non-autism problems than most other instrumentscurrently in use. The aim of the study is to present a descriptivepicture of the most common symptoms in adultswith autism as measured by the DISCO, to find outto what extent the DISCO-algorithm and clinicaldiagnosis correlate, and to find out whether or notcertain childhood measures, derived from the ori-ginal studies, were associated with specific symp-toms within the autism spectrum in adult age.
Method
The original studies
Our study group, born in 1962–84, was recruited fromthree population-based studies from Sweden of indi-viduals diagnosed with autism in early childhood (Gill-berg, 1984; Steffenburg & Gillberg 1986; Gillberg,Steffenburg, & Schaumann, 1991). All 120 individuals(84 males, 36 females) were followed up in late adoles-cence–adult life (Billstedt et al., 2005). The originalstudies of young children comprised participants withDSM-III-R (APA, 1987) autistic disorder/infantile aut-ism (61 males, 17 females) and 42 with atypical aut-ism/autistic-like condition (23 males, 19 females). Thegroup with atypical autism/autistic-like conditions hadmet 6 or more of the 16 – but not full – DSM-III-Rcriteria for autistic disorder.
The follow-up study
The individuals were followed prospectively for a periodof 13–22 years (mean age 17.8 years, 3.6 SD) and re-evaluated at ages 17–40 years (mean age 25.5 years,6.4 SD). Six families declined participation in the fol-low-up study and six individuals had died at the time of follow-up (Billstedt et al., 2005). Three of the remaining108 individuals were included in the follow-up study,but did not participate in the current DISCO-study.
Clinical diagnoses at follow-up
At follow-up, individuals who met criteria from at leasttwo of the three domains of the triad of social, com-munication and imagination/behavioural impairmentsreceived autism spectrum disorder (ASD) diagnosesafter clinical assessment. ASD cases were then subdiv-ided into three groups: (1) those with
autistic disorder/childhood autism
who met criteria for this diagnosisaccording to the DSM-IV (APA, 1994)/ICD-10 (WHO,1993), (2) those with
atypical autism
according to theICD-10 in cases showing 4 or more of the 12, but notfull DSM-IV/ICD-10 diagnostic criteria for autistic dis-order/childhood autism, and (3) those with other ASDnot meeting criteria for autistic disorder or atypicalautism. In addition, the diagnostic criteria for
Asperger syndrome
by the Gillbergs (Gillberg & Gillberg, 1989)were also checked. Clinical diagnoses were made con- jointly by the first (E.B.) and second (I.C.G.) authors of this paper, who were blind to the original specificchildhood diagnosis and symptomatology, based on allavailable information from psychiatric-psychological-medical assessment. The third author (C.G.) hadexamined all cases in childhood and was aware of theirchildhood diagnosis but did not take part in theassessment in the follow-up study.
Participants
One hundred and five individuals (75 males, 30females) with childhood diagnoses of autistic disorder/infantile autism (56 males, 15 females) or autistic-likeconditions/atypical autism (19 males, 15 females) wereincluded in this follow-up study. At follow-up, 89 of the105 participants were clinically diagnosed as havingautistic disorder. Fifteen individuals were diagnosed ashaving atypical autism and one individual did not meetcriteria for an ASD.
Intellectual functioning
All participants had undergone testing before 10 yearsof age. Only one-fourth of all individuals included wereable to take a complete IQ-test (Wechsler, 1981, 1992)at follow-up. However, all participants were assessedusing the Vineland Adaptive Behavior Scales (VABS;Sparrow, Balla, & Cicchetti, 1984) allowing a reason-able estimate of whether or not an individual should bediagnosed as belonging in the severe learning disability(SLD) category (see Billstedt et al., 2005). In the autismgroup, SLD was diagnosed in 50 cases (70%), mildlearning disability (MLD) in 17 cases (24%), near-aver-age intelligence (NA) in 2 cases (3%) and average (A)intelligence in 2 cases (3%). In the atypical group, SLDwas diagnosed in 26 cases (76%), MLD in 7 cases (21%)and A in 1 case (3%).
The DISCO
The DISCO is a 2–4-hour standardised interviewintended for interviewing a person who has known theindividual with suspected autism spectrum disorderfrom earlychildhood.The purposeof usingit isto assistcliniciansinthediagnosticwork-upandcareofpersonswith autism spectrum and other developmental dis-orders affecting social interaction and communication(Wing et al., 2002). Its algorithm enables one toinvestigate whether the necessary criteria of differentdiagnostic systems are met. The diagnostic systemsthat are used are ICD-10 (WHO, 1993), DSM-III-R (APA,1987) and DSM-IV (APA, 1994). Algorithms based onKanner’s ‘Early Infantile Autism’ (Kanner & Eisenberg,1956), Gillberg and Gillberg’s definition of AspergerSyndrome (1989), Wing & Gould’s ‘Autistic SpectrumDisorder’ (ASD; 1979), and ‘Social Impairment’ (1979)are defined and used.From the DISCO one obtains an ‘ever’ diagnosis,which is retrospective, as well as a ‘current’ diagnosis(‘ever’ includes ‘current’). During the DISCO interview,responses to more than 300 questions are coded forcomputer entry. The questions are divided into threegroups pertaining to: (i) current level of function, (ii)delay in acquiring relevant skills, and (iii) untypicalbehaviours associated with the relevant skills. In thispaper the ‘current’ responses on untypical behaviourare presented. A few items were not relevant to a larger
Autism in adults: symptom patterns and early childhood predictors
1103
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2007 The Authors Journal compilation
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2007 Association for Child and Adolescent Mental Health.
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