The Rise of Autism

"This innovative book addresses the question of why increasing numbers of people are being diagnosed with autism since the 1990s. Providing an engaging account of competing and widely debated explanations, it investigates how these have led to differing interpretations of the same data. Crucially, the author argues that the increased use of autism diagnosis is due to medicalisation across the life course, whilst holding open the possibility that the rise may also be partly accounted for by modern-day environmental exposures, again, across the life course. A further focus of the book is not on whether autism itself is valid as a diagnostic category, but whether and how it is useful as a diagnostic category, and how the utility of the diagnosis has contributed to the rise. This serves to move beyond the question of whether diagnoses are 'real' or social constructions, and instead asks: who do diagnoses serve to benefit, and at what cost do they come? The book will appeal to clinicians and health professionals, as well as medical researchers, who are interested in a review of the data which demonstrates the rising use of autism as a diagnosis, and an analysis of the reasons why this has occurred. Providing theory through which to interpret the expanding application of the diagnosis and the broadening of autism as a concept, it will also be of interest to scholars and students of sociology, philosophy, psychiatry, psychology, social work, disability studies and childhood studies.

The costs and benefits of diagnosis of ADHD: commentary on Holden et al.

EditorialIn this journal, Holden, Jenkins-Jones, Poole, Morgan, Coghill and Currie , CAPMH 7:34, 2013, report on the prevalence and financial costs of treating people with attention deficit hyperactivity disorder (ADHD) in the UK over the last ten years. We commend the authors on their thorough cost analysis, and discuss differences in prevalence estimates of diagnosed ADHD, that is the proportion of the child population with an ADHD diagnosis, which varies dramatically between studies. We also discuss the reasons for this. Regional variation in application of diagnostic criteria and clinical subjectivity are likely partial explanations.Economic and Social Research Council (ESRC

Co-Occurrence of Developmental Disorders: Children Who Share Symptoms of Autism, Dyslexia and Attention Deficit Hyperactivity Disorder

Children with autism spectrum disorders (ASD) have a higher risk of suffering from several other conditions. In this chapter I review the extent to which autistic individuals can also experience a range of other difficulties, but my focus will be on the common neurodevelopmental disorders. The most common of these include dyslexia, attention deficit hyperactivity disorder (ADHD), dyspraxia, specific language impairment, and dyscalculia. There is considerable symptom overlap in particular between ADHD and dyslexia, and like autism both are described as developmental disorders by psychiatric classification systems (American Psychiatric Association, 2000; World Health Organization., 1992). Overlapping conditions are termed \u2018co-morbidity\u2019 by medical practitioners. Co-morbidity may reflect the greater difficulties experienced by children with a combination of deficits. Sometimes it is apparent that many children with a developmental disorder could be classified in several ways. Here I will firstly examine the research evidence that examines how often symptoms of dyslexia and ADHD occur in the population of autistic children, and second, review the various theories that have tried to explain why such co-occurring difficulties are so common. \u2018Comorbidity\u2019, a term used in medical literature to mean a dual diagnosis, or multiple diagnoses, can reflect an inability to supply a single diagnosis that accounts for all symptoms. Children with ASD have been shown to have higher rates of epilepsy, with 30% of cases having epilepsy comorbid (Danielsson, Gillberg, Billstedt, Gillberg, & Olsson, 2005). Other conditions that are commonly co-morbid with ASD include hearing impairment (Kielinen, Rantala, Timonen, Linna, & Moilanen, 2004) mental health and behavioural problems (Bradley, Summers, Wood, & Bryson, 2004), including anxiety, and depression (Evans, Canavera, Kleinpeter, Maccubbin, & Taga, 2005). It has also been shown that parents of autistic children are twice as likely themselves to have suffered from psychiatric illness than parents of non-autistic children (Daniels et al., 2008). Most of these problems are distinct from those examined in this chapter: the common developmental disorders of childhood which are also found to co-occur with autism, particularly ADHD and dyslexia. Before reviewing the evidence that suggests many children share difficulties symptomatic of these conditions, and the theories of why this may be, I will briefly describe how dyslexia and ADHD manifest themselves

Interaction of the collimated neutron beam with various phantoms of the brain

Results of modelling of interaction of the collimated neutron beam with various phantoms of the brain are presented in the article. Modeling was carried out in the MCU-PTR program. Three homogeneous dosimetry phantoms of different structure have been simulated as biological tissues. Epithermal neutron flux density is 109 cm-2·s-1

Diagnosing Autism Spectrum Disorders in Children: Medical and Social Perspectives.

In this submission, five articles are presented examining one theme: diagnosis of autism spectrum disorders (ASD) in children. Three articles provides perspectives on various social and medical factors that influence the diagnosis of ASD, and the others examine social and behavioural outcomes for children diagnosed with ASD. One article provides an in depth examination of the dilemmas of diagnosis from a parental perspective. The research utilized both qualitative and quantitative methods. A secondary analysis of a longitudinal birth cohort study revealed that there were a number of children who had autistic traits equally severe as those with clinical diagnosis. Further analysis exposed a possible gender bias in diagnosis. Outcomes for children with ASD diagnoses were worse than for those without diagnoses but with comparable behaviours as preschoolers. ASD diagnosis apparently had no positive effect on the developmental trajectory of prosocial behaviour. The implications of these results are discussed. Analysis of qualitative data collected in semi-structured interviews with parents of both diagnosed and undiagnosed children exposed dilemmas faced by parents as they contemplated an ASD diagnosis and highlighted parental action to de-stigmatise the condition after diagnosis had been applied. The body of work as a whole falls at the junction of clinical and educational psychology, developmental psychology, social psychology, social psychiatry, sociology and epidemiology. It draws attention to a number of social processes that contribute to ASD diagnosis. Overall, it is argued, the work supports the conceptualisation of ASD as both a biologically and socially determined condition.ESRC/MR

