of primary care, medical and education services as well as financial hardship (Gupta and Singhal 2005; Tehee et al. 2009) . Because of the fact that children of different racial, socioeconomic and ethnic groups are affected by ASD and due to the scale of its prevalence, many problems related to ASD pose a challenge to the whole of society. The aim of this paper was to present that the increasing prevalence of ASD has given this disorder a social dimension. Economic costs and other day-to-day problems of ASD patients and their families were described. Prevalence and Social Aspect of ASD Epidemiological surveys provide the basis for awareness, planning policy and service needs, and offer the information necessary to identify potential risk factors for ASD. They also initiate the investigation of ASD prevalence in countries where such estimations have not yet been conducted. The earliest epidemiologic studies performed in the late 1960s according to Kanner’s criteria indicated the prevalence of autism to be 0.5 per 1000 people among children in England (Lotter 1996). Since then epidemiological studies of autism followed by ASD have been performed in various places worldwide. A summary of these studies is shown in Table 1. Data released in 2016 indicate the prevalence of ASD at 14.6 per 1000 (1 in 68) people among children in the USA. No change was noticed compared to the previous report published in 2014 (CDC 2016b) . ASD can be diagnosed by age 2, yet in most children ASD was identified after age 4. Less than half of young patients were diagnosed with ASD by age 3 (ADDM Network 2016). According to the data, ASD is 1.2 times more likely among white children compared to black children. Additionally, it is more common in non-Hispanic white children (15.5 per 1000) than in non-Hispanic black children (13.2 per 1000) and Hispanic children (10.1 per 1000) (CDC 2012, 2016b; Christensen et al. 2016) . Criteria Kanner’s criteria 12 different criteria Male to female ratio 2.6 3.8 Ref. Lotter (1966) Fombonne (1999) DSM-III-R, DSM-IV NR ICD-10 3.3 DSM-IV 2.8 ICD-10 2.8 DSM-IV 4.0 ICD-10 4.3 NR DSM-IV-TR DSM-IV-TR ICD-10 DSM-IV ICD-10 DSM-IV-TR DSM-IV DSM-IV-TR DSM-IV-TR DSM-IV ICD-10 NR NR NR NR 0.5 0.5 1.1 11.6 18.1 12.0 3.4 5.1 4.7 6.7 6.6 15.7 26.4 0.2 9.0 11.0 11.3 14.7 6.5 8.0 20.0 14.6 12.5 22.2 As it is presented in Table 1, the male-to-female prevalence ratio varies widely and ranges from 2.5 (Kim et al. 2011; Li et al. 2011) to 7.6 (CDC 2009). It is not entirely clear how much of the increase in prevalence of ASD can be explained by a true expansion of the incidence or by other factors such as changes in the definition of ASD and diagnostic criteria, variations in research methodology as well as greater awareness and recognition. A large impact of diagnostic criteria on the increasing rates of ASD is the result of the lack of definitive diagnostic tests for ASD. The diagnostic criteria are changing and developing with the evolution of the definition of ASD (King and Bearman 2009; Fisch 2012) . Incompatibilities among diagnostic criteria may affect the interpretation of subgroups of ASD in epidemiological studies. This problem is particularly evident in Asperger’s syndrome, for which the DSMIV/ICD-10 criteria determine age-appropriate development of language, adaptive skills and curiosity, up to 3 years of age. The application of these criteria will result in significant differences in the diagnosis of Asperger’s syndrome and autistic disorders than in the case of application of Gillberg’s et al. criteria (2001 ). As it can be seen in Table 1, the application of DSM or ICD diagnostic criteria in studies depends on the geographical region. Therefore, the comparison of the prevalence of ASD in Europe and in the United States can be difficult. There is a potential impact of the new DSM-5 criteria on the ASD prevalence and it is currently under consideration. Significant changes in these criteria include a complete removal of Rett’s disorder and consolidation of autistic