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Original Articles
Introduction
Autism spectrum disorders (ASDs) are neurodevelopmental conditions characterized by severe impairment in reciprocal social interactions and communication skills, and the presence of restricted, stereotypical behaviors (APA, 2000). ASDs commence in early childhood, follow a persistent course and are highly disabling (Newschaffer et al. 2007). Despite the high community and individual cost of ASDs (Kogan et al. 2008), these disorders have received little attention in the global public health arena. This has major implications in terms of the effective prioritization of health and community services.
In the past decade, there have been reports that childhood community rates of ASDs are higher than previously thought (Lauritsen et al. 2004; Chakrabarti & Fombonne, 2005; Baird et al. 2006). Reported prevalence estimates range widely from 0.02% in Norway (Sponheim & Skjeldal, 1998) to 0.9% in South Korea (Kim et al. 2011) for autistic disorder, and from 0.06% in Venezuela (Montiel-Nava & Pena, 2008) to 1.7% in South Korea (Kim et al. 2011) for other ASDs. However, study methodology is highly variable, making it difficult to compare and pool findings to arrive at a comprehensive picture of the distribution of ASDs.
For the first time, the Global Burden of Disease (GBD) initiative has considered childhood-onset mental disorders including attention-deficit/hyperactivity disorder (ADHD), conduct disorder (CD) and ASDs within the scope of the mental disorder burden. The GBD framework was developed for the 1993 World Development Report (World Bank, 1993) and uses disorder-specific information on mortality, prevalence and disability to estimate years of life lost due to premature mortality (YLLs) and years lived with disability (YLDs). YLLs and YLDs are aggregated into disability-adjusted life years (DALYs), an overall summary measure of health loss. The three major aims of the latest study (GBD 2010) were to systematically describe the epidemiology of disease across populations, provide comparative measures of health loss across all major diseases (incorporating fatal and non-fatal outcomes) and assess spatial and temporal differences in population health (Murray et al. 2012).
The achievement of these aims has not been without challenges, particularly with regard to ASDs. The epidemiological data for ASDs are sparse at best, particularly in older people and low- and middle-income (LMI) countries. The available data are based on inconsistently defined...