Older Adults with Autism Spectrum Disorders in Sweden: A Register Study of Diagnoses, Psychiatric Care Utilization and Psychotropic Medication of 601 Individuals
Journal of Autism and Developmental Disorders
Older Adults with Autism Spectrum Disorders in Sweden: A Register Study of Diagnoses, Psychiatric Care Utilization and Psychotropic Medication of 601 Individuals
Lena Nylander 0 1 3 4 5 6 7
Anna Axmon 0 1 3 4 5 6 7
Petra Björne 0 1 3 4 5 6 7
Gerd Ahlström 0 1 3 4 5 6 7
Christopher Gillberg 0 1 3 4 5 6 7
0 Department of Clinical Sciences/Psychiatry, Lund University , 221 00 Lund , Sweden
1 Petra Björne
2 Lena Nylander
3 VUB-teamet Psykiatriska Kliniken , Baravägen 1, 221 85 Lund , Sweden
4 Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg University , Gothenburg 411 19 , Sweden
5 Department of Health Sciences, Lund University , 221 00 Lund , Sweden
6 Research and Development Unit, City Office, City of Malmö , 205 80 Malmö , Sweden
7 Division of Occupational and Environmental Medicine, Lund University , 221 00 Lund , Sweden
In a Swedish sample of persons eligible for disability services and aged 55 years or older in 2012, persons (n = 601) with autism spectrum disorder diagnoses registered in specialist care were identified. Register data concerning diagnoses of other psychiatric disorders, psychiatric care, and psychiatric medication were reviewed. More than 60% had been in contact with psychiatric care. The majority had no intellectual disability (ID) diagnosis recorded during the study period. Apart from ID, affective disorders, anxiety and psychotic disorders were most commonly registered; alcohol/substance abuse disorders were uncommon. Psychotropic drug prescriptions were very common, especially in the ID group. Professionals need awareness of this vulnerable group; studies concerning their life circumstances and service requirements should be conducted.
Older adults; Autism spectrum disorders; Psychiatry
Autism spectrum disorders (ASDs) are often presumed to
be life-long disabilities. There are several follow-up
studies showing that these disorders, which in all cases are
present at an early age, are relatively stable from childhood
(Nordin and Gillberg 1998; Szatmari et al.
, and, especially if accompanied by intellectual
disability (ID), into adulthood
. In a review of
23 follow-up studies, Howlin and Moss
(Howlin and Moss
found that as adults, many individuals with ASD were
significantly disadvantaged in several ways, including
physical and mental health. Although two studies of the same
Swedish cohort with normal IQ ASD (n = 47) showed that
the number who met diagnostic criteria for any ASD slowly
(Cederlund et al. 2008; Helles et al. 2015)
still had the number of symptoms required for an ASD
diagnosis even in the follow-up study at mean age 30 years.
Only two of the 23 studies in the Howlin and Moss review
included any individuals older than 50 years, and most ASD
research today is still on children
(Howlin 2008; Howlin
and Moss 2012; Mukaetova-Ladinska et al. 2012)
very little is known about ASD in people older than around
(Happé and Charlton 2011; Perkins and Berkman
2012; Barber 2015; Lai and Baron-Cohen 2015; Bennett
and only recently has work been commenced in this
area. Among other things, it is not known how many older
individuals have diagnosed ASDs, how ASD is expressed in
older people, or if coexisting physical and mental disorders
are common. In recent years, there have been some studies
on this subject, primarily in the UK (James et al. 2006), the
(Kats et al. 2013)
, and the Netherlands
et al. 2010; Geurts and Vissers 2011; van Heijst and Geurts
2014; Geurts et al. 2016; Lever and Geurts 2016)
the knowledge concerning this group is still very limited,
both in Sweden and in most other countries.
A previous study by the research team
(Axmon et al.
examined use of psychiatric services in a sample of
older adults (n = 7936, mean age 53, age range 44–85) from
the general population, and found that only 6.4% had any
registered visit to psychiatric care (inpatient or outpatient)
during the 11-year period that the study comprised. Older
people with ID had higher inpatient and outpatient care
utilisation (OR 3.59).
In this study we focused on ASD, more specifically in
the older adult Swedish population eligible for municipal
services. The aim was to investigate the prevalence of
individuals with ASD diagnoses from specialist care, with and
without concurrent diagnoses of ID of varying severity. The
term “specialist care” refers to all medical clinics that are
not considered primary care, or general practice. The aims
included investigation of the pattern of coexistent
psychiatric diagnoses and the utilisation of psychiatric care and
psychotropic medication among any individuals found to
have ASD diagnoses.
