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

Published on Mar 27, 2020
· DOI :10.15585/MMWR.SS6904A1
Matthew J. Maenner29
Estimated H-index: 29
(CDC: Centers for Disease Control and Prevention),
Kelly A Shaw20
Estimated H-index: 20
(CDC: Centers for Disease Control and Prevention)
+ 31 AuthorsPatricia M. Dietz56
Estimated H-index: 56
(CDC: Centers for Disease Control and Prevention)
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 (39% versus 32%) and among black and Hispanic than white children (47%, 36%, and 27%, respectively) [corrected]. 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.
Figures & Tables
📖 Papers frequently viewed together
18 Authors (Kelly A Shaw, ..., Patricia M. Dietz)
28 Citations
24 Authors (Gil Sharon, ..., Sarkis K. Mazmanian)
256 Citations
16 Authors (Sally J Ozonoff, ..., Wendy L. Stone)
841 Citations
#1Madalina-Andreea Robea (UAIC: Alexandru Ioan Cuza University)H-Index: 2
#2Alina-Costina Luca (Grigore T. Popa University of Medicine and Pharmacy)H-Index: 3
Last. Alin Ciobica (UAIC: Alexandru Ioan Cuza University)H-Index: 24
view all 3 authors...
Recently, connections have been made between feeding and eating problems and autism spectrum disorder (ASD) and between autism pathophysiology and diet issues. These could explain some of the mechanisms which have not yet been discovered or are not sufficiently characterized. Moreover, there is an increased awareness for micronutrients in ASD due to the presence of gastrointestinal (GI) problems that can be related to feeding issues. For example, levels of vitamins B1, B6, B12, A and D are often...
5 CitationsSource
The prevalence of Autism Spectrum Disorder (ASD) has increased dramatically in recent decades, supporting the claim of an autism epidemic. Systematic monitoring of ASD allows estimating prevalence and identifying potential sources of variation over time and geographical areas. At present, ASD prevalence estimates are available worldwide, coming either from surveillance systems using existing health and educational databases or from population studies specifically performed. In the present articl...
50 CitationsSource
73 CitationsSource
#1Kelly A ShawH-Index: 20
#2Matthew J. MaennerH-Index: 29
Last. Patricia M. DietzH-Index: 56
view all 18 authors...
PROBLEM/CONDITION: Autism spectrum disorder (ASD). PERIOD COVERED: 2016. DESCRIPTION OF SYSTEM: The Early Autism and Developmental Disabilities Monitoring (Early ADDM) Network, a subset of the overall ADDM Network, is an active surveillance program that estimates ASD prevalence and monitors early identification of ASD among children aged 4 years. Children included in surveillance year 2016 were born in 2012 and had a parent or guardian who lived in the surveillance area in Arizona, Colorado, Mis...
28 CitationsSource
#1Benjamin Zablotsky (CDC: Centers for Disease Control and Prevention)H-Index: 24
#2Lindsey I. Black (CDC: Centers for Disease Control and Prevention)H-Index: 14
Last. Coleen A. Boyle (CDC: Centers for Disease Control and Prevention)H-Index: 56
view all 9 authors...
OBJECTIVES: To study the national prevalence of 10 developmental disabilities in US children aged 3 to 17 years and explore changes over time by associated demographic and socioeconomic characteristics, using the National Health Interview Survey. METHODS: Data come from the 2009 to 2017 National Health Interview Survey, a nationally representative survey of the civilian noninstitutionalized population. Parents reported physician or other health care professional diagnoses of attention-deficit/hy...
147 CitationsSource
#1Sally J. Rogers (UC Davis: University of California, Davis)H-Index: 106
#2Annette Estes (UW: University of Washington)H-Index: 59
Last. Meagan R. Talbott (UC Davis: University of California, Davis)H-Index: 7
view all 14 authors...
Objective This single-blind, randomized, multisite, intent-to-treat study was designed to replicate and extend Dawson et al.’s (Pediatrics. 2010;125: e17-e23) randomized controlled trial testing the effects of the Early Start Denver Model (ESDM), an intensive play- and routines-based intervention delivered in natural settings. Method A randomized controlled trial was conducted at 3 universities. One hundred eighteen children 14 to 24 months old with autism spectrum disorder were enrolled and ran...
