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      Prevalence of Autism Spectrum Disorder Among Children Aged 8 Years — Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2016

      research-article
      , PhD 1 , , , PhD 1 , , EdS 1 , , MPH 1 , , MPH 1 , , MA 1 , , PhD 1 , , PhD 1 , , PhD 2 , , PhD 2 , , MD 3 , 3 , , MHSA, MA 3 , 3 , , PhD 4 , , PhD 5 , , PhD 6 , , PhD 6 , 6 , , PhD- 7 , , PhD 7 , , PhD 7 , , PhD 7 , , MS 7 , , MD 8 , , PhD 8 , , PhD 9 , , MS 9 , , PhD 10 , , PhD 11 , , MS 11 , , MS 12 , , DrPH, PhD 12 , , DrPH 1
      MMWR Surveillance Summaries
      Centers for Disease Control and Prevention

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          Abstract

          Problem/Condition

          Autism spectrum disorder (ASD).

          Period Covered

          2016.

          Description of System

          The Autism and Developmental Disabilities Monitoring (ADDM) Network is an active surveillance program that provides estimates of the prevalence of ASD among children aged 8 years whose parents or guardians live in 11 ADDM Network sites in the United States (Arizona, Arkansas, Colorado, Georgia, Maryland, Minnesota, Missouri, New Jersey, North Carolina, Tennessee, and Wisconsin). Surveillance is conducted in two phases. The first phase involves review and abstraction of comprehensive evaluations that were completed by medical and educational service providers in the community. In the second phase, experienced clinicians who systematically review all abstracted information determine ASD case status. The case definition is based on ASD criteria described in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition.

          Results

          For 2016, across all 11 sites, ASD prevalence was 18.5 per 1,000 (one in 54) children aged 8 years, and ASD was 4.3 times as prevalent among boys as among girls. ASD prevalence varied by site, ranging from 13.1 (Colorado) to 31.4 (New Jersey). Prevalence estimates were approximately identical for non-Hispanic white (white), non-Hispanic black (black), and Asian/Pacific Islander children (18.5, 18.3, and 17.9, respectively) but lower for Hispanic children (15.4). Among children with ASD for whom data on intellectual or cognitive functioning were available, 33% were classified as having intellectual disability (intelligence quotient [IQ] ≤70); this percentage was higher among girls than boys (40% versus 32%) and among black and Hispanic than white children (47%, 36%, and 27%, respectively). Black children with ASD were less likely to have a first evaluation by age 36 months than were white children with ASD (40% versus 45%). The overall median age at earliest known ASD diagnosis (51 months) was similar by sex and racial and ethnic groups; however, black children with IQ ≤70 had a later median age at ASD diagnosis than white children with IQ ≤70 (48 months versus 42 months).

          Interpretation

          The prevalence of ASD varied considerably across sites and was higher than previous estimates since 2014. Although no overall difference in ASD prevalence between black and white children aged 8 years was observed, the disparities for black children persisted in early evaluation and diagnosis of ASD. Hispanic children also continue to be identified as having ASD less frequently than white or black children.

          Public Health Action

          These findings highlight the variability in the evaluation and detection of ASD across communities and between sociodemographic groups. Continued efforts are needed for early and equitable identification of ASD and timely enrollment in services.

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          Most cited references23

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          Identification and evaluation of children with autism spectrum disorders.

