Diagnoses of autism spectrum disorders in Germany: Time trends in administrative prevalence and diagnostic stability

Abstract

For Germany, no data on trends in autism spectrum disorder diagnoses are available. The primary aim of this study was to establish the time trends in the administrative prevalence of autism spectrum disorder diagnoses. The second aim was to assess the stability of autism spectrum disorder diagnoses over time. We analysed administrative outpatient data (2006-2012) from a nationwide health insurance fund and calculated the prevalence of autism spectrum disorder diagnoses for each year, stratified by age and sex. Additionally, we studied a cohort with a first-time diagnosis of autism spectrum disorder in 2007 through 2012, investigating the percentage of retained autism spectrum disorder diagnoses. From 2006 to 2012, the prevalence of autism spectrum disorder diagnoses in 0- to 24-year-olds increased from 0.22% to 0.38%. In insurees with a first-time autism spectrum disorder diagnosis in 2007, this diagnosis was carried on in all years through 2012 in 33.0% (The International Classification of Diseases, Tenth Revision diagnoses: F84.0/F84.1/F84.5) and 11.2% (F84.8/F84.9), respectively. In Germany, like in other countries, there has been an increase in the administrative prevalence of autism spectrum disorder diagnoses. Yet, prevalences are still lower than in some other Western countries. The marked percentage of autism spectrum disorder diagnoses which were not retained could indicate a significant portion of autism spectrum disorder misdiagnoses, which might contribute to rising autism spectrum disorder prevalences.

Autism spectrum disorder in children with Type 1 diabetes

“…The DPV data also demonstrated a similar frequency of ASD in those with Type 1 diabetes compared with the general population (0.24% vs. 0.38%, respectively). However, the frequency of ASD in the German/Austrian population is 0.38%, much lower than in the USA . Interestingly, our data show a male to female ratio of 7.4:1 in participants in the T1DX compared with 4:1 in the general US population for ASD diagnosis .…”

“…Interestingly, our data show a male to female ratio of 7.4:1 in participants in the T1DX compared with 4:1 in the general US population for ASD diagnosis . The DPV data showed a 5.8:1 ratio of males to females in youth with ASD and Type 1 diabetes compared with a 2–3:1 ratio of males to females in the general German population with ASD .…”

“…Interestingly, our data show a male to female ratio of 7.4:1 in participants in the T1DX compared with 4:1 in the general US population for ASD diagnosis [3,8]. The DPV data showed a 5.8:1 ratio of males to females in youth with ASD and Type 1 diabetes compared with a 2-3:1 ratio of males to females in the general German population with ASD [20,23]. Despite difficulties with social communication, the data from both the T1DX and DPV studies demonstrated no difference in diabetic ketoacidosis at presentation and during treatment, as well as no differences in severe hypoglycaemia events.…”

“…The DPV data, when controlled for age, gender, duration of diabetes and year of observation, show that Type 1 diabetes metabolic control is not affected by the additional diagnosis of ASD. However, the prevalence of ASDs is much lower in the DPV compared with the T1DX cohort [3,8,20,23].…”

Improving child and adolescent mental health care provision by scrutiny of national diagnostic practices: A call for increased international knowledge exchange.

“…However, the administrative estimated prevalence (i.e. calculated prevalence of autism spectrum disorder using administrative outpatient data from a nationwide health insurance fund) of ASD diagnoses in children and adolescents in Germany was reported to be 0.6% [3], which is markedly lower than the reported estimated administrative prevalence of 1.7% for the Netherlands [4].…”