40 CitationsSource
#1Pamela Imm (UW: University of Wisconsin-Madison)H-Index: 17
#2Tiffany White (Colorado Department of Public Health and Environment)H-Index: 5
Last. Maureen S. Durkin (UW: University of Wisconsin-Madison)H-Index: 56
view all 3 authors...
This study assessed potential under-ascertainment of autism spectrum disorder due to missing administrative information for Hispanic and non-Hispanic Black children within the Autism and Developmental Disabilities Monitoring Network. We analyzed data from two Network sites (Colorado and Wisconsin) for surveillance years 2012 and 2014 to determine whether children excluded from autism spectrum disorder prevalence estimates due to missing residency and other information differed from those include...
6 CitationsSource
#1Michael D. Kogan (Health Resources and Services Administration)H-Index: 73
#2Catherine J. Vladutiu (Health Resources and Services Administration)H-Index: 14
Last. Michael C. Lu (GW: George Washington University)H-Index: 32
view all 11 authors...
OBJECTIVES: To estimate the national prevalence of parent-reported autism spectrum disorder (ASD) diagnosis among US children aged 3 to 17 years as well as their treatment and health care experiences using the 2016 National Survey of Children’s Health (NSCH). METHODS: The 2016 NSCH is a nationally representative survey of 50 212 children focused on the health and well-being of children aged 0 to 17 years. The NSCH collected parent-reported information on whether children ever received an ASD dia...
138 CitationsSource
#1Lisa D. Wiggins (CDC: Centers for Disease Control and Prevention)H-Index: 21
#2Deborah Christensen (CDC: Centers for Disease Control and Prevention)H-Index: 20
Last. Jon Baio (CDC: Centers for Disease Control and Prevention)H-Index: 18
view all 5 authors...
For the first time, the Autism and Developmental Disabilities Monitoring Network (ADDM) at the Centers for Disease Control and Prevention (CDC) reported prevalence estimates based on two different diagnostic schemes in the 2014 surveillance period. Results found substantial agreement between surveillance case status based on Diagnostic and Statistical Manual of Mental Disorders–Fourth Edition–Text Revision (DSM-IV-TR) criteria and DSM-5 criteria ASD (kappa = 0.85). No study has replicated this a...
4 CitationsSource
#1Diana Schendel (AU: Aarhus University)H-Index: 57
#2Erla Thorsteinsson (AU: Aarhus University)H-Index: 1
This Research Letter examines cumulative incidence on autism spectrum disorder in Denmark using nationwide registered diagnosis data from 1980 to 2012 and assesses whether prevalence was stabilized.
25 CitationsSource
Cited By576
#1Xiu He (MOE: Chinese Ministry of Education)
#2Ying Tu (MOE: Chinese Ministry of Education)
Last. Mingdan You (MOE: Chinese Ministry of Education)
view all 0 authors...
Agricultural pesticides have been one of the most extensively used compounds throughout the world. The main sources of contamination for humans are dietary intake and occupational exposure. The impairments caused by agricultural pesticide exposure have been a significant global public health problem. Recent studies have shown that low-level agricultural pesticide exposure during the critical period of neurodevelopment (pregnancy and lactation) is closely related to autism spectrum disorder (ASD)...
#1Janika LeosteH-Index: 3
view all 6 authors...
#1Kyriaki Sarri (UoM: University of Macedonia)
#1Chrystiane Vasconcelos Andrade Toscano (UFAL: Federal University of Alagoas)H-Index: 3
Last. Joana M. Gaspar (UFSC: Universidade Federal de Santa Catarina)H-Index: 13
view all 6 authors...
The worldwide prevalence of ASD is around 1%. Although the pathogenesis of ASD is not entirely understood, it is recognized that a combination of genetic, epigenetics, environmental factors and immune system dysfunction can play an essential role in its development. It has been suggested that autism results from the central nervous system derangements due to low-grade chronic inflammatory reactions associated with the immune system activation. ASD individuals have increased microglial activation...
