Abstract Introduction Both suicide and self‐harm are disproportionately common in autistic people. Sex differences in risk of self‐harm and suicide are observed in the general population, but ...findings are mixed for autistic people. Self‐cutting may be a particularly risky self‐harm behaviour for suicide in autistic people. We aimed to explore sex differences and differences in method of self‐harm in the association between self‐harm and suicide in autistic and non‐autistic adolescents and young adults. Methods We used a total population register of 2.8 million Swedish residents. Participants were followed from age 12 until December 2021 for medical treatment because of self‐harm, and death from suicide. We used Cox proportional hazard regression models to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for risk of death from suicide following self‐harm, and Relative Excessive Risk due to Interaction (RERI) to explore the interaction between self‐harm and autism in females and males. Results We identified 85,143 autistic individuals (31,288 female; 53,855 male) and 2,628,382 non‐autistic individuals (1,286,481 female; 1,341,901 male) aged 12–37 years. Incidence of suicide following self‐harm was higher in autistic males (incidence per 100,000 risk‐years = 169.0 95% CI 135.1, 211.3) than females (125.4 99.4, 158.3). The relative risk was higher for autistic females (HR 26.1 95% CI 20.2, 33.7) than autistic males (12.5 9.9, 15.8). An additive effect of both autism and self‐harm was observed in both females (RERI = 9.8) and males (2.0). Autistic individuals who self‐harmed through cutting were at greatest risk of death from suicide (HR 25.1 17.9, 35.2), compared to other methods. Conclusion Autistic males and females are at increased risk of death from suicide following severe self‐harm, particularly self‐cutting.
Objective
Self‐harm among young autistic individuals is a clinical challenge, and the risk of premature death by suicide is strongly increased in this group. Using the advantage of total‐population ...and family‐based data, we investigated whether autism per se is a risk factor for self‐harm independently of psychiatric comorbidities and how it differs from self‐harm in non‐autistic individuals.
Methods
We used The Stockholm Youth Cohort, a total‐population register study, including all residents in Stockholm County aged 0–17 years between 2001 and 2011.Study participants were followed from age 10 to 27 for hospital admissions because of self‐harm. We used modified Poisson regression to calculate relative risks (RR) using robust standard error to derive 95% confidence intervals (CI).
Results
In all, 410,732 individuals were included in the cohort (9,070 with a diagnosis of autism). Autistic individuals had a fivefold increased adjusted relative risk of self‐harm (RR 5.0 95% CI 4.4–5.6). The risk increase was more pronounced for autism without intellectual disability and particularly high for self‐cutting 10.2 7.1–14.7 and more violent methods 8.9 5.2–15.4. The association between autism and self‐harm was independent of, but clearly exacerbated by comorbid psychiatric conditions. It was of similar magnitude as risks linked to these conditions per se, and not explained by shared familial factors.
Conclusion
Self‐harm severe enough to present to medical services is as common in autistic youth as in those with depression or ADHD. Potentially more lethal methods are more likely to be used of autistic self‐harmers.
Aim
Our aim was to describe the outcomes of multisystem inflammatory syndrome in children (MIS‐C) associated with COVID‐19.
Methods
This national, population‐based, longitudinal, multicentre study ...used Swedish data that were prospectively collected between 1 December 2020 and 31 May 2021. All patients met the World Health Organization criteria for MIS‐C. The outcomes 2 and 8 weeks after diagnosis are presented, and follow‐up protocols are suggested.
Results
We identified 152 cases, and 133 (87%) participated. When followed up 2 weeks after MIS‐C was diagnosed, 43% of the 119 patients had abnormal results, including complete blood cell counts, platelet counts, albumin levels, electrocardiograms and echocardiograms. After 8 weeks, 36% of 89 had an abnormal patient history, but clinical findings were uncommon. Echocardiogram results were abnormal in 5% of 67, and the most common complaint was fatigue. Older children and those who received intensive care were more likely to report symptoms and have abnormal cardiac results.
Conclusion
More than a third (36%) of the patients had persistent symptoms 8 weeks after MIS‐C, and 5% had abnormal echocardiograms. Older age and higher levels of initial care appeared to be risk factors. Structured follow‐up visits are important after MIS‐C.
