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Cited by 1,964Autism Spectrum Disorder ResearchChild Nutrition and Feeding IssuesFamily and Disability Support Research

Prevalence and Characteristics of Autism Spectrum Disorder Among Children Aged 8 Years — Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2012

Open access
Christensen, Deborah L., Baio, Jon, Braun, Kim Van Naarden, Bilder, Deborah, Charles, Jane, Constantino, John N., Daniels, Julie, Durkin, Maureen S. +10 more·2016·MMWR. Surveillance Summaries
DOI 10.15585/mmwr.ss6503a1PMC PMC6237390
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Abstract

PROBLEM/CONDITION: Autism spectrum disorder (ASD). PERIOD COVERED: 2012. DESCRIPTION OF SYSTEM: The Autism and Developmental Disabilities Monitoring (ADDM) Network is an active surveillance system that provides estimates of the prevalence and characteristics of ASD among children aged 8 years whose parents or guardians reside in 11 ADDM Network sites in the United States (Arkansas, Arizona, Colorado, Georgia, Maryland, Missouri, New Jersey, North Carolina, South Carolina, Utah, and Wisconsin). Surveillance to determine ASD case status is conducted in two phases. The first phase consists of screening and abstracting comprehensive evaluations performed by professional service providers in the community. Data sources identified for record review are categorized as either 1) education source type, including developmental evaluations to determine eligibility for special education services or 2) health care source type, including diagnostic and developmental evaluations. The second phase involves the review of all abstracted evaluations by trained clinicians to determine ASD surveillance case status. A child meets the surveillance case definition for ASD if one or more comprehensive evaluations of that child completed by a qualified professional describes behaviors that are consistent with the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision 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 ASD prevalence estimates for children aged 8 years living in catchment areas of the ADDM Network sites in 2012, overall and stratified by sex, race/ethnicity, and the type of source records (education and health records versus health records only). In addition, this report describes the proportion of children with ASD with a score consistent with intellectual disability on a standardized intellectual ability test, the age at which the earliest known comprehensive evaluation was performed, the proportion of children with a previous ASD diagnosis, the specific type of ASD diagnosis, and any special education eligibility classification. RESULTS: For 2012, the combined estimated prevalence of ASD among the 11 ADDM Network sites was 14.5 per 1,000 (one in 69) children aged 8 years. Estimated prevalence was significantly higher among boys aged 8 years (23.4 per 1,000) than among girls aged 8 years (5.2 per 1,000). Estimated ASD prevalence was significantly higher among non-Hispanic white children aged 8 years (15.3 per 1,000) compared with non-Hispanic black children (13.1 per 1,000), and Hispanic (10.2 per 1,000) children aged 8 years. Estimated prevalence varied widely among the 11 ADDM Network sites, ranging from 8.2 per 1,000 children aged 8 years (in the area of the Maryland site where only health care records were reviewed) to 24.6 per 1,000 children aged 8 years (in New Jersey, where both education and health care records were reviewed). Estimated prevalence was higher in surveillance sites where education records and health records were reviewed compared with sites where health records only were reviewed (17.1 per 1,000 and 10.4 per 1,000 children aged 8 years, respectively; p<0.05). Among children identified with ASD by the ADDM Network, 82% had a previous ASD diagnosis or educational classification; this did not vary by sex or between non-Hispanic white and non-Hispanic black children. A lower percentage of Hispanic children (78%) had a previous ASD diagnosis or classification compared with non-Hispanic white children (82%) and with non-Hispanic black children (84%). The median age at earliest known comprehensive evaluation was 40 months, and 43% of children had received an earliest known comprehensive evaluation by age 36 months. The percentage of children with an earliest known comprehensive evaluation by age 36 months was similar for boys and girls, but was higher for non-Hispanic white children (45%) compared with non-Hispanic black children (40%) and Hispanic children (39%). INTERPRETATION: Overall estimated ASD prevalence was 14.5 per 1,000 children aged 8 years in the ADDM Network sites in 2012. The higher estimated prevalence among sites that reviewed both education and health records suggests the role of special education systems in providing comprehensive evaluations and services to children with developmental disabilities. Disparities by race/ethnicity in estimated ASD prevalence, particularly for Hispanic children, as well as disparities in the age of earliest comprehensive evaluation and presence of a previous ASD diagnosis or classification, suggest that access to treatment and services might be lacking or delayed for some children. PUBLIC HEALTH ACTION: The ADDM Network will continue to monitor the prevalence and characteristics of ASD among children aged 8 years living in selected sites across the United States. Recomme

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Written from the paper’s full text.

