Ahmed Ibrahim Human Reproductive Epidemiology December 2, 2007 Autism Spectrum Disorders and Socioeconomic Status: A tale ...
<ul><li>Background: Autism Spectrum Disorders </li></ul><ul><li>Factors Affecting Demographic Studies of ASD  </li></ul><u...
<ul><li>Background: Autism Spectrum Disorders </li></ul>
Autism Spectrum Disorder: Clinical Definition <ul><li>Set of neurodevelopmental disorders  </li></ul><ul><li>Deficits fall...
3. ASD is is organized into five pervasive developmental disorders (PDD’s) Prevalent -Autism (Dr. Leo Kanner, Johns Hopkin...
Autism Spectrum Disorder: Etiology GENETIC ENVIRONMENTAL COOPERATIVE Del. Epigenesis Hoxa-1:Valproic Acid Non-mutagenic Te...
2. Factors Impacting Demographic Studies of ASD
Factors affecting ASD and Social Class studies <ul><li>Ascertainment   </li></ul><ul><li>Case definition variability  </li...
3. Review Objectives
Yes 2002 Croen et al Yes 2001 Fombonne Yes 1996 Cuccaro Yes 1970 Treffert Yes 1967 Rutter and Lockyer Yes 1966 Lotter Yes ...
No 2007 Oliviera No 1997 Fombonne No 1997 Arvidsson No 1992 Fombonne No 1971 Ritvo et. Al Association Year Citation No 200...
Review Objectives <ul><li>Investigate the distribution of autism among social class </li></ul><ul><li>2. Compare studies w...
4. Comparative Studies
Ritvo et. Al, 1971 : Los Angeles Metropolitan Area Population: Hospitalized children (12 years or younger) at the UCLA Neu...
<ul><li>Lotter et. Al, 1966- Middlesex County, London England </li></ul><ul><li>-Population: Public/private and handicappe...
Results: Lotter et al. According to the Registrar General Social Class Identification Nuclear Autistic Children:  61% soci...
The distribution of the children with autism by social class: dev. Delay controls (Graffar class I: 18%:2% ; class II: 6.7...
 
Maternal and Paternal Age and Risk of Autism Spectrum Disorders   Lisa A. Croen, PhD; Daniel V. Najjar, MS; Bruce Fireman,...
Copyright restrictions may apply. Croen, L. A. et al. Arch Pediatr Adolesc Med 2007;161:334-340. Parental Age Modeled as a...
Copyright restrictions may apply. Croen, L. A. et al. Arch Pediatr Adolesc Med 2007;161:334-340. Parental Age Modeled as a...
<ul><li>Case Control Study </li></ul><ul><li>All singleton births at Kaiser Permanente (N. California) 1995-1999 </li></ul...
 
6. Conclusions
<ul><li>There is likely no association between social class and ASD. </li></ul><ul><li>This association may not be consist...
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Autism Study Proposal

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This was a study design project for my reproductive epidemiology course pertaining to autism.

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  • .and it would be interesting to see if a nother factor was children from wealthier backgronds getting over-diagnosed, because parents may seek a more socially acceptable label than plain learning disaiblities/mental retardation and get it, as diagnostic standards vary widely - from a 10 point checklist to 3 hour interview.
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  • This useful but just shows that the association with social class is almost certainly because the children from poorer backgrounds don't get diagnosed properly. This has been improving hence the more recent the study, the more likely to find no association. Look at Wing (1981) who concluded that then.
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Autism Study Proposal

