The epidemiology of suspected autism in Shenzhen, China

I read with interest the paper by Weikang Yang and colleagues [1] (open-access) talking about "a high prevalence rate of suspected autism in children" in Longhua District, Shenzhen (China).

Detailing results based on the administration of the Autism Behavior Checklist (ABC) to some 15,000 children - "with a response rate of 91.2 %" - authors describe how approximately 2.6% of participants scored higher than 67 on the ABC and thus "had a high probability of autism" and a further 611 children (4%) scored between 53-67 and "had questionable autism". Boys, we are also told, "were more likely to develop autism when compared with their female counterparts" and certain familial factors correlated with screening outcomes.

Bearing in mind little details such as the fact that the ABC was administered to parents and that authors "only used ABC which is a screening tool to detect cases" to reach those 'high probability' and 'questionable' diagnoses of autism, these are interesting findings. That a total of 6.6% of children in this particular part of China may have "suspected autism" represents quite a leap compared with other estimates of prevalence [2] in this part of the world. Even recent data using other screening instruments such as the Childhood Autism Spectrum Test (CAST) among other things on a paediatric population based in China only came up with a estimated figure of 119 per 10,000 (1.19%) [3].

I'm willing to accept that there are issues with screening instruments used in the context of autism (see here) and so one has to be quite careful about extrapolating from their results. The authors mention the word 'overestimate' in their text; although I might also add that their sole reliance on "mainstream middle-class kindergartens" excluding "many diagnosed cases [who] may be attending special schools" means we should be cautious about discarding their findings outright.

In light of what is continuing to emerge in terms of the 'autism numbers game' in other parts of the world I'll be interested to see how this pans out in China too, bearing in mind that autism might not be the only diagnosis/label 'on the up' in China...

Music to close, and if you have half an hour or so free, how about remembering Pierre Boulez?

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[1] Yang W. et al. Epidemiological investigation of suspected autism in children and implications for healthcare system: a mainstream kindergarten-based population study in Longhua District, Shenzhen. BMC Pediatr. 2015 Dec 15;15(1):207.

[2] Wan Y. et al. Prevalence of autism spectrum disorders among children in China: a systematic review. Shanghai Arch Psychiatry. 2013 Apr;25(2):70-80.

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Yang W, Xia H, Wen G, Liu L, Fu X, Lu J, & Li H (2015). Epidemiological investigation of suspected autism in children and implications for healthcare system: a mainstream kindergarten-based population study in Longhua District, Shenzhen. BMC pediatrics, 15 (1) PMID: 26667375