#1Jessie B. Northrup (University of Pittsburgh)H-Index: 8
#2Nina B. Leezenbaum (University of Pittsburgh)H-Index: 10
Last. Susan B. Campbell (University of Pittsburgh)H-Index: 49
view all 3 authors...
Social engagement, pretend play, and concern for another’s distress represent fundamental features of typical social-emotional development in the second year. Children with autism spectrum disorder (ASD) display delays and deficits in these areas, and research on toddlers at heightened risk for ASD (HR; younger siblings of children with ASD) indicates these deficits may be apparent in toddlerhood. Prior research has examined these aspects of social-emotional development individually in HR toddle...
#1Liliana Wagner (VUMC: Vanderbilt University Medical Center)H-Index: 2
#2Laura L Corona (VUMC: Vanderbilt University Medical Center)H-Index: 3
Last. Zachary WarrenH-Index: 37
view all 11 authors...
The COVID-19 pandemic has caused unprecedented disruptions to healthcare, including direct impacts on service delivery related to autism spectrum disorder (ASD). Caregiver-mediated tele-assessment offers an opportunity to continue services while adhering to social distancing guidelines. The present study describes a model of tele-assessment for ASD in young children, implemented in direct response to disruptions in care caused by the COVID-19 pandemic. We present preliminary data on the outcomes...
12 CitationsSource
#1Lucy A. Bilaver (NU: Northwestern University)H-Index: 11
#2Sarah A. Sobotka (U of C: University of Chicago)H-Index: 7
Last. David S. Mandell (UPenn: University of Pennsylvania)H-Index: 65
view all 3 authors...
Racial and ethnic disparities in the use of nine common autism-related services among Medicaid-enrolled children with autism spectrum disorder (ASD) were examined, distinguishing between school and other community-based outpatient settings. Using 2012 Medicaid Analytic Extract data, we identified 117,848 continuously enrolled children with ASD. Several racial and ethnic disparities were found, varying by geography. Black, Asian, and Native American/Pacific Islanders received fewer outpatient ser...
#1Naomi V. Ekas (TCU: Texas Christian University)H-Index: 17
#2Chrystyna D. Kouros (SMU: Southern Methodist University)H-Index: 22
Research supports that parents of children with ASD experience higher rates of marital conflict compared to parents of neurotypically developing (NT) children; however, no known research examining reactions to interparental conflict in children with ASD exists. This study compared emotional, behavioral, and physiological responses to interparental conflict in ASD (n = 21) and NT children (n = 29). Children were presented with videotaped interactions (constructive vs. destructive conflict) of act...
#1Joshua K. Lee (UC Davis: University of California, Davis)H-Index: 11
#2Derek S. Andrews (UC Davis: University of California, Davis)H-Index: 7
Last. Christine Wu Nordahl (UC Davis: University of California, Davis)H-Index: 23
view all 7 authors...
Abstract Background Cerebral overgrowth is frequently reported in children but not in adults with autism spectrum disorder (ASD). This suggests that early cerebral overgrowth is followed by normalization of cerebral volumes. However, this notion is predicated on cross-sectional research that is vulnerable to sampling bias. For example, autistic individuals with disproportionate megalencephaly, a subgroup with higher rates of intellectual disability and larger cerebral volumes, may be underrepres...
3 CitationsSource
#1Gazi Azad (CUMC: Columbia University Medical Center)
#1Gazi Azad (CUMC: Columbia University Medical Center)
Last. Jeffrey D. Shahidullah (University of Texas at Austin)H-Index: 6
view all 5 authors...
Abstract Background Interagency collaboration between community and school settings is one mechanism to serve the complex needs of pediatric patients with autism spectrum disorder (ASD). Purpose We surveyed a national sample of community-based providers to examine their perspectives on interagency collaboration with school-based providers when serving pediatric patients with ASD. Method Medical and behavioral/mental health professionals practicing in community settings were recruited. Participan...