Materials and Methods
The present study is a nation-wide register study conducted
in Sweden and comprising the years 2002–2012, with the
exception of data on prescribed drugs which have been
obtained from 2006 only.
National Registers Used in the Study
In Sweden, individuals with permanent and considerable
functional impairment can apply for municipal services
according to the Act Concerning Support and Service for
Persons with Certain Functional Impairments (Swedish
abbreviation: LSS; 1993:387). The Act covers individuals
who can be categorised as belonging to one of three specific
groups. Group 1 consists of people who have been diagnosed
with ID and/or ASD, and are thus in need of services. Group
2 consists of people with cognitive disability after sustaining
brain injury/damage in adulthood, while Group 3 consists
of people in need of support due to other permanent and
considerable disabilities that hinder their ability to function
in daily life. Group 1 is thus the only group that is defined
mainly by diagnosis.
Individuals provided with support from the municipality
under the umbrella of this act are included in the
LSS-register as well as data on which type of support they received.
This register is maintained by the Swedish National Board
of Health and Welfare and does not contain information on
individuals’ diagnoses, only on their LSS-group
classification. The register contains only those who, after their own
application, have been found to meet criteria to be given
support. Thus, not everyone diagnosed with ASD or even ID
can be expected to be registered, which means that a number
of people with ASD, especially people with normal IQ, may
not be included in the study group.
The Swedish National Board of Health and Welfare also
maintains The Swedish National Patient Register (NPR).
The NPR contains information on all individuals using
inand outpatient specialist medical care in Sweden. It contains
no information about visits to primary health care. Specialist
psychiatric care includes all psychiatric inpatient care, as
well as any outpatient care considered to require resources
above the primary care level. Registration in the NPR is
made at the date of discharge for inpatient care, and at the
date of the visit for outpatient care. Every time a patient is
registered in this way, one primary and up to 21 secondary
diagnoses are listed. Diagnoses are coded according to the
10th revision of the International Classification of Disease
(ICD-10) (WHO 1993). Diseases and/or conditions that are
not the focus of the care episode may or may not be
registered as secondary diagnoses, depending on their relevance
to the circumstances, local procedures, or the physician’s
own preferences. It is not possible to find information in
the NPR on where or when any diagnosis was first made.
In the ICD-10, the term “mental retardation” is used rather
than “intellectual disability”. However, as “intellectual
disability”/ID is the currently preferred term
(Schalock et al.
, we will use this henceforth.
Also the Swedish Prescribed Drug Register (PDR) is kept
at the Swedish National Board of Health and Welfare, and
contains information from July 2005 onwards on dispensed
(Wettermark et al. 2007)
Through the LSS register, we identified 7936 persons (3609
women and 4327 men) in Sweden who met the following
criteria: (1) they were 55 years or older on December 31st,
2012, (2) they belonged to LSS-group 1 (i.e. had been
diagnosed with ID and/or ASD), (3) they had received at least
one service according to LSS during 2012, and (4) they were
alive at the end of 2012. As outcome data was obtained for
the time period 2002–2012, information was collected for
persons aged 44 years and above. The mean age on
December 31, 2012, was 64 years (range 55–96 years).
All individuals who, during the period examined
(2002–2012), had a registered diagnosis of any ASD—
defined as an ICD-10 code for pervasive developmental
disorder (PDD), F84.0-84.9 (n = 606, 7.63%)—were extracted
using the diagnoses registered in the NPR. Five of these 606
were excluded: four women with Rett’s syndrome, F84.2,
as single diagnosis and one man with other childhood
disintegrative disorder (F84.3), leaving 601 persons (385/64%
males and 216/36% females) in the study group. However,
several individuals (103; 17%) had more than one F84
diagnosis, two of which had as many as four different
diagnoses. Therefore, diagnoses were ranked in order to classify
each person with only one F84 diagnosis. The chosen rank
order was childhood autism (F84.0), Asperger’s syndrome
(F84.5), atypical autism (F84.1), other PDD (F84.8) and
PDD, unspecified (F84.9), based on the assumption that
childhood autism and Asperger’s syndrome, respectively,
refer to more “typical” variants of ASD than the
following terms. Only three individuals in the sample had been
registered with both childhood autism (F84.0) and
Asperger’s syndrome (F84.5) diagnoses. Since 1419 persons in
the LSS group were not registered in the NPR, i. e. did not
visit inpatient or outpatient specialist care during the period
examined, we have no information regarding their possible
ASD diagnoses. The 601 remaining individuals with
registered ASD diagnoses will be referred to below as the ASD
group. All persons in the ASD group had at least one point
of registration in the NPR during 2002–2012, meaning that
they had been in contact with specialist medical care and
that ASD had been observed by the physician.