Abstract
Background
It is unclear how to best measure the complex symptom presentation of pediatric acute-onset neuropsychiatric syndrome (PANS).
Methods
Well-characterized participants of a 2–5 year ...follow-up study (
n
= 34; 56% male) underwent clinical evaluations and completed scales assessing global symptom severity, functional impairment and specific psychiatric symptoms. We explored inter-correlations between the measures and used intraclass correlation coefficients to evaluate the agreement between clinician-, parent- and child ratings of the same constructs.
Results
Ratings on symptom-specific measures varied largely between participants. Agreement between informants was excellent on functional scales, fair-to-moderate on global severity scales and mixed on symptom-specific scales. Clinician-rated global and functional measures had stronger inter-correlations with parent- and child-rated functional measures than with symptom-specific measures.
Conclusions
General instruments assessing global severity and functioning are well suited for the assessment and follow-up of PANS, but should be complemented by symptom-specific scales representative of core symptoms.
Abstract Higher education is an increasingly necessary achievement to attain employment. However, even in cases where a student has the academic skills to succeed, educational environments may not ...support students across all other domains necessary for education success, including social and communication needs. This is especially true for students with disabilities and autistic students, where the rate of completion of non-compulsory education is unknown. We used the Stockholm Youth Cohort (children aged 0–17 years from 2001 to 2011), a total population cohort ( N = 736,180) including 3,918 autistic individuals, to investigate the association between autism without intellectual disability and completion of upper secondary education. We assessed the impact of sex and co-occurring Attention-Deficit/Hyperactivity Disorder (ADHD) on this association. By age 20 years (the expected age of completion), 68% of autistic students and 91% of non-autistic students admitted to upper secondary education had completed. In logistic regression models adjusted for student demographics, autistic students had almost five-fold higher odds of not completing secondary school (OR 4.90, 95% CI 4.56 5.26) compared to their non-autistic peers. Autistic students with ADHD had particularly high odds of non-completion of upper secondary school. Autistic students without intellectual disability attending mainstream education are substantially less likely to complete upper secondary education as compared to their peers. These findings have implications for the appraisal of how inclusive school policies serve autistic students’ academic and social needs, ultimately addressing population health and independent living.
This study used the Stockholm Youth Cohort, a total population cohort (N = 364,957), to describe patterns and predictors of qualification for upper secondary education, defined by passing graduation ...grades in core compulsory school subjects in contemporary young individuals diagnosed with autism spectrum disorders without intellectual disability (n = 6138). At the expected age for graduation, 16 years, 29% (adjusted rate difference 95% confidence interval (28.0–30.0)) fewer autistic than non-autistic individuals were qualified for upper secondary education (57% and 86%, respectively). Comorbid attention-deficit hyperactivity disorder further increased this difference. Within the group of autistic students without intellectual disability, female sex and lower family income were associated with non-qualification for upper secondary education. The proportion of students with autism without intellectual disability who qualified for upper secondary education increased at age 20. These findings underline the need for improved support for students with a diagnosis of autism without intellectual disability in mainstream education.
Lay abstract
Obtaining a quality education is important for any individual’s chances of leading a healthy and thriving life. Currently, educational policies in many countries underscore the rights of students with autism to be educated in mainstream schools. While there is some knowledge on school outcomes among students with autism from older studies, little is known about rates of qualification for upper secondary education among children with autism in mainstream schools today. This lack of knowledge is problematic since autism is diagnosed more widely, and prior evidence may not be relevant for individuals with autism and their families today. Using Swedish registers, we therefore examined this in a study including all children and young people in Stockholm County in 2001 through 2011. We found that about two thirds of children with autism without intellectual disability qualified for upper secondary education at the expected age, in comparison with about nine in ten among typically developing peers. We also found that girls with autism had further difficulties obtaining such qualification than boys and that those who were additionally diagnosed with attention-deficit hyperactivity disorder were particularly at risk of non-qualification. Finally, students with autism without intellectual disability had a greater chance of completing compulsory education if given an extended period to graduate. These findings underline the need for supportive interventions for children with autism during compulsory school. They may also challenge the inclusive education policy adopted by majority of western countries, at least in the wake of addressing special needs in mainstream schooling.
