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Autism

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Previous peer review, featured article candidate and featured article review.

Autism needs peer review now that it has been revamped following its demotion from featured article status in December 2006. The rewrite attempted to follow the Wikipedia:Manual of Style (medicine-related articles). I am asking for a review only of the main article Autism, not of its many subarticles like Controversies in autism; of course you're also welcome to review the subarticles too but that would be a lot of work! Eubulides 07:44, 11 July 2007 (UTC)[reply]

Comments by RN

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Wow... TWO THUMBS WAY UP!!! The recent editors on this article have done an amazing job, especially considering the state of it when it was demoted; I'm amazed at the state of the article right now - I didn't even think it was possible! I like the calm, hype-free approach the article takes now; especially how everything is referenced rather well.
In the past, this was a very controversial article; for example way back when there was constant squabbles over where it should be called a "disorder" or "condition" or even an "advantage" of sorts. Personally I hope it doesn't come to it, but you may have to change stuff like that. More especially though you may need to be careful about wording like "Applied Behavior Analysis has become accepted as an effective treatment"; you may need to append something like "among specialists" or mention it as "the most common" treatment instead - and similar things if you get where I am headed with this. Try to be very careful in avoiding the scientific point of view if you can without diluting the article too much (and note that I literally mean point of view - there are things that are referenced facts that don't need it) - you can delve into the deepness of the talk page archives to get some detail but I wouldn't do it too much as it can be kind of depressing :).
Thanks for the advice. The wording about ABA was taken from Strock (the cited info sheet from NIMH), but Strock merely cites the 1999 Surgeon General's report, so I went back and read that and decided that its wording was easier to follow and better supported, so I switched to that. Eubulides 00:56, 12 July 2007 (UTC)[reply]
Some sections like "Causes" do tread closely to the "not understandable by the layperson" mark, but it isn't too bad; obviously there is going to be some inherit complexity here. As a minor note I'd spell out Array comparative genomic hybridization the first time you use it, and I'd probably throw in an inline reference on for the text on the image in that section (Causes) just in case.
Thanks, I've done both of the suggestions in your "minor note". It's tough to talk about the causes of autism in simple language (other than just say "the genetics of autism is complex" :-). I'll try to tone it down if I can but would appreciate another pair of eyes, as I've worked too closely with the wording at this point. Eubulides 00:56, 12 July 2007 (UTC)[reply]
Consider elaborating on some of the minor points of "Prognosis" like "special residential provision and a high level of support" (i.e. explain "special residential provision" et al.)- I imagine such a thing would also be useful to some people as well. Don't be afraid to go into a small amount of detail.
Thanks, it turns out that "special residential provision" was a typo in Howlin et al.; it should have been "specialist residential provision". I fixed that and added more detail about what it and the other categories mean. Eubulides 01:21, 12 July 2007 (UTC)[reply]
Well, that is it for now I guess - thanks again for the editors' hard work on the article, and I do mean hard work! I hope the editors are around to submit for featured status - it definitely deserves it!!! RN 11:21, 11 July 2007 (UTC)[reply]

Comments by JFW

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  • Brilliant article - covers most of the major issues and controversies very well. Perhaps we need to devote some attention to the treatments that some parents have been seeking for the "immune overload" or "mercury poisoning" that they feel has caused their child's autism. There are also major discrepancies between the article and Conditions comorbid to autism spectrum disorders - e.g. the bowel disorders. JFW | T@lk 19:02, 11 July 2007 (UTC)[reply]
    • Thanks. The MMR and mercury controversies are huge, and deserve (and have) their own Wikipedia articles, so Autism just summarizes the topics only briefly and refers to Vaccine_controversy#The_MMR_controversy Thiomersal_controversy for people who want more details. Autism currently spends about 3 sentences on the subject; I hope that's enough, but if it's not I guess we'll see. There are indeed many major discrepancies between Autism and its subpages, but I'm afraid nobody currently has the time to fix all the problems with the other pages so for now I'm focusing on just Autism. Eubulides 01:45, 12 July 2007 (UTC)[reply]
      • Many people will have heard through "the grapevine" (internet chatrooms, parenting groups) that autism is caused by immune overload, mercury, or other garbage. They may also have heard that chelation, gold therapy, IVIG etc etc etc is effective. Unless we address these bogus claims (especially by super quacknicks Geier & Geier), some of this may be perpetuated. JFW | T@lk 14:50, 12 July 2007 (UTC)[reply]
        • I agree that there is a lot of misinformation, but the article already talks about "immune system abnormalities", "thiomersal and autism" (by far the two greatest concerns in practice) as well as "botched chelation therapy" (which has been documented to kill). There is not enough room to cover all these therapies on this page, which is why we have a separate page Autism therapies. Whether gold salts and IVIG should make the cut into the Autism page is a judgment call; but right now Google News doesn't report any hits for ("gold salts" autism) or ("gold therapy" autism) or (IVIG autism) or (intraveneous autism), whereas it has 140 hits for (mercury autism) and 70 for (MMR autism); this suggests that gold therapy and IVIG are of far less concern in practice. One thing that would help is coverage of IVIG and autism on Wikipedia; currently Autism therapies doesn't address it. Eubulides 16:03, 12 July 2007 (UTC)[reply]
      • I agree largely with your assessment. My opinion is based on experiences with an author now banned from medical articles who insisted on incorporating even the most ridiculous quackery when it came to autism. Let's see what others think. JFW | T@lk 19:39, 12 July 2007 (UTC)[reply]
        • I think the more "prophylactic" bases that can be covered now, while the article is under scrutiny and building consensus, the more stability the article will enjoy in the long run. Within days, weeks and months of completing reviews of Schizophrenia and Asperger syndrome, issues returned. Best to deal with known issues to the extent possible now. SandyGeorgia (Talk) 19:48, 12 July 2007 (UTC)[reply]
          • What sort of prophylatic bases did you have in mind? Autism therapies covers over two dozen therapies, of which Autism currently mentions 3 (ABA, TEACCH, chelation). Which others should be added and what rule should be used to keep some and exclude others? Surely Autism shouldn't mention all the alternative therapies; there's not enough room and anyway it's a constantly-mutating list. Eubulides 02:10, 13 July 2007 (UTC)[reply]
            • I defer to JFW and RN (who have both followed the series of articles longer than I have), but I think the addition you just made to the article should help. SandyGeorgia (Talk) 02:28, 13 July 2007 (UTC)[reply]
              • Thanks. For others following along, the addition cites a study of provider self-reports saying that program marketing, training availability, and parent requests appear to matter more to community service providers than scientific evidence. Eubulides 06:51, 13 July 2007 (UTC)[reply]