Data concerning gender, other psychiatric diagnoses,
psychiatric care utilisation and psychotropic medication were
reviewed, using data from the NPR (2002–2012) and PDR
In the NPR, the type of clinic where each visit is made
is registered based on codes determined by the Swedish
National Board of Health and Welfare. For this study, the
nine different types of adult psychiatric services were
collapsed into three groups, namely “general adult
psychiatric service” (also encompassing “psychiatric nursing
home”, “geropsychiatric service”, “specialised psychiatric
Fig. 1 Data catchment
care” and “psychiatric rehabilitation”), “forensic
psychiatric care on regional level” and “substance dependency
treatment” (also including “alcohol dependency care” and
“toxicomania care”). Registrations in any type of
psychiatric clinic were considered in total (any registration), as
well as inpatient and outpatient registrations separately.
We also calculated the mean and median number of days
in inpatient care for each of the ASD groups.
Three patient records were registered as “psychiatric
care for children and adolescents” and four records were
missing information on type of clinic and were therefore
excluded in this study, as were 73 records which were
duplicates with respect to person, clinic and date.
A number of individuals with ASD diagnoses also had
registered ID (ICD-10 code F70-79) diagnoses during the
period examined. In some cases a person had been
diagnosed with ID of different severities on different visits.
We have chosen a rank order where a specified ID takes
precedence over an unspecified ID, and the most severe
ID diagnosis takes precedence over the milder variants.
Concomitant psychiatric diagnoses other than ID were
categorised in nine groups: ADHD (F90), psychotic disorders
(F2), affective disorders (including bipolar) (F3), anxiety
disorders (F40-42), personality disorders (F60-61),
alcohol/substance use related disorders (F1 except F10.7A),
dementia (F00-03, F10.7A, F05.1) and other psychiatric
disorders (all other registered F diagnoses not belonging
to any of the above-mentioned groups).
From the PDR, information was collected concerning
certain psychotropic drugs, grouped according to the
Anatomical Therapeutic Chemical Classification (ATC-code).
The drug categories chosen were antipsychotics
(ATCcode N05A), anxiolytics (N05B), hypnotics and sedatives
(N05C) and antidepressants (N06A).
Figure 1 shows the procedure of data inclusion.
Ethics Approval and Consent to Participate
The study was approved by the Regional Ethical Review
Board. This study is part of a larger project, which used
anonymised datasets drawn from four—in the present
study three—official national registries maintained by
the National Board of Health and Welfare and Statistics
Sweden. The National Board of Health and Welfare and
Statistics Sweden provided separate secrecy reviews in
2014 before access to the data. Due to the requirement
for anonymised data, individuals could not be asked for
consent to participate; instead the reverse principle was
applied, with active refusal of participation required
to avoid inclusion in the study. Information about the
planned study was published in the national newspaper
‘Dagens Nyheter’ and one version was easy-to-read text
for the UNIK, the magazine of the Swedish National
Association for Persons with Intellectual Disability
(print run of 22,000 copies). The target audience for the
UNIK magazine are mainly members (people with ID)
and their families. The advertisement presented the study
and contained information on how to contact the research
manager by phone, email or mail to opt out of the study.
The research manager was responsible for contacting the
national registries to ensure that those not wanting to
participate were excluded before the registries provided any
data to the research manager. There were no refusals to
This work was funded by the Swedish Research Council
for Health, Working Life and Welfare. The funding agency
had no role in the design, analysis, and interpretation of this
study. The requirement from the national fund is only Open
profound. Forty-eight individuals (42%) in the group with
other/unspecified ID had atypical/other/unspecified ASD
diagnoses, and 19% of the ASD group had been assigned
other/unspecified ID diagnoses.
Of the 601 persons with ASD, 86 had two different
ASD diagnoses, 15 had three different diagnoses and two
had four different diagnoses.