disorder, Asperger’s disorder and pervasive developmental disorder into autism spectrum disorder, combination of socialization and communication deficits into one set of symptoms and extending the age criterion (APA 2013; Matson and Kozlowski 2011) . Despite the same diagnostic criteria, time frame and location, the application of a more thorough assessment may double the prevalence estimate within the same population. This may indicate the necessity for a careful selection of the research method (Posserud et al. 2010) . The differences in the research procedure may include terms of case-finding, sampling and diagnostic definitions (Baron-Cohen 2009) . It has been proved that the level of detail collected about and reviewed on children from multiple sources improves the result of estimates (CDC 2009) . Considering the changes in the rates of ASD, increased awareness cannot be overlooked. Qualified professionals provide a proper diagnosis in accordance with current criteria. Whereas, increasing knowledge of ASD in a society may lead to a careful observation of disturbed behavior in children by their parents and, consequently, an early search for specialist advice. Their awareness began to rise from the 1960s along with the number of works on the nature of autism (Lotter 1967; Rutter et al. 1970; DeMyer 1975) . Nevertheless, until the 1980s autism was too little known to be located in a separate place in any of the ICD or DSM classifications. In1980 the term ‘infantile autism’ was introduced under the scope of a newly generalised category of ‘pervasive developmental disorders’ (PDD) (APA 1980) . A significant increase in the knowledge of autism began in the 1990s after the publication of the diagnostic interview schedule Autism Diagnostic Interview-Revised (ADI-R), which was originally used for research purposes (Lord et al. 1994) . Higher awareness is reflected in the growing amount of research funding available for ASD and the number of ASD research grants (Singh et al. 2009) . Figure 1 shows a rapid increase in both the number of all published reports concerning ASD and research supported by the governments in the last decade. The role of mass media and all information campaigns conducted by various governmental and non-governmental organizations such as Centers for Disease Control and Prevention (Atlanta, USA), Autism-Europe (Brussels, Belgium) or Action for Autism (New Delhi, India) is very important. Thanks to them, the knowledge about ASD reaches a wide group of people. Expenditure on Children with ASD Due to the high incidence of ASD as well as a wide range of medical services required for affected children, the impact of ASD on the family and public budget is becoming increasingly important. Determination of expenditure related to ASD allows service planning, allocation of resources and appropriate changes in policy (Mandell et al. 2006) . Children with ASD have, on average, medical expenditures from 3 (Croen et al. 2006) to even 9 (Mandell et al. 2006; Peng et al. 2009) times higher than other children. Differences in the expenditure between children with ASD and other children largely come from total outpatient care, physician visits, and medications prescribed (Liptak et al. 2006) . The economic aspect can differ even between individuals with ASD and arise from personal needs connected with treatment, care and support. Costs often depend on age of the patients (Buescher et al. 2014) . Estimation of costs should also include the ability of parents of ASD children to work. The study has shown that mothers of patients with ASD have lower incomes than mothers of children with no health limitation. They are less likely to be employed and less likely to have full time jobs (Cidav et al. 2012) . The reason also lies in the difficulty in finding appropriate and affordable child care (Parish and Cloud 2006) . In estimating the health care costs of children with ASD, the presence of co-occurring conditions should be taken into consideration. Almost half of the