Comments by Colin

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Firstly, I'd like to say I'm really glad somebody decided to take on this article. Eubulides has been slaving away for a while now and has addressed a lot of the concerns that saw this FA demoted. I've read over the article fairly quickly and it looks to be very well sourced and technically competent. It is a huge improvement and puts the daughter articles to shame. I'm no medical expert, so hopefully someone from the medical projects can check the facts. I'm also not an experienced copyeditor but somebody keeps mentioning my name so I've been persuaded to have a go. Please feel free to reject my suggestions/opinions. I do think the text needs a good going-over. Generally, it is pitched above the so-called general reader that we're supposed to aim for. I don't mean that it needs to be dumbed way down, or that we need to laboriously explain every hard concept. It is more a change of style, sentence order and being a little less terse. OK, I started with the lead and that's all I've managed for now. Note: I've used the word "you" without knowing who actually wrote the text. Don't take it personally :-). If you find this useful, I'll continue. Colin°Talk 17:27, 11 July 2007 (UTC)[reply]

Reviewing the Lead

The lead starts with a number of "also called" names. There are problems with each of these: "autistic disorder" uses the adjectival form of the noun so can be considered a variant of the same word. Similarly, the "childhood" and "infantile autism" names are variants of the core subject and equating them with "autism" may mislead the reader into thinking this affects childhood only. The latter eponym forms haven't been used in the title of an English-language article on PubMed in the last 30 years. Therefore, I suggest the whole "also called" be dropped.

Thanks very much for the detailed comments. Working through them one by one. I take your point about "Kanner's syndrome" and "Kanner syndrome" and have dropped those aliases. The other names are still in widespread use so I think they should be mentioned somewhere. I moved them to Autism#Characteristics with what I hope is a straightforward change. Eubulides 02:56, 12 July 2007 (UTC)[reply]

There should be some sort of punctuation between "autism" and "emphasizing" in the last sentence of the first paragraph. The use of the phrase "first reports" might draw parallels with finding something new (as with news reports). Would "first descriptions" be less ambiguous?

I changed "first reports of autism emphasizing" to "first descriptions of autism, which emphasized". Eubulides 03:01, 12 July 2007 (UTC)[reply]

"In most cases the causes of autism are not known." isn't consistent wrt plurality. Perhaps: "In most cases, the cause of autism is not known". "Genetic risk determines over 90% of whether a child will develop autism" is not clear. What is "genetic risk" -- is this a predisposition caused by certain genes or the risk of having those genes? The "90% of whether" hangs in the air. It isn't clear to me what this 90% is a percentage of. Are we saying, "It is estimated that there is a genetic component involved in 90% of cases of autism"? Perhaps these first two sentences can be linked.

Several different things can cause autism, so it wouldn't seem right to say just "cause". I don't follow the point about consistency; the sentence appears grammatically consistent to me. To address the second issue I replaced "Genetic risk determines" with "Heritability determines". Eubulides 04:02, 12 July 2007 (UTC)[reply]

You use "but" a lot, which reads like the text is having an argument with itself. The reader gets the impression that the first half is wrong, incomplete, inexact, etc, while the second half is the accurate correction. This isn't how NPOV is done.

