Severity of the Condition

The present discussion of the seriousness of Autism (in distinction to the seriousness of the aspect treated) falls into two parts:  morbidity/mortality/outcome and effect on day to day function.

Several studies have examined mortality in this condition, the largest being that of Shavelle et al., (2001) which tracked over 13,000 persons with autism for over 14 years.  This study showed that the mortality rate in autism is at least double that of the general population.  It has been known for some time that mentally retarded persons with autism are at greater risk of mortality due to associated medical conditions such as epilepsy.  However, Shavelle et al., (2001) also showed increased risk in those only marginally intellectually handicapped autistic populations.

In severely affected patients with Autism, the nature of the presenting communication deficits and accompanying cognitive difficulties complicate assessment of parameters relating to internal states.  However, in less disabled individuals assessment of depression and suicidality is achievable.  Assessment of affected individuals shows that between 29 and 43 percent are depressed by the time of reaching adolescence or adulthood (Sterling et al., 2007; Vickerstaff et al., 2007; Howlin, 2000).  This depression correlates with the affected individuals’ appreciation of the impact of their condition (Vickerstaff et al., 2007).  Suicidality (meaning suicidal thinking, attempts at suicide and completed suicides) occurs at rates estimated to be in the range 10 to 53 percent (Howlin, 2000; Wolff and McGuire, 1995; Wing, 1981).

Outcome in Autism is poor.  Agreement in terms of precise quantitation is limited by differences in diagnostic methods and measures used to assess outcome, but most studies report a relatively bleak prognosis in relation to self determination, independent living, employment and human relationships.  The term “autism” was coined by Kanner, who reported follow up of his original patient population in 1973.  Of 96 patients only 11 had any form of employment and only 1 was married.  Many were highly dependent and institutionalized.

Howlin (2000) reviews data gathered from cross sectional studies in adulthood, or studies based on prospective follow up from childhood, analyzing outcome in higher functioning autistic individuals (the best case).  In this analysis, estimates of outcome were variable due to differences in assessment measures and selection of subjects, but the worst case figures were as follows:

  • the proportion in work is 5 percent;
  • the proportion living independently is 16 percent;
  • 16 percent have an assessment of ‘good’ outcome; and
  • rates of psychiatric disturbance were up to 67 percent.

In a follow up of affected individuals more representative of lower functioning Autism, Howlin et al. (2004) reported that follow up into adulthood confirmed a majority of cases had an outcome classified as “poor” or “very poor”.

By definition of Autism, affected individuals are significantly impaired in basic features of human behavior such as interacting with other people and communicating.  Affected individuals also display many disruptive or problem behaviors (Dominick et al., 2007), such as those summarized below in Table 1.

Table 1. Frequency of Disruptive Behaviors

Disruptive Behavior

% of Autistic Patients Showing Behavior

Feeding difficulties 76%
Abnormal Sleep Patterns 64%
Self-Injurious Behavior 33%
Aggression 33%
Temper Tantrums 71%