children with ASD can have one of the three co-occurring conditions (including attention deficit/hyperactivity disorder (ADHD), intellectual Fig. 1 Frequency of reports concerning ASD (1946–2016) Bibliographic research related to the use of term “autism or autistic” in records from the collection of PubMed database. In the search two sets of proceedings: with filters (Article types: Research Support, U.S. Government; Research Support, U.S. Gov’t, P.H.S.; Research Support, U.S. Gov’t, Non-P.H.S.; Research Support, Non-U.S. Gov’t) and without any filter were applied. Results by year (as timeline) were downloaded in the CSV file. Records from 2017 were excluded from the timelines due to the lack of a full annual balance sheet disability (ID) or epilepsy). Therefore, in children with ASD and one or more co-occurring conditions, average expenditures are even twice as high as in those with ASD without a co-occurring condition (Peacock et al. 2012) . It was also found that early intensive behavioral intervention for children with ASD affects long-term monetary savings for families and society (Jacobson et al. 1998) . The costs associated with ASD can also directly affect the family of a child with ASD through family out-of-pocket expenses, including home and garden special adaptations, replacement and repair of house and content damages, specialist equipment (e.g. pushchairs and toys), training and seminars courses, travel, diet specialists, education materials. Half of the families of children with ASD report time off work due to their child’s illness over the period of 6 months (Barrett et al. 2012) . The average loss of annual income among parents of children with ASD is even 14% of their reported income (Montes and Halterman 2008) . A summary of expenditures for children with ASD is presented in Table 2. It should be noted that differences in expenditure among the USA, UK and China may result from differences in practice style and health care financing. USA (Pennsylvania) (1994–1999) 0–21 Health care costs $9980 per year USA (North Dakota) (1998–2004) 0–20 Health care costs $7894 per year USA (1999–2000) < 19 Health care costs $6132 per year UK (1999–2000) 4–10 Health care costs and non-health care £ 689 per week costs USA (2000–2004) < 18 Health care costs $5592 per year USA (2004) 1–21 Health care costs $6830 per year USA (California) (2003–2004) 2–18 Health care costs $2757 per year USA (2003–2005) 2–17 Health care costs $10,709 per year USA (2005) ≤ 15 Loss of income of parents associated $6200 per year with having child with ASD USA (2005) 3–20 Health care costs $14,957 per year UK (2006–2007) 2–4 Health care costs and non-health care £ 3083 per 6 month costs China (2007–2009) 1–15 Health care costs USA (2011) NR Health care costs USA (2011) NR Behavioral intervention Ref. Mandell et al. (2006) Peng et al. (2009) Liptak et al. (2006) Järbrink et al. 2003 Leslie and Martin (2007) Shimabukuro et al. (2008 ) Croen et al. (2006) Peacock et al. (2012) Montes and Halterman (2008) Cidav et al. (2013 ) Barrett et al. (2012) RMB 17,293 per year Wang et al. (2012 ) Higher by $4110–$6200 per year CDC (2016a) $40,000–60,000 per year CDC (2016a) While a wide range of papers is focused on the childhood autism, its prevalence, costs and treatment, it is hard to find information about care system of adults with this disorder. The majority of reports refer to patients in the age range 3–17. This tendency clearly indicates how little attention is paid to individuals with ASD. As ASD is characterized by social, communication and behavioral disabilities, their severity will influence the ability to work and live independently. The growing interest in the use of medical home model for adults with ASD can be seen. Yet, little is known about their availability (Bruder et al. 2012) . The health care status of adults with ASD is also neglected and concentrates mainly on the comorbid conditions (Koritsas and Iacono 2009) . It is reported that the vast majority of ASD patients is unable