The association of attention deficit hyperactivity disorder with socioeconomic disadvantage: alternative explanations and evidence

addresses: ESRC Centre for Genomics in Society (Egenis) & Institute of Health Research, University of Exeter Medical School, Exeter, UK.OnlineOpen Article. This is a copy of an article published in the Journal of Child Psychology and Psychiatry. This journal is available online at: http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1469-7610Studies throughout Northern Europe, the United States and Australia have found an association between childhood attention deficit hyperactivity disorder (ADHD) and family socioeconomic disadvantage. We report further evidence for the association and review potential causal pathways that might explain the link.ESRC’s Secondary Data Analysis InitiativeNational Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) for the South West Peninsul

Prevalence of parent-reported ASD and ADHD in the UK: Findings from the millennium cohort study

The final publication is available at Springer via http://dx.doi.org/10.1007/s10803-013-1849-0The UK prevalence of parent-reported autism spectrum disorder (ASD) and attention deficit/hyperactivity disorder (ADHD) were estimated from the Millennium Cohort Study. Case definition was if a doctor or health care professional had ever told parents that their child had ASD and/or ADHD. Data were collected in 2008/2009 for 14,043 children. 1.7 % of children were reported as having ASD (95 % CI 1.4-2.0) at mean age 7.2 years (SD = 0.2; range = 6.3-8.2). 1.4 % reportedly had ADHD (95 % CI 1.2-1.7), and 0.3 % had both ASD and ADHD (95 % CI 0.2-0.5). After adjusting for socio-economic disadvantage, only male sex (p < 0.001 for both conditions) and cognitive ability, p = 0.004 (ASD); p = 0.01 (ADHD) remained strongly associated. The observed prevalence of parent-reported ASD is high compared to earlier UK and US estimates. Parent-reported ADHD is low compared to US estimates using the same measure. © 2013 Springer Science+Business Media New York.National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) for the South West Peninsul

Does father-child conflict mediate the association between fathers' postnatal depressive symptoms and children's adjustment problems at 7 years old?

This is the author accepted manuscript. The final version is available from Cambridge University Press via the DOI in this record.Background Paternal depressive symptoms are associated with children's emotional and behavioural problems, which may be mediated by negative parenting. But there is no research on the influence of paternal depressive symptoms on children's emotion regulation and limited literature investigating fathers’ parenting as a mediator in the pathway between paternal depressive symptoms and children's externalizing and internalizing problems. We aimed to investigate the mediating role of father–child conflict (at 3 years) in the association between postnatal paternal depressive symptoms (at 9 months) and children's emotional and behavioural problems (at 7 years) (aim 1). We also examined whether mediation pathways were more pronounced for boys or for girls (aim 2). Method Secondary data analysis was conducted on the Millennium Cohort Study, when children were 9 months, 3 years and 7 years old (n = 3520). Main study variables were measured by self-report questionnaires. Fathers completed the Rutter Scale (depressive symptoms) and the Parent–Child Relationship Questionnaire (father–child conflict), while mothers completed the Strengths and Difficulties Questionnaire and the Social Behaviour Questionnaire (child emotional and behavioural problems, emotion regulation). We used structural equation modelling to estimate direct, indirect and total effects of paternal depressive symptoms on child outcomes, mediated by father–child conflict whilst adjusting for relevant covariates (maternal depressive symptoms, child temperament, marital conflict, and socio-economic factors such as poverty indicator and fathers’ education level). Multi-group and interaction analysis was then conducted to determine the differential effect by gender of the association between paternal depressive symptoms on child outcomes via father–child conflict. Results Father–child conflict mediated the association between paternal depressive symptoms and emotion regulation problems [standardized indirect effect (SIE) 95% confidence interval (CI) −0.03 to −0.01, p < 0.001; standardized total effect (STE) 95% CI −0.05 to −0.01, p < 0.05] (aim 1). Father–child conflict mediated a larger proportion of the effect in boys (SIE 95% CI −0.03 to −0.01, p < 0.001; STE 95% CI −0.05 to 0.00, p = 0.063) than it did in girls (SIE 95% CI −0.02 to −0.01, p < 0.001; STE 95% CI −0.04 to 0.01, p = 0.216) (aim 2). Conclusions Father–child conflict may mediate the association between postnatal paternal depressive symptoms and children's emotion regulation problems. Paternal depressive symptoms and father–child conflict resolution may be potential targets in preventative interventions

Autism diagnosis as a social process.

When a child or adult is referred for an autism diagnosis, clinicians from different backgrounds work together to make a diagnostic decision. A few studies have asked clinicians in interview how they feel about diagnosis and what the challenges are. We interviewed clinicians in child and adult assessment services in England, and from different professional backgrounds, about the challenges of autism diagnosis and the factors that might influence the assessment process. We found that there were a number of challenges in autism diagnosis, especially when someone coming for diagnosis was considered to be near the diagnostic threshold. Clinicians told us that making a diagnosis was like creating a 'narrative': looking at many different factors that told a story about a person, rather than just looking at the results of diagnostic tests. Clinicians do not always agree with the results of those tests and have to use their specialist clinical judgement to make decisions. Clinicians were concerned about the amount of time people have to wait for an autism assessment, and the resulting pressure on the assessment process. The findings of this work can help us to understand how diagnosis happens and consider ways in which it can be improved for adults, children and families coming for assessment, as well as clinicians