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ELECTRONIC ARTICLE:
Naya Juul-Dam, Jeanne Townsend, and Eric Courchesne
Prenatal, Perinatal, and Neonatal Factors in Autism, Pervasive Developmental Disorder-Not Otherwise Specified, and the General Population
Pediatrics 2001; 107: e63 [Abstract] [Full text] [PDF]
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P3Rs published:

[Read P3R] Limitations of this study
Alan Leviton   (5 April 2001)
[Read P3R] Toward a Unifying Diagnostic Criteria for Autism
James W Koeppel   (23 April 2001)

Limitations of this study 5 April 2001
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Alan Leviton,
epidemiologist
Children's Hospital

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Re: Limitations of this study

alan.leviton{at}tch.harvard.edu Alan Leviton

Naya Juul-Dam, Jeanne Townsend, and Eric Courchesne. Prenatal, Perinatal, and Neonatal Factors in Autism, Pervasive Developmental Disorder-Not Otherwise Specified, and the General Population. Pediatrics 2001; 107: e63

This paper suffers from a number of potentially important limitations, any of which might be sufficient to cast doubt on the validity of the findings.

1. Historical controls (1) 2. Sample size so small (at least for PDD) that the study has very little power (2). 3. Quality of data, especially of data from population sources (3). 4. Bonferonni correction when it might not be appropriate (4).

1. Bhansali MS, Patil PK, Badwe RA, Havaldar R, Desai PB. Historical control bias: adjuvant chemotherapy in esophageal cancer. Dis Esophagus 1997;10:51-4. 2. Gross PA. Collection of data documenting risk factors: safeguards in conducting case-control studies. Am J Med 1984;76:28-33. 3. Moster D, Markestad T, Terje Lie R. Assessing quality of obstetric care for low-risk deliveries; methodological problems in the use of population based mortality data. Acta Obstet Gynecol Scand 2000;79:478-84. 4. Rothman KJ. No adjustments are needed for multiple comparisons. Epidemiology 1990;1:43-6.

Toward a Unifying Diagnostic Criteria for Autism 23 April 2001
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James W Koeppel,
Psychologist
Corona-Norco Unified School District

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Re: Toward a Unifying Diagnostic Criteria for Autism

RJKoeppel{at}aol.com James W Koeppel

I read Naya Juul-Dam, Jeanne Townsend, and Eric Courchesne's (1) article on pre-, peri-, and neonatal factors in autism with great interest. Although not a main point in their article, the researchers seemed very careful to utilize a stringent diagnostic criteria for autism. It would be helpful if their colleagues would do the same in their own practices.

As an autism consultant for one of the largest school districts in California, I have found that many physicians, psychologists, and others in a position to diagnose autism will often use the label to describe a patient who clearly meets criteria for Asperger's Disorder or Pervasive Developmental Disorder Not Otherwise Specified (PDD-NOS) (2). When talking to these professionals, some will admit to falsely diagnosing autism in order to ensure that the families can take advantage of various benefits afforded to children with autism, but not with Asperger's Disorder or PDD- NOS. Others simply are confused about the diagnostic criteria.

Although intentions may be good, the ethics of this practice are highly dubious. Problems stemming from this poor practice include setting up incorrect parental expectation, further confusion among the professional and non-professional community regarding the diagnosis of autism, and faulty populations used in studies where researchers use archival data rather than relying upon their own evaluations when attempting to get a pool of autistic subjects.

I hope diagnosticians take a lesson from Juul-Dam et. al. and stick with the DSM-IV until something better comes along.

1. Juul-Dam N, Townsend J., Courchesne, E. Prenatal, Perinatal, and Neonatal Factors in Autism, Pervasive Developmental Disorder-Not Otherwise Specified, and the General Population. Pediatrics. 2001;107:767.

2. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders Fourth Edition, Text Revision. Washington, DC, American Psyciatric Association. 2000; 69-84.