to live independently (Bruder et al. 2012). Conclusions and Directions for the Future Autism spectrum disorder has a significant impact on the health care and finance systems and represents a challenge in the research planning. As it is shown in Fig. 1, the number of ASD research grants funded by the USA and non-USA governments in the last decade has significantly increased. In the USA, in the years 1997–2006 the majority of projects concentrated on basic science (65%) compared to clinical (15%) and translational research (20%) (Singh et al. 2009) . A very important area of research is an early detection of ASD. To meet the concerns of adults with ASD, family members, practitioners and researchers, the areas that make a difference to people’s day-to-day lives (e.g. effective public services, evidence-based interventions, programs to enhance individuals’ life skills, understanding of the place of people with ASD in society) should be among the research priorities (Pellicano et al. 2014) . High incidence of ASD increases problems with access to early diagnosis and intervention as well as economic issues associated with ASD, which in turn deepens the family crisis. Major challenges for the future of a child with ASD include education and the possibility of employment in adulthood (Pellicano et al. 2014) . All of these problems associated with ASD should find support in the legal system. In order to improve living conditions of children with ASD and their families, there is a need for the development of social policy in four key areas: health insurance, public funding policies which support evidence-based practices for ASD, federal policies and funding which support equal access to services, criteria for evidence-based practices, and research that meets the criteria for evidence-based practices (Howlin and Moss 2012) . The progress observed in the last decade associated with the diagnosis, treatment, awareness, funding, as well as improving the functioning of the family of a child with ASD allows optimism in relation to the future. It should be noted that the research of ASD, physician activities, efforts to develop policies and raising awareness should be coordinated and the ethical issues should be taken into account. Author Contributions All authors read and approved the final manuscript. Compliance with Ethical Standards Conflict of interest The authors declare that they have no conflict of interest. Research Involving Human and Animal Participants This article does not contain any studies with human participants performed by any of the authors. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. 1 3 ADDM Network : Autism Developmental Disabilities Monitoring Network Surveillance Year 2010 Principal Investigators . ( 2014 ). Prevalence of autism spectrum disorder among children aged 8 years-Autism and developmental disabilities monitoring network, 11 sites , United States, 2010 . In The morbidity and mortality weekly report surveillance summaries. 63 , pp. 1 - 21 . ADDM Network : Autism and Developmental Disabilities Monitoring Network . ( 2016 ). In Community report from the autism and developmental disabilities monitoring (ADDM) network . https:// www.cdc.gov/ncbddd/autism/documents /comm-report-autismfull-report.pdf. Accessed June 2017 . APA: American Psychiatric Association. ( 1980 ). In Diagnostic and statistical manual of mental disorders . 3rd edn . (pp. 87 - 92 ). Washington: APA. APA: American Psychiatric Association. ( 2013 ). In Diagnostic and statistical manual of mental disorders. 