TL;DR

In 2012, the ADDM Network estimated ASD prevalence among children aged 8 years across 11 U.S. sites at 14.5 per 1,000 (one in 69), with wide variation by site and higher estimates where both education and health records were reviewed. Prevalence was higher among boys and non-Hispanic white children, and although 87% had a developmental concern by age 36 months, the median age at earliest known comprehensive evaluation was 40 months.

Key findings

  • Combined estimated ASD prevalence was 14.5 per 1,000 (one in 69) children aged 8 years; site estimates ranged from 8.2 per 1,000 (Maryland, health records only) to 24.6 per 1,000 (New Jersey). Sites reviewing education and health records had higher estimated prevalence than health-records-only sites (17.1 vs. 10.4 per 1,000; PR: 1.6; 95% CI: 1.5–1.7; p<0.001).
  • Estimated prevalence was 23.4 per 1,000 among boys and 5.2 per 1,000 among girls (male-to-female PR: 4.5; 95% CI: 4.2–4.8). By race/ethnicity, estimates were 15.3 per 1,000 for non-Hispanic white, 13.1 for non-Hispanic black, 11.4 for Asian/Pacific Islander, and 10.2 for Hispanic children.
  • Among 3,353 children with intellectual ability data in nine areas, 31.4% were in the intellectual disability range (IQ ≤70), 24.6% in the borderline range (IQ 71–85), and 44.1% in the average or above-average range (IQ >85). Estimated prevalence was 3.9 per 1,000 for ASD with intellectual disability and 8.6 per 1,000 for ASD without intellectual disability.
  • Overall, 82% had a previous ASD diagnosis or educational classification; 74% had an earliest known DSM-IV-TR ASD diagnosis, including autistic disorder (46%), ASD-NOS/PDD-NOS (44%), and Asperger disorder (10%). The median age at earliest known comprehensive evaluation was 40 months, and 43% had an earliest known comprehensive evaluation by age 36 months.

Methods

  • Active, multisite, records-based surveillance in 11 ADDM Network sites among children born in 2004 and aged 8 years in 2012; the surveillance area included 346,978 children aged 8 years.
  • Two-phase case ascertainment: screening and abstraction of education and health records, followed by clinician review of composite records against the DSM-IV-TR-based ASD surveillance case definition (autistic disorder, PDD-NOS, or Asperger disorder).
  • Prevalence was calculated using NCHS vintage 2014 postcensal bridged-race population estimates and stratified by site, sex, and race/ethnicity; analyses used Pearson chi-square tests, prevalence ratios, and median tests, with clinician-review reliability of 90.4% agreement (κ = 0.8).

Limitations

  • The paper states seven limitations: reliance on available source records; varied source-record types across sites and possible underestimation where education records were unavailable; education records generally unavailable for private-school or home-schooled children; surveillance areas not representative of the U.S. or their states; nondecennial population estimates may have error; birth-certificate restriction may not fully eliminate bias from children who moved; and broad race/ethnicity categories, including inability to distinguish Hispanic children by primary household language.
  • The paper also notes that prevalence estimates do not reflect the missing-record adjustment, and that 2010–2012 comparisons were restricted to eight sites with comparable surveillance areas and record source types; individual site changes were not clearly explained and may reflect local health-care variation or record-retention changes.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.15585/mmwr.ss6503a1

Cites

41 of 41 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 47 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    The percentage of children with earliest known comprehensive evaluation at age ≤36 months was significantly higher for non-Hispanic white children (45%) compared with non-Hispanic black children (40%; p<0.05).

    “but was significantly higher for non-Hispanic white children (45%) compared with non-Hispanic black children (40%; p<0.05) and with Hispanic children (39%; p<0.05)”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The ADDM ASD surveillance case criteria accurately identify children with ASD.
  • Findingown data

    Estimated ASD prevalence was higher in surveillance sites where education records and health records were reviewed compared with sites where health records only were reviewed (17.1 per 1,000 vs 10.4 per 1,000 children aged 8 years; p<0.05).