I removed some "but"s here. At this point I need to take a break but will continue later. Eubulides 08:23, 12 July 2007 (UTC)[reply]

Another overused word is "cases" which is a rather clinical term. For example, you could rephrase "In rare cases autism is associated with ..." to "Autism has occasionally been associated with..." or similar. Do you mean to use as weak a link as "associated"?

I removed some "cases" here. Many are still left, I'm afraid; I couldn't think of nicer rewording for them. In the example you mention, there is a strong association in those rare cases; I added "strongly" to help clear that up. The cited source (Arndt et al.) is cautious about causation, using wording like "Five teratogens related to autism risk have been identified in epidemiological studies"; I didn't want to go beyond what the source says. Eubulides 16:40, 12 July 2007 (UTC)[reply]

The "not been confirmed by reliable studies" only gives one aspect of the counter-argument here. There have been large, reliable studies that have failed to confirm the link. I'm not sure how to reword to say this and perhaps this is too much detail. Rather than go into specifics of what studies have/have not been done, can we just say something about lack of evidence (perhaps with a link to evidence based medicine).

Thanks, I reworded it to say those theories "have no convincing scientific evidence". This matches Rutter's wording better anyway, and Rutter is a better source than what I was using. Eubulides 17:19, 12 July 2007 (UTC)[reply]

The "but its detailed mechanism is unknown" is another unnecessary "but" and I think the word "mechanism" is going to confuse the reader at this point. To say "is unknown" is also rather extreme if we later devote a whole section to this topic. We clearly know or think we know something.

I changed it to "mechanism that is not well understood". Eubulides 17:22, 12 July 2007 (UTC)[reply]

There are quite a lot of short sentences. That can be helpful, particularly in complex areas. But the lead shouldn't be complex. The text often doesn't flow and the paragraphs aren't cohesive. For example, one paragraph has causes and mechanism, and another has screening, treatment and culture. I'm not saying we need a separate paragraph for each topic, but if you combine topics then they need to be better linked. Too often, the reader is surprised by a sentence that is talking about something unrelated to the previous one.

Sometimes the order of a sentence means that an unfamiliar concept is thrown at the reader with no introduction. For example, "Applied Behaviour Analysis" starts a sentence but is only explained to be "an effective treatment" at the end. The name (ABA) really doesn't give the reader any clues as to what it is. That's not your fault, of course, but you need to compensate.

"No cure is known" is a back-to-front form of the cliché: "There is no known cure". The word "known" is redundant. So, we're left with "There is no cure", which is so short it demands to be combined with something. I think this sentence should come before the therapies one. We need to give the reader an idea of where Autism is on the spectrum of treatable but incurable conditions. For example, coeliac disease and diabetes have effective solutions that enable the person to lead a relatively normal life.

I changed it to "There is no cure." I tried to combine it but this weakened the text. There is some advantage to having a strong short sentence like "There is no cure." I added some text to try to address the flow and cohesion issues that you mentioned in the three paragraphs above. It's hard within this limited space to avoid jamming topics together but specific rewording suggestions are welcome. I applied several changes to try to address the above issues. Eubulides 17:57, 12 July 2007 (UTC)[reply]

The autistic culture is part of a very long sentence. I understand what you are saying, but the wording is weak.

If long sentences are weak maybe we should stick to short sentences. :-) Anyway, if you understand the sentence then most of the battle is won; any suggestions for improving it are welcome. Eubulides 18:07, 12 July 2007 (UTC)[reply]

The reader may not know what a "review" is. I haven't looked at your prevalence figures in detail but to go from "vary widely" to giving a relatively tight range seems contradictory. Perhaps the "vary widely" sentence can be dropped for the sake of brevity. The "It is not known whether prevalence has increased as well." is a rather bland way of summing up the whole Autism (incidence) controversy!

Colin°Talk 17:27, 11 July 2007 (UTC)[reply]

I wikilinked to Review, for what that's worth. And I dropped the "vary widely" sentence. Can you tell that I like bland? Anyway, thanks very much for the review; the lead is now much stronger. If you have time to review the rest I'd be both grateful and amazed. Eubulides 18:07, 12 July 2007 (UTC)[reply]
And you claim not to be an experienced copyeditor! Ha, now your goose is cooked, the cat is out of the bag! Kudos to Eubulides for a real turnaround on the article; now if the daughter articles could only be cleaned up. I left some questions/comments on the talk page a few days ago, but unlike Colin, I'm *really* not a good copyeditor, and don't feel up to the task of tweaking the wording in those areas, so hope someone more capable will have a go at my list. SandyGeorgia (Talk) 20:11, 11 July 2007 (UTC)[reply]

Reviewing Classification

I've been a bit braver and have copy edited some of the text directly where I think I can make changes without affecting the meaning. If there's a change you're not sure about, let me know. Here are some remaining comments:

The "dysfunctional" link (to Abnormality (behavior)) isn't appropriate since I think you are using the word to mean someone unable to look after themselves and operate in society.