  1. 1. Ahmed Ibrahim Human Reproductive Epidemiology December 2, 2007 Autism Spectrum Disorders and Socioeconomic Status: A tale of two spectra
  2. 2. <ul><li>Background: Autism Spectrum Disorders </li></ul><ul><li>Factors Affecting Demographic Studies of ASD </li></ul><ul><li>Review Objectives </li></ul><ul><li>Comparative Studies </li></ul><ul><li>Conclusions </li></ul>Presentation Preview
  3. 3. <ul><li>Background: Autism Spectrum Disorders </li></ul>
  4. 4. Autism Spectrum Disorder: Clinical Definition <ul><li>Set of neurodevelopmental disorders </li></ul><ul><li>Deficits fall into three categories </li></ul><ul><li>-Social Interaction </li></ul><ul><li>-Communication/Linguistic Development </li></ul><ul><li>-Repetitive stereotyped behavior </li></ul>
  5. 5. 3. ASD is is organized into five pervasive developmental disorders (PDD’s) Prevalent -Autism (Dr. Leo Kanner, Johns Hopkins Hospital, 1943) -Asperger Syndrome (Dr. Hans Asperger, Germany, 1943) Rare -PDD-NOS (aka miscellaneous) -Rett Syndrome (primarily female cases) -Child Disintegrative Disorder. Autism Spectrum Disorder: Historical
  6. 6. Autism Spectrum Disorder: Etiology GENETIC ENVIRONMENTAL COOPERATIVE Del. Epigenesis Hoxa-1:Valproic Acid Non-mutagenic Teratogenesis -Rubella -Mercury Exposure Chromosomal Aberrations Fragile X syndrome Single-gene mutations RELN Mutagenesis
  7. 7. 2. Factors Impacting Demographic Studies of ASD
  8. 8. Factors affecting ASD and Social Class studies <ul><li>Ascertainment </li></ul><ul><li>Case definition variability </li></ul><ul><li>Small sample size </li></ul><ul><li>Inadequate control group </li></ul><ul><li>Limited measures of social class </li></ul><ul><li>Social class fluctuation (over time) </li></ul>
  9. 9. 3. Review Objectives
  10. 10. Yes 2002 Croen et al Yes 2001 Fombonne Yes 1996 Cuccaro Yes 1970 Treffert Yes 1967 Rutter and Lockyer Yes 1966 Lotter Yes 1960 Creak and Ini Association Year Citation
  11. 11. No 2007 Oliviera No 1997 Fombonne No 1997 Arvidsson No 1992 Fombonne No 1971 Ritvo et. Al Association Year Citation No 2007 Oliviera No 1997 Fombonne No 1997 Arvidsson No 1992 Fombonne No 1971 Ritvo et. Al
  12. 12. Review Objectives <ul><li>Investigate the distribution of autism among social class </li></ul><ul><li>2. Compare studies which used active and passive surveillance of autism among social class. </li></ul><ul><li>Hypothesis: There is no association between Autism and social class. Furthermore, passive surveillance is not an accurate approach of predicting the distribution of autism and social class. </li></ul>
  13. 13. 4. Comparative Studies
  14. 14. Ritvo et. Al, 1971 : Los Angeles Metropolitan Area Population: Hospitalized children (12 years or younger) at the UCLA Neuropsychiatric Institute. -Time period: 1961-1970 -Total Sample: 148 patients -Cases: 74 patients diagnosed with autism -Control group: sex, age, and TOA matched 74 patients with other disorders
  15. 15. <ul><li>Lotter et. Al, 1966- Middlesex County, London England </li></ul><ul><li>-Population: Public/private and handicapped children (8-10) in 9 schools in Middlesex county </li></ul><ul><li>-Ascertainment: Surveys mailed to public/private school administrators/teachers </li></ul><ul><li>Stage I: 75,930 children screened through school administrators </li></ul><ul><li>-Cases: Multi-stage screening involving evaluation by investigators and child behavior psychologists, medical records, parent interviews to determine case definition. </li></ul><ul><li>35 were diagnosed as and 26 showing autistic behavior </li></ul><ul><li>15 were diagnosed with nuclear autism (severe autism) </li></ul><ul><li>20 were diagnosed with mild “non-nuclear” autism </li></ul><ul><li>Remaining 26 were retained for comparison </li></ul>
  16. 16. Results: Lotter et al. According to the Registrar General Social Class Identification Nuclear Autistic Children: 61% social class I, II Non-nuclear Autistic children: 31% social class I, II Children with autistic behavior: 24% social class I, II Note: 24% of all active males in Middlesex were in the upper two social class levels. I Professional etc occupations II Managerial and technical occupations IIIN Skilled non-manual occupations IIIM Skilled manual occupations IV Partly-skilled occupations V Unskilled occupations VI Armed forces Registrar General Social Class Identification
  17. 17. The distribution of the children with autism by social class: dev. Delay controls (Graffar class I: 18%:2% ; class II: 6.7%: 6%; class III: 24.8%:22% ; class IV: 41%:63%; class V: 9.5%:7%) Epidemiology of autism spectrum disorder in Portugal: prevalence, clinical characterization, and medical conditions (2007) Guiomar Oliveira* MD PhD, et al.
  18. 19. Maternal and Paternal Age and Risk of Autism Spectrum Disorders Lisa A. Croen, PhD; Daniel V. Najjar, MS; Bruce Fireman, MA; Judith K. Grether, PhD <ul><li>Retrospective Cohort Study </li></ul><ul><li>All singleton births at Kaiser Permanente (N. California) 1995-1999 </li></ul><ul><li>Cases were identified as diagnosed twice during outpatient visits at KP </li></ul><ul><li>Of 132 844 births, 593 were diagnosed as autistic. </li></ul><ul><li>Maternal age, paternal age, and income level among other covariates were investigated. </li></ul>
  19. 20. Copyright restrictions may apply. Croen, L. A. et al. Arch Pediatr Adolesc Med 2007;161:334-340. Parental Age Modeled as a Categorical Variable for Autism Spectrum Disorders
  20. 21. Copyright restrictions may apply. Croen, L. A. et al. Arch Pediatr Adolesc Med 2007;161:334-340. Parental Age Modeled as a Continuous Variable for ASDs
  21. 22. <ul><li>Case Control Study </li></ul><ul><li>All singleton births at Kaiser Permanente (N. California) 1995-1999 </li></ul><ul><li>Cases were identified as diagnosed by Metropolitan Atlanta Developmental Disabilities Surveillance Program (MADDSP) born between 1983-1993 </li></ul><ul><li>Controls were healthy Atlanta children (3-10 years of age) n=617 </li></ul><ul><li>Maternal age, paternal age, and income level among other covariates were investigated. </li></ul>
  22. 24. 6. Conclusions
  23. 25. <ul><li>There is likely no association between social class and ASD. </li></ul><ul><li>This association may not be consistent across all syndromes of ASD. </li></ul><ul><li>Educational level is more closely associated with ASD than median family income. </li></ul><ul><li>Educational level likely is correlated with both parental age </li></ul>6. Conclusions
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