    “Estimated prevalence was higher in surveillance sites where education records and health records were reviewed compared with sites where health records only were reviewed (17.1 per 1,000 and 10.4 per 1,000 children aged 8 years, respectively; p<0.05).”
    Quote in the paperSubstantial claim
  • Findingown data

    Among all 3,353 children with data on intellectual ability, 24.6% were classified in the borderline range (IQ: 71-85).

    “24.6% were classified in the borderline range (IQ: 71–85)”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Children with ASD who had data on intellectual ability are representative of all children with ASD in the nine areas.
  • Findingown data

    The percentage of children with documentation of developmental concerns at age ≤36 months was significantly higher for Hispanic children (90%) compared with non-Hispanic white children (86%; p<0.05).

    “the percentage was significantly higher for non-Hispanic black children (91%) and for Hispanic children (90%) compared with non-Hispanic white children (86%; p<0.05)”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The ADDM ASD surveillance case criteria accurately identify children with ASD.
  • Findingown data

    The percentage of ASD cases classified in the intellectual disability range was significantly higher among girls compared with boys in all nine areas combined (37% and 30%, respectively; p<0.01).

    “The percentage of ASD cases classified in the intellectual disability range was significantly higher among girls compared with boys in all nine areas combined (37% and 30%, respectively; p<0.01).”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Children with ASD who had data on intellectual ability are representative of all children with ASD in the nine areas.
  • May combine two claims. 37
  • Classified as probably not a substantial claim. 41

  • May combine two claims.

    Findingown data

    In the pooled ADDM Network data, the population of children aged 8 years was 53.3% non-Hispanic white, 21.4% non-Hispanic black, 19.8% Hispanic, 4.8% Asian/Pacific Islander, and 0.6% American Indian/Alaska Native.

    “In the pooled data, the population was 53.3% non-Hispanic white, 21.4% non-Hispanic black, 19.8% Hispanic, 4.8% Asian/Pacific Islander, and 0.6% American Indian/Alaska Native.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The geographic surveillance area for the 11 ADDM Network sites in 2012 included 346,978 children aged 8 years, comprising 8.5% of the U.S. population of children aged 8 years for that year.

    “The geographic surveillance area for the 11 ADDM Network sites in 2012 included 346,978 children aged 8 years, which comprised 8.5% of the U.S. population of children aged 8 years for that year (Table 1).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Estimated ASD prevalence varied widely among the 11 ADDM Network sites, ranging from 8.2 per 1,000 children aged 8 years in the Maryland area where only health care records were reviewed to 24.6 per 1,000 children aged 8 years in New Jersey, where both education and health care records were reviewed.

    “Estimated prevalence varied widely among the 11 ADDM Network sites, ranging from 8.2 per 1,000 children aged 8 years (in the area of the Maryland site where only health care records were reviewed) to 24.6 per 1,000 children aged 8 years (in New Jersey, where both education and health care records were reviewed).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The estimated prevalence of ASD without intellectual disability was 8.6 per 1,000 and ranged from 3.2 per 1,000 (Arkansas) to 12.2 per 1,000 (New Jersey).

    “The estimated prevalence of ASD without intellectual disability was 8.6 per 1,000 and ranged from 3.2 per 1,000 (in Arkansas) to 12.2 per 1,000 (in New Jersey)”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The ADDM ASD surveillance case criteria accurately identify children with ASD.
    • Rests on an assumption: Children with ASD who had data on intellectual ability are representative of all children with ASD in the nine areas.

  • May combine two claims.

    Findingown data

    Estimated ASD prevalence was highest in New Jersey (24.6), Maryland (education and health records reviewed, 18.2), Utah (17.3), and North Carolina (16.8).

    “Estimated ASD prevalence was highest in New Jersey (24.6), Maryland (education and health records reviewed, 18.2), Utah (17.3), and North Carolina (16.8).”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The ADDM ASD surveillance case criteria accurately identify children with ASD.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingnone given

    The population distribution of children by race/ethnicity varied by study site.

    “The population distribution of children by race/ethnicity varied by study site.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Site-specific male-to-female prevalence ratios ranged from 4.1 (Colorado) to 6.2 (Maryland, health records only reviewed) and were all statistically significant.

    “site-specific male-to-female prevalence ratios ranged from 4.1 (in Colorado) to 6.2 (in Maryland [health records only reviewed]) and were all statistically significant”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The ADDM ASD surveillance case criteria accurately identify children with ASD.