If the HFA folk "appear unexceptional to others" surely they don't have autism. There must be some degree of oddness since the definition requires social-interaction problems. Can you think of an alternative?

Colin°Talk 20:26, 14 July 2007 (UTC)[reply]

  • Thanks, I reworded the "dysfunctional" and "appear unexceptional to others" sentence, replacing it with something that matches a cited source better (I used Happé). Eubulides 05:46, 16 July 2007 (UTC)[reply]

Reviewing Characteristics

I've made some more changes to the text. Please fix up anywhere I've wrongly altered the meaning/emphasis.

I'm not familiar with the term: "children with a history of language impairment." and am not sure why the reader should be interested in comparisons with that group. Does it overlap autism, or does the definition exclude autism?

  • The idea of that study was to focus on the effects of autism proper, distinguishing them from effects that come from non-autistic language impairment. "History of language impairment" (HLI in the paper) merely means the child had language impairment at some point in its life; this is not a common term but the cited reference uses that idea and uses the abbreviation "HLI" a lot. It'd be nice if we had cleaner and more to-the-point data for autism, tantrums, and aggression, but that's the best data I know right now. Eubulides 05:46, 16 July 2007 (UTC)[reply]

The "Other symptoms" section has over-short paragraphs. With the sleep problems, are you saying that autistic children have more sleep problems than is typical for a child with "developmental disabilities". The sentence isn't clear, especially since autism is a developmental disability.

Colin°Talk 21:48, 14 July 2007 (UTC)[reply]

Reviewing Causes

The "perhaps" in the 1st paragraph is a little troublesome. Encyclopaedic text should be sure of what it says, and attribute doubt to others. Who is suggesting this and who doubts it?

The "perhaps" tried to briefly summarize Happé et al. I reworded it by using "some researchers argue" here. Eubulides 18:07, 17 July 2007 (UTC)[reply]

The "It is now clear that" is out-of-place since there was no earlier discussion in the text that raised the possibility that the genetics weren't complex.

I removed that phrase here. Eubulides 18:10, 17 July 2007 (UTC)[reply]

The "A large database" sentence is long and devoid of punctuation. I'm not clear how a "large database" can "summarise". Note also the UK spelling.

Thanks for catching that; I do tend to write sentences that must be puzzled out like Sudoku sometimes. To try to fix this I changed "A large database containing genetic linkage and CNV data connecting autism to genetic loci summarises research indicating…" to "The Autism Genome Project database contains genetic linkage and CNV data that connect autism to genetic loci and suggest…" here. Eubulides 18:23, 17 July 2007 (UTC)[reply]

The part dealing teratogens claims that because these do their damage an an early stage, autism must arise at an early stage. Based on that sentence (i.e. not the source) I can't conclude that. Some forms of autism may develop at an early stage, but this doesn't prove they all or even most do.

You're of course correct. However, the quote from the source is surprisingly strong: Arndt et al. write "The fact that each of these teratogens appears to act during the embryonic period (the first eight weeks of life) does not rule out the possibility that autism could be initiated at other stages of development, or that later influences could add to the effects of an early injury. However, the coincidence of critical periods for the first five environmental risk factors identified is strong evidence that autism arises very early in development." I added the qualifier "though this does not exclude the possibility that autism can be initiated or affected during later stages" here. Eubulides 18:44, 17 July 2007 (UTC)[reply]
On further thought I made some more changes for clarity and and brevity in this section, here. Eubulides 20:24, 17 July 2007 (UTC)[reply]

The "It can happen that" sentence is problematic. Firstly, it is a very weak statement. I see that Sandy also noticed this on the talk page. (BTW: serendepity (sic) is not the word you are looking for; there is nothing fortuitous about that chance alignment.) The second problem is that "it happens" is effectively saying that this is chance and coincidence. I know you want to say that and it is very likely to be true but it isn't NPOV. I've tried rewording this. Colin°Talk 13:02, 17 July 2007 (UTC)[reply]

Thanks for the rewording. A nit: is there some reason "become aware of" replaced "notice"? "Notice" is shorter. Eubulides 18:47, 17 July 2007 (UTC)[reply]
Hmm. I thought it implied (better than "notice" alone) that they were noticing something that may be new or may have gone unnoticed for a while or may have been a gradual change. Change back if you prefer. Colin°Talk 20:29, 17 July 2007 (UTC)[reply]

Reviewing Mechanism

The first pathophysiology paragraph is possibly too absolute. Are these changes found in all autistic brains and are such brains always bigger/heavier?

The neuronal effects have been observed in all brains studied (though admittedly few brains have been studied). The size and weight is just a result about the averages, so I replaced "are greater" with "tend to be greater". Eubulides 20:32, 17 July 2007 (UTC)[reply]

On the other end of the scale, "potentially could sometimes help cause ASD" is tentative and weak. How about moving the "potentially" to the start and modify slightly to "It is possible that abberant...". The rest of the sentence needs rephrased: "help" is an inappropriate word here. You don't need the "However" but you do need a comma after "area".