5th edn . Arlington, VA: American Psychiatric Association. Baird , G. , Simonoff , E. , Pickles , A. , Chandler , S. , Loucas , T. , Meldrum , D. , et al. ( 2006 ). Prevalence of disorders of the autism spectrum in a population cohort of children in South Thames: The special needs and autism project (SNAP) . Lancet , 368 ( 9531 ), 210 - 215 . Baron-Cohen , S. , Scott , F. J. , Allison , C. , Williams , J. , Bolton , P. , Matthews , F. E. , et al. ( 2009 ). Prevalence of autism-spectrum conditions: UK school-based population study . The British Journal of Psychiatry , 194 ( 6 ), 500 - 509 . https://doi.org/10.1192/bjp. bp. 108 .059345. Barrett , B. , Byford , S. , Sharac , J. , Hudry , K. , Leadbitter , K. , Temple , K. , et al. ( 2012 ). Service and wider societal costs of very young children with autism in the UK . Journal of Autism and Developmental Disorders , 42 ( 5 ), 797 - 804 . https://doi.org/10.1007/ s10803-011-1306-x. Belmonte , M. K. , Cook , E. H. Jr. , Anderson , G. M. , Rubenstein , J. L. , Greenough , W. T., Beckel-Mitchener , A. , et al. ( 2004 ). Autism as a disorder of neural information processing: Directions for research and targets for therapy . Molecular Psychiatry , 9 ( 7 ), 646 - 663 . Blumberg , S. J. , Bramlett , M. D. , Kogan , M. D. , Schieve , L. A. , Jones , J. R. , & Lu , M. C. ( 2013 ). Changes in prevalence of parentreported autism spectrum disorder in school-aged U.S. children: 2007 to 2011-2012 . National Health Statistics Reports, 65 , 1 - 28 . Boyle , C. A. , Boulet , S. , Schieve , L. A. , Cohen , R. A. , Blumberg , S. J. , Yeargin-Allsopp , M. , et al. ( 2011 ). Trends in the prevalence of developmental disabilities in US children, 1997 - 2008 . Pediatrics, 127 ( 6 ), 1034 - 1042 . https://doi.org/10.1542/peds.2010- 2989 . Bruder , M. B. , Kerins , G. , Mazzarella , C. , Sims , J. , & Stein , N. ( 2012 ). Brief report: The medical care of adults with autism spectrum disorders: Identifying the needs . Journal of Autism and Developmental Disorders , 42 ( 11 ), 2498 - 2504 . https://doi.org/10.1007/ s10803-012-1496-x. Buescher , A. V. , Cidav , Z. , Knapp , M. , & Mandell , D. S. ( 2014 ). Costs of autism spectrum disorders in the United Kingdom and the United States . JAMA Pediatrics , 168 ( 8 ), 721 - 728 . https://doi. org/10.1001/jamapediatrics. 2014 . 210 . CDC: Centers for Disease Control and Prevention Autism and Developmental Disabilities Monitoring Network Surveillance Year 2000 Principal Investigators . ( 2007a ). Prevalence of autism spectrum disorders-Autism and developmental disabilities monitoring network, six sites , United States . 2000 . In MMWR Surveillance Summaries, (Vol. 56 , pp. 1 - 11 ). CDC: Centers for Disease Control and Prevention. (2007b). Autism and developmental disabilities monitoring network surveillance year 2002 principal investigators; prevalence of autism spectrum disorders-Autism and developmental disabilities monitoring network, 14 sites , United States, 2002 . In MMWR Surveillance Summaries, (Vol. 56 , pp. 12 - 28 ). CDC: Centers for Disease Control and Prevention . ( 2009 ). Autism and developmental disabilities monitoring network surveillance year 2006 principal investigators; prevalence of autism spectrum disorders-Autism and developmental disabilities monitoring network , United States , 2006 . In The Morbidity and Mortality Weekly Report Surveillance Summaries , (Vol. 58 , pp. 1 - 20 ). CDC: Centers for Disease Control and Prevention . ( 2012 ). Prevalence of autism spectrum disorders-Autism and developmental disabilities monitoring network, 14 Sites , United States, 2008 . In The Morbidity and Mortality Weekly Report , (Vol. 61 , pp. 1 - 19 ). CDC: Centers for Disease Control and Prevention. (2016a). Identified prevalence of autism spectrum disorder autism and developmental disabilities monitoring network 2000-2012 combining data from all sites . In The Morbidity and Mortality Weekly Report. CDC: Centers for Disease Control and Prevention. (2016b). CDC estimates 1 in 68 school-aged children have autism; no change from previous estimate . In The Morbidity and Mortality Weekly Report. Christensen , D. L. , Bilder , D. A. , Zahorodny , W. , Pettygrove , S. , Durkin , M. S. , Fitzgerald , R. T., et al. ( 2016 ). Prevalence and characteristics of autism spectrum disorder among 4-year-old children in the autism and developmental disabilities monitoring network . Journal of Developmental & Behavioral Pediatrics , 37 ( 1 ), 1 - 8 . https://doi.org/10.1097/DBP.0000000000000235. Cidav , Z. , Lawer , L. , Marcus , S. C. , & Mandell , D. S. ( 2013 ). Agerelated variation in health service use and associated expenditures among children with autism . Journal of Autism and Developmental Disorders , 43 ( 4 ), 924 - 931 . https://doi.org/10.1007/ s10803-012-1637-2. Cidav , Z. , Marcus , S. C. , & Mandell , D. S. ( 2012 ). Implications of childhood autism for parental employment and earnings . Pediatrics , 129 , 617 - 623 . https://doi.org/10.1542/peds.2011- 2700 . Croen , L. A. , Grether , J. K. , Hoogstrate , J. , & Selvin , S. ( 2002 ). The changing prevalence of autism in California . The Journal of Autism and Developmental Disorders , 32 ( 3 ), 207 - 215 . Croen , L. A. , Najjar , D. V. , Ray , G. T. , Lotspeich , L. , & Bernal , P. ( 2006 ). A comparison of health care utilization and costs of children with and without autism spectrum disorders in a large groupmodel health plan . Pediatrics , 118 ( 4 ), e1203 - e1211 . Davidovitch , M. , Hemo , B. , Manning-Courtney , P. , & Fombonne , E. ( 2013 ). Prevalence and incidence of autism spectrum disorder in an Israeli population . The Journal of Autism and Developmental Disorders , 43 ( 4 ), 785 - 793 . https://doi.org/10.1007/ s10803-012-1611-z. DeMyer , M. ( 1975 ). Research in infantile autism: A strategy and its results . Biological Psychiatry , 10 ( 4 ), 433 - 452 . Fisch , G. S. ( 2012 ). Nosology and epidemiology in autism: Classification counts . American Journal of Medical Genetics Part C: Seminars in Medical Genetics, 160C(2) , 91 - 103 . https://doi. org/10.1002/ajmg.c. 31325 . Fombonne , E. ( 1999 ). The epidemiology of autism: A review . Psychological Medicine , 29 ( 4 ), 769 - 786 . Gillberg , C. , Gillberg , C. , Råstam , M. , & Wentz , E. ( 2001 ). Asperger syndrome (and high functioning autism) diagnostic interview (ASDI): A preliminary study of a new structured clinical interview . Autism , 5 ( 1 ), 57 - 66 . Gupta , A. , & Singhal , N. ( 2005 ). Psychosocial support for families of children with autism . Asia Pacific Disability Rehabilitation Journal , 16 , 62 - 83 . Hallmayer , J. , Cleveland , S. , Torres , A. , Phillips , J. , Cohen , B. , Torigoe , T. , et al. ( 2011 ). Genetic heritability and shared environmental factors among twin pairs with autism . Archives of General Psychiatry , 68 ( 11 ), 1095 - 1102 . https://doi.org/10.1001/ archgenpsychiatry. 2011 . 76 . Howlin , P. , & Moss , P. ( 2012 ). Adults with autism spectrum disorders . Canadian Journal of Psychiatry , 57 ( 5 ), 275 - 283 . Isaksen , J. , Diseth , T. H. , Schjølberg , S. , & Skjeldal , O. H. ( 2012 ). Observed prevalence of autism spectrum disorders in two Norwegian counties . The European Journal of Paediatric Neurology , 16 ( 6 ), 592 - 598 . https://doi.org/10.1016/j.ejpn. 2012 . 01 .014. Jacobson , J. , Mulick , J. , & Green , G. ( 1998 ). Cost-benefit estimates for early intensive behavioral intervention for young children with autism-General model and single state case . Behavioral Interventions , 13 , 201 - 226 . Järbrink , K. , Fombonne , E. , & Knapp , M. ( 2003 ). Measuring the parental, service and cost impacts of children with autistic spectrum disorder: A pilot study . Journal of Autism and Developmental Disorders , 33 ( 4 ), 395 - 402 . Kałużna-Czaplińska , J. , Żurawicz , E. , & Jóźwik , J. ( 2014 ). Chromatographic techniques coupled with mass spectrometry for the determination of organic acids in the study of autism . Journal of Chromatography B , 964 , 128 - 135 . https://doi.org/10.1016/j. jchromb. 2013 . 10 .026. Kałużna-Czaplińska , J. , Żurawicz , E. , Michalska , M. , & Rynkowski , J. ( 2013 ). A focus on homocysteine in autism . Acta Biochimica Polonica , 60 ( 2 ), 137 - 142 . Karst , J. S. , & Van Hecke , A. V. ( 2012 ). Parent and family impact of autism spectrum disorders: A review and proposed model for intervention evaluation . Clinical Child and Family Psychology Review , 15 ( 3 ), 247 - 277 . https://doi.org/10.1007/ s10567-012-0119-6. Kawamura , Y. , Takahashi , O. , & Ishii , T. ( 2008 ). Reevaluating the incidence of pervasive developmental disorders: Impact of elevated rates of detection through implementation of an integrated system of screening in Toyota, Japan . Psychiatry and Clinical Neurosciences , 62 ( 2 ), 152 - 159 . https://doi. org/10.1111/j.1440- 1819 . 