A High Prevalence of Autism Spectrum Disorder in Preschool Children in an Immigrant, Multiethnic Population in Sweden: C
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ORIGINAL PAPER
A High Prevalence of Autism Spectrum Disorder in Preschool Children in an Immigrant, Multiethnic Population in Sweden: Challenges for Health Care Petra Linnsand1,2 · Christopher Gillberg1 · Åsa Nilses3 · Bibbi Hagberg1 · Gudrun Nygren1,2
© The Author(s) 2020
Abstract This study examines the prevalence of autism spectrum disorder (ASD) in preschool children in an immigrant population. Possible risk factors for ASD and individual needs for the children and their families are described, as well as implications for health care. The estimated minimum prevalence for ASD in the area was 3.66% for children aged 2–5 years. Multiple risk factors and extensive individual needs for the children and their families were observed. The high prevalence of ASD and the plethora of needs in immigrant communities pose challenges for health care. A coordinated health care system is necessary to meet the many and individual needs. Keywords Autism · Prevalence · Immigrant population · Health care
Introduction Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder characterized by social communication impairments and behavioral restrictions. These deficits originate in early childhood and impact everyday functioning (American Psychiatric Association 2013). The importance of identifying ASD at an early age has been highlighted in many studies (Coleman and Gillberg 2012; Fernell et al. 2013; Magan-Maganto et al. 2017; Zwaigenbaum et al. 2015). A comprehensive assessment, preferably by an interdisciplinary team, is essential (Gillberg 2010), and a reliable diagnosis can be made by 24 months of age in many cases (Sanchack and Thomas 2016). Co-existing conditions are very common (Carlsson et al. 2013; Gillberg 2010; Gillberg and Billstedt 2000; Posserud et al. 2018; Reinvall et al. * Petra Linnsand [email protected] 1
Gillberg Neuropsychiatry Centre, Sahlgrenska Academy, University of Gothenburg, Kungsgatan 12, 411 19 Gothenburg, Sweden
2
Child and Adolescent Specialist Centre, Angered Hospital, Halmtorget 1, 424 65 Angered, Sweden
3
Center for Progress in Children’s Mental Health, Kungsgatan 12, 411 19 Gothenburg, Sweden
2016; Soke et al. 2018). In 2010, Gillberg (2010) introduced the concept of ESSENCE (Early Symptomatic Syndromes Eliciting Neurodevelopmental Clinical Examinations) to provide an umbrella term for the overlapping and coexisting neurodevelopmental disorders or developmental problems, including ASD in early childhood. The number of reported cases of ASD has increased over the past 30 years and the current prevalence has been estimated to be at least 1.5% in developed countries (Lyall et al. 2017). Studies from different countries have suggested the prevalence of ASD, especially in combination with intellectual disability (ID), to be higher among children of immigrant than non-immigrant women (Abdullahi et al. 2018, 2019a; Bolton et al. 2014; Fairthorne et al. 2017; Gillberg et al. 1987; Keen et al. 2010; Magnusson et al. 2012; Wing 1993). In a systematic review, a higher pre
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