Thanks, I reworded it along the lines you suggested, here. Eubulides 22:36, 17 July 2007 (UTC)[reply]

I think you may need to spell out MNS in the neuropsychology section. In complex topics, a new reader can forget acronyms quite quickly since there's little effort being made to remember them. Colin°Talk 15:35, 17 July 2007 (UTC)[reply]

Thanks, done. Eubulides 22:42, 17 July 2007 (UTC)[reply]

Reviewing Screening

Two delays and two mays in one sentence. Colin°Talk 15:35, 17 July 2007 (UTC)[reply]

I fixed that here. Eubulides 22:50, 17 July 2007 (UTC)[reply]

Reviewing Diagnosis

What is "stage 2 diagnosis"?

That's a UKism; it's a multidisciplinary multiagency assessment (MAA) which is another UKism. Basically, it's the complete diagnosis and evaluations previously described in that paragraph. I changed "30 weeks between first concern to completion of stage 2 diagnosis" to "30 weeks from first concern to completed diagnosis and assessment" here. Eubulides 23:04, 17 July 2007 (UTC)[reply]

Reviewing Treatment

Is the "respond unusually to these medications" talking about paradoxical reaction or something else?

The "Few are supported" sentence is very, very long. Chop, chop.

In the final sentence, the "After childhood" should begin the sentence, otherwise the reader consumes a lot of text with no context. Colin°Talk 20:19, 17 July 2007 (UTC)[reply]

The source says just "atypical", which would include paradoxical reactions but also the merely out-of-the-ordinary reactions. I changed it to say "atypical" rather than "unusual". I chopped up the "Few are supported" sentence, and reworded the last sentence as you suggested. Here are the changes to Autism#Treatment that I made in response to the above comments. Eubulides 05:29, 18 July 2007 (UTC)[reply]

Reviewing Epidemiology

"A broader review" - That second review looks to be more specific (in that it concentrates on ASD/PDD rather than "common neurologic disorders") so in what way is it "broader"? It is disappointing that a review from 2007 should include no high-quality studies beyond 1999. I seriously doubt this general neurological review is the best source for discussing the epidemiology of autism. It contains only three paragraphs and just over 200 words on autism and admits to "major limitations", specifically with older data. Those studies are all old; between 8 and 15 years old! For a subject that receives so much attention, it strikes me that we should concentrate on good quality recent studies (i.e. this century!)

Sigh, nobody likes Hirtz et al.; they're too conservative and their standards are too high. :-) To get better consensus I removed the citation. I'll try to catch up with your other comments later. Eubulides 16:50, 18 July 2007 (UTC)[reply]

In the final sentence, you use "but" to diss "most recent reviews" with the "2006 British study". It isn't acceptable for you (as a WP editor) to do that. To do that, you'd have to find a review that said the 2006 British study was a significant challenge to the current consensus. Perhaps that's possible? Alternatively, you could just passively discuss the issues by saying "Individual studies sometimes report figures outside the consensus range. For example, a 2006..."

The "but" came from Newschaffer et al. Here's a quote from their paper (they use "However" not "but" but it's the same thing): "Most recent reviews of the prevalence literature tend to conclude that prevalence of autistic disorder falls between 10 and 20 per 10,000. Recent prevalence estimates for the ASDs collectively have been surprisingly consistent, in comparison with the heterogeneity of autistic disorder estimates, falling close to 60 per 10,000 (7, 13, 22, 23). However, the most recent prevalence survey available at this writing reported ASD prevalence of ASDs in a population of more than 55,000 British eight- and nine-year-olds to be more than 110 per 10,000 (8)." (That "ASD prevalence of ASDs" is surely a typo: they meant either "ASD prevalence" or "prevalence of ASDs". They needed a copyeditor too!) Please see below for how I fixed the "but". Eubulides 20:33, 18 July 2007 (UTC)[reply]

However, reading the abstract of the 2006 study (in the Lancet, so I suppose that says something), I see "A narrower definition of childhood autism, which combined clinical consensus with instrument criteria for past and current presentation, provided a prevalence of 24.8 per 10,000" (i.e. 2.48 per 1,000) which is not such an outlier. I don't know the details of narrow/wide definitions so can't comment on whether the other reviews were using the narrow or wide view?