Figure 3 shows that, apart from the heterogeneous
group “other psychiatric disorders”, affective disorders
were the most commonly registered conditions, followed
by anxiety and psychotic disorders. This pattern is fairly
consistent across the ASD categories. The group with no
ID dominates among those with registered psychiatric
diagnoses. Most common in this group were affective and
anxiety disorders. People with ASD and ID have also often
been diagnosed with psychiatric disorders, especially
disorders in the “other” group.
A small number of patients had been diagnosed with
ADHD. Similar to alcohol and/or substance use-related
disorders, ADHD was diagnosed mainly in the group
Fig. 3 Psychiatric diagnoses in
people with/without ID and in
Table 2 shows the number of persons with psychiatric
care utilisation as well as the number of psychiatric care
visits. Number of visits (out-patient as well as in-patient)
to different categories of adult psychiatric care is shown, as
well as number of days as psychiatric inpatient for the five
ASD categories. Almost all visits are made in clinics
belonging to the category “general adult psychiatric care”. Visits
to clinics giving forensic psychiatric care had been made
by people diagnosed with Asperger’s syndrome (F84.5) and
PDD, unspecified (F84.9). Only individuals with an
Asperger’s syndrome diagnosis, had made visits to substance
dependency treatment clinics. The group with Asperger’s
syndrome had the highest number of people who had spent
time as psychiatric inpatients. 220 (37%) of the 601 persons
had not been in psychiatric care during the period examined.
Their ASD diagnoses have thus been registered in somatic
Table 3 shows number, percentages and the OR for using
any specialist psychiatric care for the ASD subgroups, ID
versus no ID, gender and age group, respectively. The OR
for people with Asperger’s syndrome to have contact with
specialist psychiatry was almost seven compared to people
Number of visits to different categories of psychiatric
psychiatric care on
aOne person may contribute with more than one visit
Any No psychiatric care
psychiatric n (%)
OR for any psychiatric care 95% CI
versus no psychiatric care
F84.0 childhood autism
F84.5 Asperger syndrome
F84.1 atypical autism
F84.8 other pervasive
with childhood autism. The OR was also elevated for people
with ID compared to no ID, for males and for younger versus
Table 4 shows the number and percentage of people,
categorised as those with and without a registered ID diagnosis,
with at least one prescription of psychotropic drugs. The
drugs investigated were categorised as neuroleptics (N05A),
anxiolytics (N05B), hypnotics and sedatives (N05C) and
antidepressants (N06A). The table also shows the number
and percentage of people prescribed with more than one
category of the above mentioned drugs.
To our knowledge, this register study describes the largest
group of older adults with ASD diagnoses that has ever been
studied. Several authors
(e. g. Happé and Charlton 2011;
Perkins and Berkman 2012; Bennett 2016)
the need for research and data on older people with ASD,
and our study provides knowledge concerning psychiatric
diagnoses, psychiatric care and psychotropic medication.
The most common ASD diagnosis in the group was
childhood autism (F84.0), often regarded as the most severe form
of ASD. This may be due to diagnostic traditions—with only
one available autism diagnosis instead of a spectrum—when
the persons were young and the autism diagnosis was first
made, and/or the selection of the group being based on their
need for extensive help. In the younger subgroup (born after
1950), Asperger’s syndrome (F84.5) was a more common
diagnosis than in the older part of the group. Since we have
no way of knowing when any diagnosis in the group was
first made, we have no explanation for this, other than that
the Asperger’s syndrome diagnosis was first listed in ICD-10
(WHO 1993) and that it has slowly become more
wellknown and used in the past 10–15 years. However, since the
more recent diagnostic manual DSM-5
Psychiatric Association 2013)
lists only one label, autism spectrum
disorder (ASD), it is to be expected that other diagnoses,
e.g. childhood autism or Asperger’s syndrome, will be less
used in the future.
Studies from recent years have shown that ASD may be
more difficult to diagnose in females than in males
et al. 2012; Frazier et al. 2014)
and this is indicated by our
study as well, where there was a tendency towards other or
unspecified ASD being more common among women than
in men. The same tendency was seen in the older ASD group
as compared with the younger one. However, tendencies in
this study must be regarded with caution, since no measures
of statistical significance are included.
The majority of the group had no registered ID diagnosis.