          Autism spectrum disorders are not rare; many primary care pediatricians care for several children with autism spectrum disorders. Pediatricians play an important role in early recognition of autism spectrum disorders, because they usually are the first point of contact for parents. Parents are now much more aware of the early signs of autism spectrum disorders because of frequent coverage in the media; if their child demonstrates any of the published signs, they will most likely raise their concerns to their child's pediatrician. It is important that pediatricians be able to recognize the signs and symptoms of autism spectrum disorders and have a strategy for assessing them systematically. Pediatricians also must be aware of local resources that can assist in making a definitive diagnosis of, and in managing, autism spectrum disorders. The pediatrician must be familiar with developmental, educational, and community resources as well as medical subspecialty clinics. This clinical report is 1 of 2 documents that replace the original American Academy of Pediatrics policy statement and technical report published in 2001. This report addresses background information, including definition, history, epidemiology, diagnostic criteria, early signs, neuropathologic aspects, and etiologic possibilities in autism spectrum disorders. In addition, this report provides an algorithm to help the pediatrician develop a strategy for early identification of children with autism spectrum disorders. The accompanying clinical report addresses the management of children with autism spectrum disorders and follows this report on page 1162 [available at www.pediatrics.org/cgi/content/full/120/5/1162]. Both clinical reports are complemented by the toolkit titled "Autism: Caring for Children With Autism Spectrum Disorders: A Resource Toolkit for Clinicians," which contains screening and surveillance tools, practical forms, tables, and parent handouts to assist the pediatrician in the identification, evaluation, and management of autism spectrum disorders in children.
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            Prevalence and Trends of Developmental Disabilities among Children in the United States: 2009–2017

            To study the national prevalence of ten developmental disabilities in US children aged 3–17 years and explore changes over time by associated demographic and socioeconomic characteristics using the 2009–2017 National Health Interview Survey (NHIS). Data come from the NHIS, a nationally-representative survey of the civilian noninstitutionalized population. Parents reported physician or other health care professional diagnoses of attention-deficit/hyperactivity disorder (ADHD); autism spectrum disorder (ASD); blindness; cerebral palsy; moderate to profound hearing loss; learning disability (LD); intellectual disability (ID); seizures; stuttering or stammering; and other developmental delays. Weighted percentages for each of the selected developmental disabilities and any developmental disability were calculated between 2009–2017 and stratified by selected demographic/socioeconomic characteristics. From 2009–2011 to 2015–2017, there were overall significant increases in the prevalence of any developmental disability (16.2% to 17.8%, p<.001), ADHD (8.5% to 9.5%, p <.01), ASD (1.1% to 2.5%, p <.001), and ID (0.9% to 1.2%, p <.05), but a significant decrease for any other developmental delay (4.7% to 4.1% , p <.05). The prevalence of any developmental disability increased among boys, children ages 12–17, non-Hispanic white and Hispanic children, children with private insurance only, and children with birthweights ≥2,500 grams. An increase in prevalence of any developmental disability was also seen for children living in urban areas and with less educated mothers. The prevalence of developmental disability among US children aged 3–17 years increased between 2009–2017. Changes by demographic and socioeconomic subgroups may be related to improvements in awareness and access to health care. From the 2009–2017 NHIS, there was a 9.5% increase in the prevalence of developmental disabilities among children aged 3–17.
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              Prevalence of autism spectrum disorder among children aged 8 years - autism and developmental disabilities monitoring network, 11 sites, United States, 2010.