Narrow view. Here's a quote from the 2006 Lancet study by Baird et al. which may help explain things:
"ICD-10 and DSM-IV diagnostic criteria have been used most commonly in recent prevalence studies but still allow scope for variation in interpretation. Different severity thresholds applied within the same qualitative domains of impairment result in different prevalence rates. Our narrow autism group who met robust criteria of autism on ADI plus ADOS and consensus clinical diagnosis could represent the most reliable and repeatable diagnostic group for studies looking at prevalence over time and place. We postulate that this narrow autism group could represent the older conceptualisation of autism that is commonly associated with mental retardation and occurs four or five times more frequently in boys than in girls.… Children shown in this study to have ASD but who were not locally diagnosed had other coexisting developmental disorders causing significant impairment."
To help try to address this issue I mentioned the broadening diagnostic criteria and removed the "but" here. Eubulides 21:31, 18 July 2007 (UTC)[reply]
Incidentally, are you aware of the recent prominent news reports about unpublished UK work estimating over 17 per 1,000 for ASD? See, for example, The MMR story that wasn't. It's a real zoo out there. Eubulides 21:31, 18 July 2007 (UTC)[reply]

The 10-15% known condition seems to contradict the earlier Causes section which says this happens "only rarely".

Most of the known conditions are single-gene but it's not a huge majority. Maybe 5–10% are single gene (I'm guessing here). Anyway, you're right, "only rarely" was too strong. I rewrote it to say "Typically autism cannot be traced to a single-gene mutation…" here. Eubulides 21:46, 18 July 2007 (UTC)[reply]

The "2001 British study of 26 autistic children" is rather a small sample size for discussing the occurrence of different levels of mental retardations. Are there no larger studies?

Nothing recent. At least, none that I know of, and I looked. Some older studies are PMID 3610999 (23 adults in Sweden, 1987) and PMID 1383189 (201 young adults in Japan, 1992). The Japanese results are dated and are hard to explain (it wasn't a population-based study); I'm not sure they're worth mentioning. I found no recent review of this subject, though I suspect Howlin's 2004 book (ISBN 0415309689) would be a good source I don't have it. Autism#Prognosis does say "Few high-quality studies address long-term prognosis", citing Seltzer et al. 2004 (PMID 15666341), so it's not just me who has had trouble finding studies in this area. Part of the problem is that diagnosis was much rarer formerly, so there aren't that many adults to choose from. Eubulides 22:16, 18 July 2007 (UTC)[reply]

To be continued... Colin°Talk 13:00, 18 July 2007 (UTC)[reply]

Thanks again. These comments are all quite helpful. Eubulides 22:16, 18 July 2007 (UTC)[reply]

"associated with epilepsy, with variations in risk due to age...Boys are at higher risk for autism than girls." The first "risk" isn't clear (but the ref is clearly talking about risk of epilepsy in those with ASD). Can you make it explicit, especially since you use the word "risk" in the following sentence and we are back to risk of ASD.

Thanks, I changed "risk" to "risk of epilepsy". Eubulides 04:06, 27 July 2007 (UTC)[reply]

The word "risk" is used throughout this article. This word generally means the chance of something bad happening. Now, the idea that autism is "simply another way of being" (which you mention earlier) is a distinctly minority POV. However, if you can find ways of describing things without loaded terms, then it keeps everyone happy. I'm not suggesting you remove all the "risks" but it is something to consider each time you use the word.

My vague recollection is that every instance of the word "risk" comes from the cited sources. I understand what you mean about terminology, though, and will try to avoid it when it comes to my own word choices. Eubulides 04:06, 27 July 2007 (UTC)[reply]

"Autism's incidence is less useful than its prevalence" might be better rephrased as "less useful a xxxx than its prevalence" where xxxx is "term", "concept", "statistic" or whatever you think incidence/prevalence are. Ultimately, I failed to understand (from this sentence) why prevalence is more useful than incidence.

Thanks, I changed that. Eubulides 04:06, 27 July 2007 (UTC)[reply]

"..public awareness. though as-yet.." punctuation not quite right here. "A widely-cited.." is a huge sentence!

Thanks, I fixed the punctuation. It is a long sentence, but is it that unreadable? Suggestions for improvement are welcome. If it's any consolation, the sentence has a Gunning fog index of 16.01, which is a bit less than the text of the article as a whole (currently 16.59 according to one online calculator). Eubulides 04:06, 27 July 2007 (UTC)[reply]

I think you need to explain "real" a bit better. The distinction is not between real and (its opposite) imaginary, which some might interpret as an insult implying folk just made it up. I know what you are trying to say, but I'm not sure how to revise it.