2008 . 01748 .x. Kim , Y. S. , Leventhal , B. L. , Koh , Y. J. , Fombonne , E. , Laska , E. , Lim , E. C. , et al. ( 2011 ). Prevalence of autism spectrum disorders in a total population sample . The American Journal of Psychiatry , 168 ( 9 ), 904 - 912 . https://doi.org/10.1176/appi.ajp. 2011 . 10101532 . King , M. , & Bearman , P. ( 2009 ). Diagnostic change and the increased prevalence of autism . International Journal of Epidemiology , 38 ( 5 ), 1224 - 1234 . https://doi.org/10.1093/ije/dyp261. Kogan , M. D. , Blumberg , S. J. , Schieve , L. A. , Boyle , C. A. , Perrin , J. M. , Ghandour , R. M. , et al. ( 2009 ). Prevalence of parent-reported diagnosis of autism spectrum disorder among children in the US 2007 . Pediatrics, 124 ( 5 ), 1395 - 1403 . Koritsas , S. , & Iacono , T. ( 2009 ). Limitations in life participation and independence due to secondary conditions . American Journal on Intellectual and Developmental Disabilities , 114 ( 6 ), 437 - 448 . https://doi.org/10.1352/1944-7588- 114 .6.437. Leslie , D. L. , & Martin , A. ( 2007 ). Health care expenditures associated with autism spectrum disorders . Archives of Pediatrics and Adolescent Medicine , 161 ( 4 ), 350 - 355 . Li , N. , Chen , G. , Song , X. , Du , W. , & Zheng , X. ( 2011 ). Prevalence of autism-caused disability among Chinese children: A national population-based survey . Epilepsy & Behavior , 22 ( 4 ), 786 - 789 . https://doi.org/10.1016/j.yebeh. 2011 . 10 .002. Liptak , G. S. , Stuart , T. , & Auinger , P. ( 2006 ). Health care utilization and expenditures for children with autism: Data from U.S. national samples . Journal of Autism and Developmental Disorders , 36 ( 7 ), 871 - 879 . Lord , C. , Rutter , M. , & Le Couteur , A. ( 1994 ). Autism diagnostic interview-Revised: A revised version of a diagnostic interview for caregivers of individuals with possible pervasive developmental disorders . Journal of Autism and Developmental Disorders , 24 ( 5 ), 659 - 686 . Lotter , V. ( 1966 ). Epidemiology of autistic conditions in young children . Social Psychology , 1 , 124 - 135 . https://doi.org/10.1007/ BF00584048. Lotter , V. ( 1967 ). Epidemiology of autistic conditions in young children: II. Some characteristics of the parents and children . Social Psychiatry , 4 ( 1 ), 163 - 173 . https://doi.org/10.1007/BF00578950. Mandell , D. S. , Cao , J. , Ittenbach , R. , & Pinto-Martin , J. ( 2006 ). Medicaid expenditures for children with autistic spectrum disorders: 1994 to 1999 . Journal of Autism and Developmental Disorders , 36 ( 4 ), 475 - 485 . Matson , J. L. , & Kozlowski , A. M. ( 2011 ). The increasing prevalence of autism spectrum disorders . Research in Autism Spectrum Disorders , 5 , 418 - 425 . https://doi.org/10.1016/j.rasd. 2010 . 06 .004. McElhanon , B. O. , McCracken , C. , Karpen , S. , & Sharp , W. G. ( 2014 ). Gastrointestinal symptoms in autism spectrum disorder: A metaanalysis . Pediatrics , 133 , 872 - 883 . https://doi.org/10.1542/ peds.2013- 3995 . Montes , G. , & Halterman , J. S. ( 2008 ). Association of childhood autism spectrum disorders and loss of family income . Pediatrics , 121 ( 4 ), 821 - 826 . https://doi.org/10.1542/peds.2007- 1594 . Nygren , G. , Cederlund , M. , Sandberg , E. , Gillstedt , F. , Arvidsson , T. , Gillberg , I. C. , et al ( 2012 ). The prevalence of autism spectrum disorders in toddlers: A population study of 2-year-old Swedish children . Journal of Autism and Developmental Disorders , 42 ( 7 ), 1491 - 1497 . https://doi.org/10.1007/s10803-011-1391-x. Parish , S. L. , & Cloud , J. M. ( 2006 ). Financial well-being of young children with disabilities and their families . Social Work , 51 ( 3 ), 223 - 232 . Peacock , G. , Amendah , D. , Ouyang , L. , & Grosse , S. D. ( 2012 ). Autism spectrum disorders and health care expenditures: The effects of co-occurring conditions . Journal of Developmental and Behavioral Pediatrics , 33 ( 1 ), 2 - 8 . https://doi.org/10.1097/ DBP.0b013e31823969de. Pellicano , E. , Dinsmore , A. , & Charman , T. ( 2014 ). What should autism research focus upon? Community views and priorities from the United Kingdom . Autism, 18 ( 7 ), 756 - 770 . https://doi. org/10.1177/1362361314529627. Peng , C.