This could be due either to under registration of ID, or to
ASD being diagnosed in increasing numbers in individuals
with intellectual functioning in the normal range,
including in older adults. Surprisingly, mild ID was less common
than severe ID in the ASD group, and most common was
other/unspecified ID. This is probably an effect of the ID
diagnoses being registered in connection with visits in the
care system on account of symptoms of illness rather than
after a cognitive assessment; moreover, the physicians in
question may have had registered information provided to
them by care staff from social services in the event that he/
she did not have access to earlier evaluations. If care staff
found information about ASD more pertinent, mild ID may
have stayed unregistered. Furthermore, severe/profound ID
may be more conspicuous during a medical examination.
Also, it is more likely that individuals with more severe
impairments and pervasive needs are registered in the LSS
register. This register, as mentioned above, can thus not be
expected to include all people with ASD, which is a
limitation to this study.
As in general adult psychiatry, apart from the
heterogeneous group “other psychiatric disorders”, affective disorders
were the most commonly diagnosed concomitant
psychiatric disorders, followed by anxiety and psychotic disorders,
in the total ASD sample. Patients with childhood autism
(F84.0) and ID had more “other” psychiatric disorders than
the other groups, which may reflect diagnostic
difficulties with patients who often have very low communicative
skills. Affective and anxiety disorders were often
diagnosed in patients with Asperger’s syndrome (F84.5)
without ID, which is in concordance with other studies
and Geurts 2016)
. Alcohol and/or substance use-related
disorders were diagnosed mainly in the group without ID,
probably reflecting the fact that the more disabled persons
had very limited access to the pathogens in question. Only
patients with Asperger’s syndrome diagnoses had been
visiting specialist clinics for these disorders, which,
according to clinical experience, may also be underdiagnosed and
thus undertreated in persons with ID.
Our results are, to a great extent, in line with the earlier
studies on adults with ASD, which have shown that
concomitant psychiatric symptoms and diagnoses are common
(Hutton et al. 2008; Hofvander et al. 2009; Buck et al. 2014;
Hirvikoski et al. 2016; Helles et al. 2015)
, also when
compared to other psychiatrically referred adults (Joshi et al.
2013). Patients with Asperger’s syndrome diagnoses, F84.5
and no ID make up the majority among those with
registered psychiatric diagnoses. Affective and anxiety disorders
were the most common concurrent disorders, as was the case
in for example the younger normal IQ sample studied by
Hofvander et al. (2009). Similarly, Hutton et al. (2008) also
reported that mood disorders were the most frequent
newonset psychiatric disorders in their study group. In contrast
to the latter study, where 43% of 122 persons with ASD also
had ADHD, we found only 4% with a registered diagnosis
of ADHD. This may indicate that awareness of the possible
existence of ADHD not only in children and young adults
but also in older adults is a recent phenomenon
et al. 2012; Guldberg-Kjär et al. 2013)
. The former belief, as
expressed in the DSM-IV
, that ADHD should not be diagnosed in
individuals with ASD, may also provide an explanation for these low
numbers of ADHD diagnoses.
In our study, the total number of individuals diagnosed
with any psychotic disorder was 71, or almost 12%; this
figure roughly matches the findings of Hofvander et al.
(2009), while Lever and
as an exclusion criterion. In another sample from an adult
psychiatric clinic (n = 270), 21% had been diagnosed with
a psychotic disorder
(Nylander et al. 2012)
; and in a recent
population-based study, Supekar et al. (2016) found a
prevalence of 18% for schizophrenia in adults 35 years or older
with ASD. Thus, our results do not differ from other
findings, and point toward a high prevalence of psychotic
disorders in middle-aged or older individuals with ASD.
In a recent study by Lever and
48 individuals with ASD, 55–79 years old and with IQ > 80,
66.9% were found to have some kind of lifetime
psychiatric disorder, and 44% reported symptoms consistent with a
mood disorder diagnosis. Lever and Geurts also found that
self-reported psychiatric symptoms were more common in
this ASD group of older people than in an age-matched
control group, but less common than in two comparison groups
of younger people with ASD. In our sample, which is not
based on self-reported lifetime symptoms but on registered
diagnoses, 49.6% of the whole ASD group had some kind of
psychiatric diagnosis during the period examined, and 19.6%
had had a mood disorder diagnosis. Of the group (n = 345)
who had no ID diagnosis registered, 69.2% had some kind of
psychiatric diagnosis but only 10.8% had affective disorder
diagnoses. Twelve percent had some kind of psychotic
disorder diagnosis, which is the same prevalence as was found
by Hofvander et al. (2009).
