Risk and Correlates of Autism Spectrum Disorder in Children With Epilepsy: A Community-Based Study

Abstract

The prevalence of autism spectrum disorders for children with epilepsy in the general population is unknown. In a prospective community-based study of newly diagnosed childhood epilepsy, autism spectrum disorder was determined from parental interviews, medical records, and expert reviews by a child psychiatrist. A total of 28 (5%) participants had autism spectrum disorders. West syndrome (prevalence ratio = 4.53, P = .002) and intellectual impairment (prevalence ratio = 4.34, P = .002) were independently associated with autism spectrum disorder. Absent West syndrome, male gender was associated with autism spectrum disorder (prevalence ratio = 3.71, P = .02). For participants with overall normal cognitive abilities, 2.2% had autism spectrum disorder, which is substantially higher than estimates from the general population (0.5%-0.9%). In addition to West syndrome, which has repeatedly been shown to have a special relationship with autism spectrum disorder, the most important determinants of autism spectrum disorder in the general population (intellectual impairment and male sex) are also important in young people with epilepsy.

Keywords

autistic spectrum disorders epilepsy epidemiology West syndrome

Get full access to this article

View all access options for this article.

References

Rapin I. , Tuchman RF Autism: definition, neurobiology, screening, diagnosis. Pediatr Clin North Am. 2008;55:1129-1146.

Volkmar FR , State M. , Klin A. Autism and autism spectrum disorders: diagnostic issues for the coming decade . J Child Psychol Psychiatry. 2009 ;50:108-115.

Berg AT , Berkovic SF , Brodie MJ , et al. Revised terminology and concepts for organization of seizures and epilepsies: Report of the ILAE Commission on Classification and Terminology, 2005-2009. Epilepsia. 2010;51:676-685.

Kelley MS , Jacobs MP , Lowenstein DH The NINDS epilepsy research benchmarks. Epilepsia . 2009;50:579-582.

Tuchman R. , Cuccaro M. , Alessandri M. Autism and epilepsy: historical perspective. Brain Dev. 2010;32:709-718.

Amiet C. , Gourfinkel-An I. , Bouzamondo A. , et al. Epilepsy in autism is associated with intellectual disability and gender: evidence from a meta-analysis. Biol Psychiatry . 2008;64:577-582.

Tuchman RF , Rapin I. , Shinnar S. Autistic and dysphasic children. II: epilepsy. Pediatrics . 1991;88:1219-1225.

Clark DF , Roberts W. , Daraksan M. , et al. The prevalence of autistic spectrum disorder in children surveyed in a tertiary care epilepsy clinic. Epilepsia. 2005;46:1970-1977.

Steffenburg S. , Gillberg C. , Steffenburg U. Psychiatric disorders in children and adolescents with mental retardation and active epilepsy. Arch Neurol. 1996;53:904-912.

10.

Saemundsen E. , Ludvigsson P. , Rafnsson V. Risk of autism spectrum disorders after infantile spasms: a population-based study nested in a cohort with seizures in the first year of life. Epilepsia. 2008;49:1865-1870.

11.

Matsuo M. , Maeda T. , Sasaki K. , et al. Frequent association of autism spectrum disorder in patients with childhood onset epilepsy. Brain Dev. 2010;32:759-763.

12.

Berg AT , Shinnar S. , Levy SR , Testa FM Newly diagnosed epilepsy in children: presentation at diagnosis. Epilepsia. 1999;40:445-452.

13.

Berg AT , Langfitt JT , Testa FM , et al. Global Cognitive Function in Children with Epilepsy: A community-based study. Epilepsia. 2008;49:608-614.

14.

American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC: American Psychiatric Association; 2000.

15.

Spiegelman D. , Hertzmark E. Easy SAS calculations for risk and prevalence ratios and differences. Am J Epidemiol. 2005 ;162:199-200.

16.

Autism and Developmental Disabilities Monitoring Network C. Prevalence of autism spectrum disorders-Autism and Developmental Disabilities Monitoring Network, United States, 2006. MMWR. 2009;58:1-20.

17.

Brugha T. , McManus S. , Meltzer H. , et al. Autism spectrum disorders in adults living in households throughout England: report from the adult psychiatric morbidity survey 2007. In: Care NHS Information Centre for Health and Social Care, 2009. http://www.scie-socialcareonline.org.uk/searchp.asp?query=author=%22BRUGHA%20T.%22. Accessed August 25, 2010.

18.

Newschaffer CJ , Croen LA , Daniels J. , et al. The epidemiology of autistic spectrum disorders. Ann Rev Public Health. 2007;28: 235-258.

19.

Chakrabati S. , Fombonne E. Pervasive developmental disorder in preschool children. JAMA. 2001;285:3093-3099.

20.

Tuchman R. , Rapin I. Epilepsy in autism. Lancet Neurol. 2002;1: 352-358.

21.

Tuchman RF , Rapin I. Regression in pervasive developmental disorders: seizures and epileptiform electroencephalographic correlates. Pediatrics. 1997;99:560-566.

22.

Spence SJ , Schneider MT The role of epilepsy and epileptiform EEGs in autism spectrum disorders . Pediatr Res. 2009;65: 599-606.

23.

Vasconcellos E. , Wyllie E. , Sullivan S. , et al. Mental retardation in pediatric candidates for epilepsy surgery: the role of early seizure onset . Epilepsia . 2001;42:268-274.

24.

Hermann B. , Seidenberg M. , Bell B. , et al. The neurodevelopmental impact of childhood-onset temporal lobe epilepsy on brain structure and function. Epilepsia. 2002;43:1062-1071.

25.

Cormack F. , Cross JH , Isaacs E. , et al. The development of intellectual abilities in pediatric temporal lobe epilepsy. Epilepsia. 2007; 48:201-204.

26.

Camfield P. , Camfield C. Nova Scotia pediatric epilepsy study. In: Jallon P , Berg A , Dulac O , Hauser A , eds. Prognosis of Epilepsies. Montrouge, France: John Libbey, Eurotext;; 2003: 113-126.

27.

Kuban KCK , O’Shea TM , Allred EN , et al. Positive screening on the modified checklist for autism in toddlers (M-CHAT) in extremely low gestational age newborns. J Pediatr . 2009;154:535-540.