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IJE Advance Access originally published online on September 7, 2009
International Journal of Epidemiology 2009 38(5):1234-1238; doi:10.1093/ije/dyp256
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Published by Oxford University Press on behalf of the International Epidemiological Association © The Author 2009; all rights reserved.

Commentary: Effects of diagnostic thresholds and research vs service and administrative diagnosis on autism prevalence

Tony Charman1,*, Andrew Pickles2, Susie Chandler1, Lorna Wing3, Susan Bryson4, Emily Simonoff5, Tom Loucas6 and Gillian Baird7

1 Centre for Research in Autism and Education, Department of Psychology and Human Development, Institute of Education, London, UK.
2 Division of Epidemiology & Health Sciences, University of Manchester, Manchester, UK.
3 The NAS Lorna Wing Centre for Autism, Elliot House, Bromley, Kent, UK.
4 Departments of Pediatrics and Psychology, Dalhousie University, Halifax, Nova Scotia, Canada.
5 Institute of Psychiatry, Kings College London, London, UK.
6 School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK.
7 Guy's & St Thomas’ NHS Foundation Trust, London, UK.

* Corresponding author. Centre for Research in Autism and Education, Department of Psychology and Human Development, Institute of Education, London, WC1H 0AL, UK. E-mail: t.charman@ioe.ac.uk

Accepted 23 September 2008

The first 150 words of the full text of this article appear below.

King and Bearman1 are to be congratulated on their sophisticated analysis of the Californian Department of Developmental Services (DDS) database. In contrast with previous attempts to examine diagnostic substitution and diagnostic accretion (both in the same data source2 and in national administrative data sources3), which allowed time trends but not individual child-level diagnostic substitutions and accretions to be examined, they demonstrated that children previously classified with ‘mental retardation’ account for one-quarter of the measured increase in autism prevalence in the DDS. However, King and Bearman highlight the fact that this leaves nearly three-quarters of the increase to be explained by other factors. The information available in administrative databases such as the DDS do not allow for any test of what these ‘other factors’ might be. Thus, their analysis does not answer the ‘great questions’ that have engaged both the scientific community and the general public: has there been a . . . [Full Text of this Article]


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