Intended for healthcare professionals

Rapid response to:

Clinical Review State of the Art Review

Autism spectrum disorder: advances in diagnosis and evaluation

BMJ 2018; 361 doi: (Published 21 May 2018) Cite this as: BMJ 2018;361:k1674

Rapid Response:

The rise in autism - this is how the Department of Health replied in 2000. What about now?

As I recorded in my letter below [1], I currently await some response from the Department of Health and Social Care about the rise in autism. When I was first in touch with them based on my experiences in Haringey in 2000 they sent me by way of reassurance a paper by Eric Fombonne, 'The epidemiology of autism: a review' (1999) [2], so it is is exceedingly interesting to compare the picture then with current data:

"Across surveys, the median prevalence estimate was 5.2/10000. Half the surveys had 95% confidence intervals consistent with population estimates of 5.4-5.5/10000. Prevalence rates significantly increased with publication year, reflecting changes in case definition and improved recognition; the median rate was 7.2/10 000 for 11 surveys conducted since 1989...There was no evidence for a secular increase in the incidence of autism. In eight surveys, rates for other forms of pervasive developmental disorders were two to three times higher than the rate for autism...Based on recent surveys, a minimum estimate of 18.7/10000 for all forms of pervasive developmental disorders was derived, which outlines the needs in special services for a large group of children."

It is interesting to notice that Fombonne's figure 18.2/10,000 is close to the contemporaneous (1999) National Statistics mental health survey which discovered a rate of 0.2% for 11 to 15 year olds, but for the 5 to 10 year olds (although diagnosis would be highly incomplete) it was already 0.4%, while being monitored by the same services.

Already Fombonne was arguing not very persuasively - if you were on the ground - that there was no real change, but just changes in criteria, substitution, whatever, and this is continuous with the accounting strategies of the present, although PDD was itself already the broadest criterion and that was 19 year ago. But now we are looking at conservative estimates of 250/10,000 [3,4] and still no emergency? It should be said - although I had much less experience in 2000 - that this is exactly where I thought we would be now if people went on talking like this, and we are. The trend is unremittingly up, and it is the government's own data which tells us this.

[1] John Stone, 'Re: Autism spectrum disorder: advances in diagnosis and evaluation' 27 July,

[2] Eric Fombonne, 'The epidemiology of autism: a review', Psychol Med. 1999 Jul;29(4):769-86,

[3] Metzler et al, 'The mental health of children and adolescents in Great Britain' National Statistics 1999, p.33 Table 4.1 'Prevalence of Mental Disorders', Pervasive development disorder is listed under 'less common disorders',

[4] John Stone, 'Re: Autism spectrum disorder: advances in diagnosis and evaluation', 21 May 2018,

[5] 'Re: Autism spectrum disorder: advances in diagnosis and evaluation: Nothing to see here folks!', 26 July 2018,

Competing interests: No competing interests

28 July 2018
John Stone
UK Editor
London N22