-Z. , Hatlestad , P. , Klug , M. G. , Kerbeshian , J. , & Burd , L. ( 2009 ). Health care costs and utilization rates for children with pervasive developmental disorders in North Dakota from 1998 to 2004: Impact on Medicaid . Journal of Child Neurology , 24 ( 2 ), 140 - 147 . https://doi.org/10.1177/0883073808321059. Posserud , M. , Lundervold , A. J. , Lie , S. A. , & Gillberg , C. ( 2010 ). The prevalence of autism spectrum disorders: Impact of diagnostic instrument and non-response bias . Social Psychiatry and Psychiatric Epidemiology , 45 ( 3 ), 319 - 327 . https://doi.org/10.1007/ s00127-009-0087-4. Rutter , M. ( 1970 ). Autistic children: Infancy to adulthood . Seminars in Psychology, 2 ( 4 ), 435 - 450 . Saemundsen , E. , Magnússon , P. , Georgsdóttir , I. , Egilsson , E. , & Rafnsson , V. ( 2013 ). Prevalence of autism spectrum disorders in an Icelandic birth cohort . British Medical Journal Open 6 , e002748. https://doi.org/10.1136/bmjopen-2013-002748. Shimabukuro , T. T. , Grosse , S. D. , & Rice , C. ( 2008 ). Medical expenditures for children with an autism spectrum disorder in a privately insured population . Journal of Autism and Developmental Disorders , 38 ( 3 ), 546 - 552 . Singh , J. , Illes , J. , Lazzeroni , L. , & Hallmayer , J. ( 2009 ). Trends in US autism research funding . Journal of Autism and Developmental Disorders , 39 ( 5 ), 788 - 795 . https://doi.org/10.1007/ s10803-008-0685-0. Szatmari , P. , Liu , X. Q. , Goldberg , J. , Zwaigenbaum , L. , Paterson , A. D. , Woodbury-Smith , M. , et al. ( 2012 ). Sex differences in repetitive stereotyped behaviors in autism: Implications for genetic liability . American Journal of Medical Genetics Part B: Neuropsychiatric Genetics, 159B(1) , 5 - 12 . https://doi.org/10.1002/ ajmg.b. 31238 . Tehee , E. , Honan , R. , & Hevey , D. ( 2009 ). Factors contributing to stress in parents of individuals with autistic spectrum disorders . Journal of Applied Research in Intellectual Disabilities , 22 , 34 - 42 . https://doi.org/10.1111/j.1468- 3148 . 2008 . 00437 .x. Wang , J. , Zhou , X. , Xia , W. , & Tomoda , T. ( 2012 ). Parent-reported health care expenditures associated with autism spectrum disorders in Heilongjiang province , China. BMC Health Services Research , 12 ( 1 ), 7. https://doi.org/10.1186/ 1472 -6963-12-7. Xu , L. M. , Li , J. R. , Huang , Y. , Zhao , M. , Tang , X. , & Wei , L. ( 2012 ). Autism: An evidence-based knowledgebase of autism genetics . Nucleic Acids Research , 40 , D1016 - D1022 . https://doi. org/10.1093/nar/gkr1145. Yeargin-Allsopp , M. , Rice , C. , Karapurkar , T. , Doernberg , N. , Boyle , C. , & Murphy , C. ( 2003 ). Prevalence of autism in a US metropolitan area . The Journal of the American Medical Association , 289 ( 1 ), 49 - 55 . Zablotsky , B. , Black , L. I. , Maenner , M. J. , Schieve , L. A. , & Blumberg , S. J. ( 2015 ). Estimated prevalence of autism and other developmental disabilities following questionnaire changes in the 2014 national health interview survey . National Health Statistics Reports , 87 , 1 - 20 . Żurawicz , E. , Kałużna-Czaplińska , J. , & Rynkowski , J. ( 2013 ). Chromatographic methods in the study of autism . Biomedical Chromatography , 27 ( 10 ), 1273 - 1279 . https://doi.org/10.1002/bmc.2911.


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Joanna Kałużna-Czaplińska, Ewa Żurawicz, Jagoda Jóźwik-Pruska. Focus on the Social Aspect of Autism, Journal of Autism and Developmental Disorders, 2017, 1861-1867, DOI: 10.1007/s10803-017-3407-7