"would suggest more attention and funding on ..." doesn't work. How about "would suggestion more attention and funding should be directed towards ... than continuing..". The phrase "it is conceivable that" generally implies a reluctant admission of a possibility. It isn't neutral enough. Colin°Talk 19:47, 26 July 2007 (UTC)[reply]

Thanks, I made this change to fix the problems noted in the above two paragraphs. I removed the "conceivable" sentence for the reason you mention, as well as for a couple of other reasons: (1) it's dated, (2) it's about etiology and therefore doesn't belong in "Epidemiology". Eubulides 04:39, 27 July 2007 (UTC)[reply]
Soon after making the above changes, Midgley commented on the same area, and I made the following further changes. Eubulides 05:32, 27 July 2007 (UTC)[reply]

Comments by Countincr

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  • This was my first visit to the article and after a brief reading, result of recent improvement drive was quite obvious. Hats off to everyone involved. However I think there are some minor issues that needs to be addressed:
  1. No mention of ICD criteria! Is there any particular reason behind this? May be I am unaware of shortcomings as I am not an expert on this field, but as far as I know it is widely used for diagnosis and some consider DSM and ICD to be complementary.
    These days ICD is basically the same as DSM for autism, no? But I added some text to this effect. Eubulides 08:01, 12 July 2007 (UTC)[reply]
  2. Assessment tools like CARS, ADI should be briefly discussed.
    Thanks, I added this. Eubulides 08:01, 12 July 2007 (UTC)[reply]
  3. Imaging studies like PET and gated MRI's findings should be mentioned. If we can find a PET image somewhere that will improve the aesthetic aspect of the article as well.
    I'm afraid you'll have to help me out with this one. I'm unaware of research using gated MRI for autism. For PET, were you thinking of any studies in particular? As for getting images I'd love to add some if we can get them; the current article has way too few images. Eubulides 08:01, 12 July 2007 (UTC)[reply]
    TimVickers (talk · contribs) is often able to help in this area; you might drop him a note. SandyGeorgia (Talk) 16:47, 12 July 2007 (UTC)[reply]
  4. Cognitive and behavioural therapies should be detailed a bit more in treatment section. Since they have their own articles, several lines would be enough.
    I added a bit of text there. Eubulides 08:01, 12 July 2007 (UTC)[reply]
  5. A general reader might wonder what happens to these children when they grow up; prognosis section on this regard I think is some what brief.
    I added a bit there too. Perhaps more could be added; suggestions would help. Eubulides 08:01, 12 July 2007 (UTC)[reply]

I hope I am not too critical, certainly that was not the intention. My overall impression on Autism is very positive. I am going to link it to scientific review and hopefully we will get some views from different angles.--Countincr ( T@lk ) 23:30, 11 July 2007 (UTC)[reply]

Thanks for the review. For your convenience the changes I made in response to your review can be found here and here. Eubulides 08:01, 12 July 2007 (UTC)[reply]
I have emailed publishers for PMID 15751273 and PMID 14762598 for SPECT images and I'll let you know if they agrees for GFDL or CC licensing. I also took the liberty of editing infobox image. There were too many distracting things, I wanted to draw the attention to the subject and did some other minor corrections. We can also put images of posters and one or two diagrams.--Countincr ( T@lk ) 01:39, 13 July 2007 (UTC)[reply]
What posters? The Fair Use folks are really cracking down at WP:FAC. SandyGeorgia (Talk) 01:45, 13 July 2007 (UTC)[reply]
I meant posters from Gov. agencies for autistic awareness (see Bridgeman Art Library v. Corel Corp.). Although I do not think Fair use rationale is necessary for this article, it can be applied to posters in general as per policy guideline.--Countincr ( T@lk ) 23:00, 13 July 2007 (UTC)[reply]
Google Images reports [1] and [2] as sources for public-domain images about autism, but these images aren't that suitable for Autism, I'm afraid. Eubulides 21:29, 16 July 2007 (UTC)[reply]
I did a goolge search as well, nothing exiting. See if you find Image:Autism.svg useful. Have not had any response from the journals yet.--Countincr ( t@lk ) 23:27, 16 July 2007 (UTC)[reply]
I have mixed feelings about the autism awareness ribbon. It doesn't add much technically. It would be more appropriate in an article on the subject of autism advocacy than in an article about autism itself. Eubulides 23:51, 16 July 2007 (UTC)[reply]
IMO, the autism awareness ribbon doesn't illustrate the encylopedic aspects of the topic and is more appropriate for a website or support group. SandyGeorgia (Talk) 02:35, 17 July 2007 (UTC)[reply]

