Gunnar Toft1,2, Chuang Liu3, Jyothi Menon1, Diana Schendel4,5,6, Georg Loss3, Vera Ehrenstein1. 1. Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark. 2. Steno Diabetes Center, Aarhus University Hospital, Aarhus, Denmark. 3. Personalized Health Care Data Science, F. Hoffmann-La Roche, Basel, Switzerland. 4. Lundbeck Foundation Initiative for Integrative Psychiatric Research, Aarhus, Denmark. 5. National Centre for Register-Based Research, Department of Economics and Business, Aarhus University, Aarhus, Denmark. 6. Department of Public Health, Aarhus University, Aarhus, Denmark.
Abstract
Importance: Population-based data on educational and employment outcomes in adulthood among individuals diagnosed with autism spectrum disorder (ASD) in childhood are currently limited. Objective: To evaluate educational attainment and employment among individuals with and without a diagnosis of ASD before age 12 years in Denmark. Design, Setting, and Participants: This nationwide cross-sectional prevalence study was conducted using data from Danish registers. Individuals with a diagnosis of ASD recorded before age 12 years were identified among all individuals born in Denmark between January 1, 1989, and December 31, 1991, who were alive at age 25 years. Individuals with ASD were then matched on a 10:1 ratio by age, sex, and region of residence with a comparison population of individuals without a diagnosis of ASD at age 12 years. Data were analyzed from March 2019 to December 2020. Exposures: Autism spectrum disorder diagnosis and diagnostic subtype recorded before age 12 years. Main Outcomes and Measures: Adjusted prevalence ratios (aPRs) with 95% CIs for the completion of compulsory primary and lower secondary school (grade 9), upper secondary school (grades 10-12 or vocational), and tertiary school (university) and for employment by age 25 years were estimated using log-binomial regression analysis. Results: A total of 810 individuals with a diagnosis of ASD before age 12 years were matched with a comparison population of 8100 individuals without ASD. The prevalence of ninth-grade completion was similar among those with and without ASD (785 individuals [96.9%] and 7982 individuals [98.5%], respectively; aPR, 0.98; 95% CI, 0.97-1.00). Compared with those without ASD, persons with ASD had a lower prevalence of completing upper secondary school (6338 individuals [78.2%] vs 286 individuals [35.3%], respectively; aPR, 0.46; 95% CI, 0.42-0.50) and tertiary school (2185 individuals [27.0%] vs 70 individuals [8.6%]; aPR, 0.33; 95% CI, 0.26-0.41) and obtaining employment (4284 individuals [77.7%] vs 177 individuals [27.2%]; aPR, 0.35; 95% CI, 0.31-0.40) at age 25 years. A ninth-grade final examination score was available for 394 individuals (48.6%) with ASD and 7417 individuals (91.6%) without ASD. In an analysis stratified by ASD subtype, individuals diagnosed with childhood autism had lower educational attainment and employment than those diagnosed with Asperger syndrome or pervasive developmental disorder not otherwise specified. A total of 461 individuals (56.9%) with ASD were receiving public assistance or a pension (ie, disability benefits) at age 25 years compared with 1094 individuals (13.5%) without ASD in the comparison population. Conclusions and Relevance: In this population-based cross-sectional study, a diagnosis of ASD in childhood was not associated with the completion of compulsory primary and lower secondary education (ninth grade). An ASD diagnosis before age 12 years was associated with a lower prevalence of attaining education beyond ninth grade and obtaining employment by age 25 years, indicating a substantially higher risk of reliance on public assistance in young adulthood.
Importance: Population-based data on educational and employment outcomes in adulthood among individuals diagnosed with autism spectrum disorder (ASD) in childhood are currently limited. Objective: To evaluate educational attainment and employment among individuals with and without a diagnosis of ASD before age 12 years in Denmark. Design, Setting, and Participants: This nationwide cross-sectional prevalence study was conducted using data from Danish registers. Individuals with a diagnosis of ASD recorded before age 12 years were identified among all individuals born in Denmark between January 1, 1989, and December 31, 1991, who were alive at age 25 years. Individuals with ASD were then matched on a 10:1 ratio by age, sex, and region of residence with a comparison population of individuals without a diagnosis of ASD at age 12 years. Data were analyzed from March 2019 to December 2020. Exposures: Autism spectrum disorder diagnosis and diagnostic subtype recorded before age 12 years. Main Outcomes and Measures: Adjusted prevalence ratios (aPRs) with 95% CIs for the completion of compulsory primary and lower secondary school (grade 9), upper secondary school (grades 10-12 or vocational), and tertiary school (university) and for employment by age 25 years were estimated using log-binomial regression analysis. Results: A total of 810 individuals with a diagnosis of ASD before age 12 years were matched with a comparison population of 8100 individuals without ASD. The prevalence of ninth-grade completion was similar among those with and without ASD (785 individuals [96.9%] and 7982 individuals [98.5%], respectively; aPR, 0.98; 95% CI, 0.97-1.00). Compared with those without ASD, persons with ASD had a lower prevalence of completing upper secondary school (6338 individuals [78.2%] vs 286 individuals [35.3%], respectively; aPR, 0.46; 95% CI, 0.42-0.50) and tertiary school (2185 individuals [27.0%] vs 70 individuals [8.6%]; aPR, 0.33; 95% CI, 0.26-0.41) and obtaining employment (4284 individuals [77.7%] vs 177 individuals [27.2%]; aPR, 0.35; 95% CI, 0.31-0.40) at age 25 years. A ninth-grade final examination score was available for 394 individuals (48.6%) with ASD and 7417 individuals (91.6%) without ASD. In an analysis stratified by ASD subtype, individuals diagnosed with childhood autism had lower educational attainment and employment than those diagnosed with Asperger syndrome or pervasive developmental disorder not otherwise specified. A total of 461 individuals (56.9%) with ASD were receiving public assistance or a pension (ie, disability benefits) at age 25 years compared with 1094 individuals (13.5%) without ASD in the comparison population. Conclusions and Relevance: In this population-based cross-sectional study, a diagnosis of ASD in childhood was not associated with the completion of compulsory primary and lower secondary education (ninth grade). An ASD diagnosis before age 12 years was associated with a lower prevalence of attaining education beyond ninth grade and obtaining employment by age 25 years, indicating a substantially higher risk of reliance on public assistance in young adulthood.
Authors: Marco Solmi; Minjin Song; Dong Keon Yon; Seung Won Lee; Eric Fombonne; Min Seo Kim; Seoyeon Park; Min Ho Lee; Jimin Hwang; Roberto Keller; Ai Koyanagi; Louis Jacob; Elena Dragioti; Lee Smith; Christoph U Correll; Paolo Fusar-Poli; Giovanni Croatto; Andre F Carvalho; Jae Won Oh; San Lee; Corentin J Gosling; Keun-Ah Cheon; Dimitris Mavridis; Che-Sheng Chu; Chih-Sung Liang; Joaquim Radua; Laurent Boyer; Guillaume Fond; Jae Il Shin; Samuele Cortese Journal: Mol Psychiatry Date: 2022-06-29 Impact factor: 15.992