Elsevier

The Journal of Pediatrics

Volume 154, Issue 3, March 2009, Pages 345-350.e1
The Journal of Pediatrics

Original article
Increased Risks of Congenital, Neurologic, and Endocrine Disorders Associated with Autism in Preschool Children: Cognitive Ability Differences

https://doi.org/10.1016/j.jpeds.2008.09.043Get rights and content

Objective

To investigate the increased risk of congenital, neurologic, and endocrine disorders in autistic preschool children and to probe possible cognitive impairment-associated variation in such risks.

Study design

Using a population-based longitudinal study, a total of 3440 autistic children born in 1997-1999 and 33 391 age- and residential urbanicity–matched control subjects were identified from the National Health Insurance Research Database in Taiwan. Conditional logistic analyses were performed to estimate the strength of association stratified by the presence of cognitive impairment.

Results

Autistic children were found to have greatly elevated risks of congenital anomalies (eg, tuberous sclerosis: adjusted odds ratio [aOR] = 34∼61) and neurologic disorders (eg, epilepsy: aOR = 5∼13) compared with their matched nonautistic peers. The increased risk of medical diseases for mentally retarded autism were approximately 1.6 to 9 times greater than those for isolated autism.

Conclusions

The observed cognitive impairment-related variation in the increased risk of congenital, neurological, and endocrine disorders with autism may provide some clinical and etiologic implications that warrant investigation in the future.

Section snippets

Methods

This study was a population-based, matched case-control study of preschool children with the diagnosis of autism in Taiwan. The data were obtained from the 1997-2004 National Health Insurance Research Databases (NHIRD), and detailed descriptions are available elsewhere.17, 18, 19 In brief, the National Health Insurance Program (NHIP) was launched on March 1, 1995 to provide all civilian residents with mandatory comprehensive medical care coverage, including vision, dental, mental health, and

Results

The follow-up period ranged from 5 to 8 years by the end of 2004. Table I shows the comparison of sociodemographics and diagnostic processes across 2 subgroups of autistic cases and control subjects. The male-female ratio was 4:1 in cases and nearly 1:1 in control subjects; roughly 1 in 6 to 7 autistic cases were from highest socioeconomic status (ie, EC I: 16.1%), slightly greater than the estimate in control subjects (10.6%). In addition, a moderate female- and lower socioeconomic

Discussion

To our knowledge, this research is one of few population-based studies that used nationally representative samples. The large sample size of autistic cases made it possible to evaluate the links between rare medical conditions or disorders with autism and to have a comparison of risk-factor profile and diagnosis process between organic and isolated autism.5 Also, the follow-up period, ranging from 5 to 8 years in this study, provided a window to explore the risk of autism associated with

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    This work is completely supported by the National Health Research Institutes, which had no involvement in the study design, data collection, analysis, and interpretation, report writing, or the decision to submit the paper for publication. The authors declare no conflicts of interest.

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