Pediatric acute‐onset neuropsychiatric syndrome is a clinical concept used to describe a subgroup of children with sudden onset of psychiatric and somatic symptoms. The diagnostic term and especially ...management of children differs depending on the clinical setting to which they present, and the diagnosis and management is controversial. The aim of this paper is to propose a clinical guidance including homogenous diagnostic work‐up and management of paediatric acute onset neuropsychiatric syndrome within the Nordic countries. The guidance is authored by a Nordic‐UK working group consisting of paediatric neurologist, child psychiatrists and psychologists from Denmark, Norway, Sweden and Great Britain, and is the result of broad consensus.
Conclusion
Consensus was achieved in the collaboration on work‐up and treatment of patients with paediatric acute‐onset neuropsychiatric syndrome, which we hope will improve and homogenise patient care and enable future collaborative research in the field.
PANS and PANDAS are research diagnoses characterized by acute presentation of psychiatric and neuropsychiatric and/ or somatic symptoms. A hypothetical neuroinflammatory pathogenesis has directed ...proposals for evaluation as well as treatment in PANS. However, confirmed evidence of such a mechanism is lacking, which contributes to uncertainty concerning clinical management. The symptom presentation of PANS/PANDAS warrants psychiatric as well as somatic evaluation. Treatment with antibiotics and/or immunomodulatory medication may augment, but should not push aside psychiatric care.
The overall objective of this thesis is to estimate recent changes in and current prevalence of autism spectrum disorders (ASD) among young people in Stockholm County. An additional objective is to ...explore potential risk factors for ASD in view of the increasing occurrence in the population. For this purpose, a register-based total population study was set up and ASD case ascertainment validated as a means and research model for achieving the overall objective.All studies were based on the Stockholm Youth Cohort (SYC), a longitudinal total population study of 0-17 year olds resident in Stockholm County at any time since 2001. Prospectively compiled data for this population were merged from regional and national registers. In study I, we found that 96.0% of clinical case notes from randomly sampled ASD cases in the SYC were consistent with a diagnosis of ASD. Furthermore, we confirmed ASD in 82.5% of affected twins in the SYC by means of cross-validation against a twin study. In study II, we reported that ASD prevalence at the end of 2011 was 1.5% among 0-27 year olds (N=735,096), of whom 25.9% had a registered diagnosis of ID. The ASD prevalence was highest among teenagers at 2.4%. The male: female prevalence ratio for ASD decreased with age (from 3.3:1 among 0-12 year olds, to 1.9:1 among 18-27 year olds), particularly for ASD without ID. Between 2001 and 2011, the prevalence of ASD increased almost 3.5 fold among 2-17 year olds, mainly due to an eightfold increase of ASD without ID. In contrast, the prevalence of ASD with ID increased only slightly during this period.The recent increase in ASD prevalence has attracted research interest toward risk factors for ASD that have increased in a parallel manner, such as parental age and weight. In study III, we found that higher parental age increased the risk of offspring ASD as well as stronger parental age effects for ASD with, than without, ID. We found the risk of ASD to be greater for offspring of older mothers than for those of older fathers. Furthermore, the paternal age effect on ASD risk was only evident among offspring to mothers aged 35 years or younger, while maternal age increased the risk of ASD regardless of paternal age. In the population- based analysis of study IV, we found that maternal overweight increased the risk of ASD, while no such effect was evident in the sibling analysis. In addition to the finding that too much weight gain during pregnancy increases the risk of offspring ASD, this study was the first to report that too little weight gain also constitutes a risk.In conclusion, the prevalence of identified ASD without comorbid ID has increased substantially between 2001 and 2011 in Stockholm, and ASD currently affects more than 2% of teenagers, with important implications for the planning of health and educational services. Changes in diagnostic practice and awareness are likely to be the main drivers of the rise, but an actual true increase in ASD incidence cannot be ruled out. Collectively, these studies confirm the relevance of categorizing ASD according to ID. Finally, the SYC, with its extensive register-based data as well as a valid and thorough ASD case ascertainment constitutes an important resource for ASD research.
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