Review by BirgitteSB

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  • Lead: It is one of the five pervasive developmental disorders (PDD) or autism spectrum disorders (ASD), which are closely related and usually less severe than autism It would be more clear to say "It is the most severe of the five pervasive developmental disorders (PDD) or autism spectrum disorders (ASD), which are all closely related."
  • Characteristics: My biggest problem with the article is this section and it's overwhelming focus on children. I think some of that material might be better in "Screening" section which is right to focus on children. This is a life-long disorder and we need to have this section focus on the general characteristics as much as possible. Since social development is naturally about development, I think it is fine to give a run-down of the development milestones autistic children struggle with as they age. However there still need to be something about rest of the lifetime. Communication should not focus so much on development and maybe some of that should go in "Screening". Repetitive behavior is nicely general, but Other Symptoms returns to focusing on children. Do splinter skills disappear with maturity? I realize that if the studies done are solely with children then you cannot change that, but I really think you should look over your sources once more and be certain the restriction is always necessary. I have the feeling that contributors just got in the habit of typing "children" at times.
    • Thanks for this suggestion. I just now looked at each use of the word "children", and they were all taken from the citations (i.e., the cited material is about children, not all individuals) except for the splinter-skill reference. Good catch! So I corrected that one. It is a judgment call whether some of this stuff belongs under "Screening" and vice versa, but it is a development disorder and some of the characteristics discussion will naturally focus on children. The reason it's written the way it is, is because the literature for the more-general area is pretty sparse; but if we can track down some reliable sources in the more-general area I'd welcome adding the info to "Characteristics". Eubulides 21:02, 13 July 2007 (UTC)[reply]
    • Since writing the above I have added more material on the limited research on adult residential programs (citing Van Bourgondien et al.), references to issues with residential care, job training and placement, sexuality, social skills, and estate planning for adults (citing Aman), severity of symptoms in later childhood (citing Howlin) and in adults (citing Seltzer et al.). Eubulides 23:24, 15 July 2007 (UTC)[reply]
  • Screening: Any of the following warning signs is reason to have a child evaluated by a specialist: Please directly attribute this advice to someone. I almost want to insist it should either be prose or else done up as an illustration to the text, but I can live with the bullet points as long as there is a strong attribution.
  • Treatment: This section has the focus solely on children. How effective is treatment long term? It is effective at promoting social and language development and in reducing behaviors that interfere with functioning and learning. But does the social and language development continue when treatment is stopped, or stall, or regress? Do the problematic behaviors return when treatment is discontinued? I have read a little of the lawsuits people have undertaken to have school systems provide treatment and that there is little treatment available once a autistic person "ages out" of the schools. Do you think that aspect should be covered in this article? I would like to see something said of adult treatment in any event The paragraph on drugs reads as though autistic adults don't exist. Also the article often talks of the range of severity of this disorder, but this sections reads as if the severity has no relevance on treatments. I would imagine it does but if not you should say something explicitly about that facet.
    • I've changed the wording slightly in "Treatment" but the bottom line is that the vast majority of treatment is for children, and that the studies on efficacy for treatment hardly ever do long-term followups. I found no reliable sources to address your technical questions so I'm afraid the article will have to remain silent about them. For treatment and financing, I added this change to document some of the financial pressures families face, and this to talk about the limited data on adult treatment, and I chnaged change a "a child" to "someone" when talking about drugs. Severity does affect treatment, and I added this to talk about that. Eubulides 08:17, 14 July 2007 (UTC)[reply]
      • What I would still like to see, and this goes for "Characteristics" as well, is just that the adult situation is decalared to be little studied rather than simply ommited. Which you have done in the diff given above, but I think reading the article the lack of knowledge on adults almost becomes a theme. I know you have to find a source on this, but there has to be something out there that is focused on autism in adults. I would love to have a few places where it declared that adults exist but there is little that can be said definatively about them in this area.--BirgitteSB 16:26, 14 July 2007 (UTC)[reply]
        • If someone can find a good medical review article focused on autism in adults, that would be great. I looked hard for one in the past day or two but came up dry. Eubulides 19:16, 14 July 2007 (UTC)[reply]
  • Cultural references: This section is far to short. I am not sure that Cultural references is a good title.
  • Writing level: I find the writing level to be a little more difficult than is absolutely necessary. Is etiology a key concept to autism that you must say, its etiology is usually unknown.? Why applied behavior analysis (ABA) has demonstrated efficacy in rather than "applied behavior analysis (ABA) has been effective at"? I think you should look for things that can be re-written in lay-mans terms where possible.
    • I replaced "etiology" with "theory of causation". "Demonstrated efficacy" does not mean the same thing as "has been effective at"; it means that the treatment is at least as good as other treatments in a clinical trial. I replaced "efficacy" with "therapeutic effect in clinical trials that is at least as good as other treatments" though to be honest this is pretty long and maybe I should just change it back to "efficacy"? Anyway, for reference here are the details about these edits. If you spot any other unnecessary medical jargon please let us know. Eubulides 06:59, 15 July 2007 (UTC)[reply]

Overall I am impressed with the article and wish you guys good luck returning it to FA.--BirgitteSB 19:51, 13 July 2007 (UTC)[reply]

I think the work you have done since this review has addressed each of my concerns. I realize we are all slaves to the sources available, but I hope everyone maintaining this article can keep the child/adult issue in mind for the future. And hopefully more sources about this disorder in adults will become available at some point.--BirgitteSB 12:47, 16 July 2007 (UTC)[reply]

Spoken article link

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I posted this question to the article talk page, but it doesn't appear anyone knows the answer; maybe by posting it here, someone will weigh in. The link to the Spoken article in External links is now to a very outdated article; should that link be removed to the talk page, and is there any policy/guideline about removing Spoken article links? I haven't located anything. SandyGeorgia (Talk) 15:19, 15 July 2007 (UTC)[reply]

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