Of our ASD group, 381 patients (63.4%) had been in
contact with specialised psychiatric care and 151 (25%) had
been in-patients during the period examined. This exceeds
the numbers (20% in contact with psychiatric care) reported
by Axmon et al. (2016) for the larger group of older people
eligible for LSS services, which in turn exceeded the 6% in
the matched group from the general population. Only 15
individuals, or 11%, of the group with Asperger’s syndrome
had not been in contact with psychiatric care, and 43% had
been psychiatric in-patients, which may be interpreted as a
sign of vulnerability in these individuals. The OR for being
in contact with specialist psychiatry was almost seven times
higher for people with Asperger’s syndrome compared to
people with childhood autism. Also, people with Asperger’s
syndrome exclusively had been in contact with substance
dependency treatment clinics or forensic psychiatry, which
may point to a greater risk for substance dependency and/
or criminal behaviour in this intellectually more able group.
Other factors raising the OR for psychiatric contact were the
presence of ID, male gender and belonging to the younger
rather than older group.
Other authors have found that psychotropic medication,
including polypharmacy, is frequently prescribed to adults
(Esbensen et al. 2009; Åkerström 2001; Buck
et al. 2014; Jobski et al. 2017)
. In the group that we studied,
63% of patients without registered ID diagnosis and as many
as 84% of those with ID in combination with ASD had been
prescribed antipsychotic medication. This is in contrast to
the number (12%) of individuals with diagnosed
concomitant psychotic disorders but may be seen as an indication
that it is common practice to treat people with ASD,
especially if they also have ID, with antipsychotics as a way of
managing behaviours. The effects and side effects of these
treatments in adults and older adults require i
). Also the other categories of psychotropic
drugs investigated were more frequently prescribed to
individuals with double diagnoses. Three or four different
psychotropic drugs were prescribed to 32 and 24% of all
individuals examined, respectively. Only 58 (9.6%) of all
indiviuals in the study had not been prescribed any of the
studied psychotropic drugs during the study period, although
50% had no psychiatric diagnosis other than ASD, with or
without ID registered. Compared to other findings, e.g. those
of Jobski et al. (2017), this group of older adults with ASD
were very often prescribed psychotropic drugs.
We have no way of knowing to what extent the group in
our study is representative for all older adults in Sweden
with ASD. The group was selected according to three
criteria: (1) having received LSS service in 2012, (2) having been
in contact with secondary health care and (3) having been
assigned an ASD diagnosis during 2002–2012. It is likely
that several individuals in the studied age group had not
been given any LSS service, and/or not been in contact with
health care, and/or not assigned an ASD diagnosis when
seeking medical care. It is also probable that some
individuals with ASD have not been classified in LSS group 1, but
have received services resulting from classification in one of
the other two groups. However, since 87% of all LSS service
users have been classified in LSS group 1 (Socialstyrelsen
2017), the number of older people with ASD in LSS groups
2 or 3 is probably very small. Our results should thus be
seen as minimum numbers, and to our knowledge it is the
largest group of older adults with ASD hitherto described
in the world. The selection of cases on the basis of the
LSSregister does “guarantee” that the individuals included had
significant functional impairments, and therefore meet the
basic requirements for an ASD diagnosis.
The results showed that there are older people in Sweden
with ASD diagnoses who have significant needs for
services, and who require psychiatric specialist services due to
concomitant psychiatric disorders. It seems that the group
with Asperger’s syndrome, or ASD without ID, is especially
vulnerable to psychiatric disorders. There is, as a number of
authors have pointed out, a lack of research concerning ASD
in this age group, and it is likely that ASD is underdiagnosed
and that older individuals with ASD are provided with
inadequate support due to this lack of knowledge. Still, not much
is known concerning which socio-economic conditions older
individuals with ASD live under, which services they need
or which services they actually are offered.
Acknowledgments This work was funded by the Swedish Research
Council for Health, Working Life and Welfare (Forte Dnr: 2014-4753).
The funding agency had no role in the design, analysis, and
interpretation of this study. The requirement from the national fund is only Open
Author Contributions LN, AA, PB, GA, CG have contributed
considerably to the manuscript.
Open Access This article is distributed under the terms of the
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