Comparison of 2 Case Definitions for Ascertaining the Prevalence of Autism Spectrum Disorder Among 8-Year-Old Children

Maenner, Matthew J; Graves, Sierra J; Peacock, Georgina; Honein, Margaret A; Boyle, Coleen A; Dietz, Patricia M

doi:10.1093/aje/kwab106

Cited by 18Autism Spectrum Disorder ResearchChild Nutrition and Feeding IssuesDown syndrome and intellectual disability research

Comparison of 2 Case Definitions for Ascertaining the Prevalence of Autism Spectrum Disorder Among 8-Year-Old Children

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Maenner, Matthew J, Graves, Sierra J, Peacock, Georgina, Honein, Margaret A, Boyle, Coleen A, Dietz, Patricia M·2021·American Journal of Epidemiology

DOI 10.1093/aje/kwab106PMC PMC9022042

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Abstract

The Autism and Developmental Disabilities Monitoring (ADDM) Network conducts population-based surveillance of autism spectrum disorder (ASD) among 8-year-old children in multiple US communities. From 2000 to 2016, investigators at ADDM Network sites classified ASD from collected text descriptions of behaviors from medical and educational evaluations which were reviewed and coded by ADDM Network clinicians. It took at least 4 years to publish data from a given surveillance year. In 2018, we developed an alternative case definition utilizing ASD diagnoses or classifications made by community professionals. Using data from surveillance years 2014 and 2016, we compared the new and previous ASD case definitions. Compared with the prevalence based on the previous case definition, the prevalence based on the new case definition was similar for 2014 and slightly lower for 2016. Sex and race/ethnicity prevalence ratios were nearly unchanged. Compared with the previous case definition, the new case definition’s sensitivity was 86% and its positive predictive value was 89%. The new case definition does not require clinical review and collects about half as much data, yielding more timely reporting. It also more directly measures community identification of ASD, thus allowing for more valid comparisons among communities, and reduces resource requirements while retaining measurement properties similar to those of the previous definition.

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Surveillance in 2020 was conducted using the same methods as in 2018.
“Surveillance was conducted using the same methods as in 2018 (7,10).”
From Early Identification of Autism Spectrum Disorder Among Children Aged 4 Years — Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2020 (2023) · cites this paper as [10]
A change to the ASD case definition for 2018 that no longer required clinician review of records could also contribute to higher prevalence among Black and Hispanic children who were less likely to have detailed health information available for review and therefore less likely to meet the case definition with previous methods.
“A change to the ASD case definition for 2018 that no longer required clinician review of records (12) could also contribute to higher prevalence among Black and Hispanic children who were less likely to have detailed health information available for review and therefore less likely to meet the case definition with previous methods (18).”
From Early Identification of Autism Spectrum Disorder Among Children Aged 4 Years — Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2018 (2021) · cites this paper as [12]

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Authors: Maenner, M. J., Graves, S. J., Peacock, G., Honein, M. A., Boyle, C. A., & Dietz, P. M.
Affiliations: Centers for Disease Control and Prevention (US)
Corresponding author: Maenner, Matthew J
ORCID: Maenner, Matthew J
Peacock, Georgina
Honein, Margaret A
Dietz, Patricia M
Venue: American Journal of Epidemiology
Publisher: Oxford University Press (OUP)
Published: 2021-04-13
Volume: 190
Issue: 10
Pages: 2198-2207
ISSN: 0002-9262 (ISSN-L)
1476-6256
DOI: 10.1093/aje/kwab106
PMC: PMC9022042
OpenAlex: W3155774834
Cited by: 18
References: 25
Citations by year: 2025: 5 · 2024: 1 · 2023: 6 · 2022: 3 · 2021: 3
FWCI: 1.71
Type: journal article
Language: en
Open access: hybrid
doi.org
Licence: public-domain
Locations: American Journal of Epidemiology (publishedVersion, public-domain)
PubMed (publishedVersion)
PubMed Central (acceptedVersion)
Funders: National Institutes of Health (CC999999)
Centers for Disease Control and Prevention
Oak Ridge Institute for Science and Education
National Center on Birth Defects and Developmental Disabilities
Topics: Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
Health Sciences › Medicine › Psychiatry and Mental health › Child Nutrition and Feeding Issues
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Down syndrome and intellectual disability research
Keywords: autism spectrum disorder, case definition, prevalence, 8-year-old children, diagnostic classification, community diagnosis, sensitivity and positive predictive value, sex differences, racial and ethnic disparities
MeSH terms: Autism Spectrum Disorder, Child, Female, Humans, Male, Population Surveillance, United States, Prevalence

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Comparison of 2 Case Definitions for Ascertaining the Prevalence of Autism Spectrum Disorder Among 8-Year-Old Children

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