              (2014)
              Autism spectrum disorder (ASD). 2010. The Autism and Developmental Disabilities Monitoring (ADDM) Network is an active surveillance system in the United States that provides estimates of the prevalence of ASD and other characteristics among children aged 8 years whose parents or guardians live in 11 ADDM sites in the United States. ADDM surveillance is conducted in two phases. The first phase consists of screening and abstracting comprehensive evaluations performed by professional providers in the community. Multiple data sources for these evaluations include general pediatric health clinics and specialized programs for children with developmental disabilities. In addition, most ADDM Network sites also review and abstract records of children receiving special education services in public schools. The second phase involves review of all abstracted evaluations by trained clinicians to determine ASD surveillance case status. A child meets the surveillance case definition for ASD if a comprehensive evaluation of that child completed by a qualified professional describes behaviors consistent with the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) diagnostic criteria for any of the following conditions: autistic disorder, pervasive developmental disorder-not otherwise specified (including atypical autism), or Asperger disorder. This report provides updated prevalence estimates for ASD from the 2010 surveillance year. In addition to prevalence estimates, characteristics of the population of children with ASD are described. For 2010, the overall prevalence of ASD among the ADDM sites was 14.7 per 1,000 (one in 68) children aged 8 years. Overall ASD prevalence estimates varied among sites from 5.7 to 21.9 per 1,000 children aged 8 years. ASD prevalence estimates also varied by sex and racial/ethnic group. Approximately one in 42 boys and one in 189 girls living in the ADDM Network communities were identified as having ASD. Non-Hispanic white children were approximately 30% more likely to be identified with ASD than non-Hispanic black children and were almost 50% more likely to be identified with ASD than Hispanic children. Among the seven sites with sufficient data on intellectual ability, 31% of children with ASD were classified as having IQ scores in the range of intellectual disability (IQ ≤70), 23% in the borderline range (IQ = 71-85), and 46% in the average or above average range of intellectual ability (IQ >85). The proportion of children classified in the range of intellectual disability differed by race/ethnicity. Approximately 48% of non-Hispanic black children with ASD were classified in the range of intellectual disability compared with 38% of Hispanic children and 25% of non-Hispanic white children. The median age of earliest known ASD diagnosis was 53 months and did not differ significantly by sex or race/ethnicity. These findings from CDC's ADDM Network, which are based on 2010 data reported from 11 sites, provide updated population-based estimates of the prevalence of ASD in multiple communities in the United States. Because the ADDM Network sites do not provide a representative sample of the entire United States, the combined prevalence estimates presented in this report cannot be generalized to all children aged 8 years in the United States population. Consistent with previous reports from the ADDM Network, findings from the 2010 surveillance year were marked by significant variations in ASD prevalence by geographic area, sex, race/ethnicity, and level of intellectual ability. The extent to which this variation might be attributable to diagnostic practices, underrecognition of ASD symptoms in some racial/ethnic groups, socioeconomic disparities in access to services, and regional differences in clinical or school-based practices that might influence the findings in this report is unclear. ADDM Network investigators will continue to monitor the prevalence of ASD in select communities, with a focus on exploring changes within these communities that might affect both the observed prevalence of ASD and population-based characteristics of children identified with ASD. Although ASD is sometimes diagnosed by 2 years of age, the median age of the first ASD diagnosis remains older than age 4 years in the ADDM Network communities. Recommendations from the ADDM Network include enhancing strategies to address the need for 1) standardized, widely adopted measures to document ASD severity and functional limitations associated with ASD diagnosis; 2) improved recognition and documentation of symptoms of ASD, particularly among both boys and girls, children without intellectual disability, and children in all racial/ethnic groups; and 3) decreasing the age when children receive their first evaluation for and a diagnosis of ASD and are enrolled in community-based support systems.
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                Author and article information

                Journal
                MMWR Surveill Summ
                MMWR Surveill Summ
                SS
                MMWR Surveillance Summaries
                Centers for Disease Control and Prevention
                1546-0738
                1545-8636
                27 March 2020
                27 March 2020
                : 69
                : 4
                : 1-12
                Affiliations
                National Center on Birth Defects and Developmental Disabilities, CDC, Atlanta, Georgia; University of Arizona, Tucson; University of Arkansas for Medical Sciences, Little Rock; Colorado Department of Public Health and Environment, Denver; University of Colorado School of Medicine, Department of Pediatrics, Aurora; Johns Hopkins University, Baltimore, Maryland; University of Minnesota, Minneapolis; Washington University in St. Louis, Missouri; Rutgers New Jersey Medical School, Newark; University of North Carolina, Chapel Hill; Vanderbilt University Medical Center, Nashville, Tennessee; University of Wisconsin, Madison
                Author notes
                Corresponding author: Matthew J. Maenner, National Center on Birth Defects and Developmental Disabilities, CDC. Telephone: 404-498-3072; E-mail: mmaenner@ 123456cdc.gov .
                Article
                ss6904a1
                10.15585/mmwr.ss6904a1
                7119644
                32214087
                5294f413-bd97-4b95-9b0a-25d1d9b78c5f

                All material in the MMWR Series is in the public domain and may be used and reprinted without permission; citation as to source, however, is appreciated.

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