  • May combine two claims.

    Findingown data

    Combining data from all nine sites, the estimated prevalence of ASD with intellectual disability was 3.9 per 1,000 and ranged from 1.8 per 1,000 (Colorado) to 5.3 per 1,000 (North Carolina).

    “Combining data from all nine sites, the estimated prevalence of ASD with intellectual disability was 3.9 per 1,000 and ranged from 1.8 per 1,000 (in Colorado) to 5.3 per 1,000 (in North Carolina)”
    • Also stated in: § Discussion · hedged
      “The estimated prevalence of ASD with intellectual disability was 3.9 per 1,000 overall and ranged from 1.8 per 1,000 (in Colorado) to 5.3 per 1,000 (in North Carolina).”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The ADDM ASD surveillance case criteria accurately identify children with ASD.
    • Rests on an assumption: Children with ASD who had data on intellectual ability are representative of all children with ASD in the nine areas.

  • May combine two claims.

    Findingown data

    The percentage of children with ASD who had a previous ASD diagnosis or educational classification did not vary by sex or between non-Hispanic white and non-Hispanic black children.

    “this did not vary by sex or between non-Hispanic white and non-Hispanic black children.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    The percentage of children who were matched to a birth certificate did not vary by sex or race/ethnicity.

    “The percentage of children who were matched to a birth certificate did not vary by sex or race/ethnicity.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Across all 11 sites, estimated ASD prevalence might have increased by <1% in four sites (Arizona, Colorado, Missouri, and Wisconsin), by 1%-<2% in three sites (Georgia, North Carolina, and New Jersey), and by 2.0%-3.3% in four sites (Arkansas, Maryland, South Carolina, and Utah).

    “Across all 11 sites, estimated ASD prevalence might have increased by <1% in four sites (Arizona, Colorado, Missouri, and Wisconsin), by 1%–<2% in three sites (Georgia, North Carolina, and New Jersey) and by 2.0%–3.3% in four sites (Arkansas, Maryland, South Carolina, and Utah).”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The ADDM ASD surveillance case criteria accurately identify children with ASD.
    • Rests on an assumption: Missing records would have had a similar ASD case yield to reviewed records, so the estimated potential increase is valid.

  • May combine two claims.

    Findingown data

    The median age at earliest known comprehensive evaluation was 40 months, ranging from 30 months (North Carolina) to 48 months (Arkansas).

    “The median age at earliest known comprehensive evaluation was 40 months, ranging from 30 months (North Carolina) to 48 months (Arkansas)”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The ADDM ASD surveillance case criteria accurately identify children with ASD.

  • May combine two claims.

    Findingown data

    Despite similar combined estimates for the eight sites in 2010 and 2012 (15.1 and 15.2 per 1,000, respectively), there were significant differences in ASD prevalence estimates between 2010 and 2012 for three of these sites.

    “Despite the similar findings when the population was restricted to these eight sites for 2010 and 2012 (15.1 and 15.2 per 1,000, respectively), there were significant differences in ASD prevalence estimates between 2010 and 2012 for three of these sites.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Prevalence estimates were similar for 2010 and 2012 for children with ASD with intellectual disability and for children with ASD without intellectual disability.

    “Prevalence estimates were similar for 2010 and 2012 for children with ASD with intellectual disability and for children with ASD without intellectual disability.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The ADDM ASD surveillance case criteria accurately identify children with ASD.
    • Rests on an assumption: Children with ASD who had data on intellectual ability are representative of all children with ASD in the nine areas.

  • May combine two claims.

    Findingown data

    Although overall estimated ASD prevalence between 2010 and 2012 was similar across the eight comparable sites, the same was not true of all individual surveillance sites; three sites had significantly different prevalence estimates in 2012 compared with 2010.

    “Although overall estimated ASD prevalence between 2010 and 2012 was similar across the eight sites that were comparable between these 2 years, the same was not true of all of the individual surveillance sites, three of which had significantly different prevalence estimates in 2012 compared with 2010.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The ADDM ASD surveillance case criteria accurately identify children with ASD.

  • May combine two claims.

    Findingown data

    Combined data from the seven ADDM Network areas that reviewed records at education sources indicate that 79% of children with ASD had special education records; this percentage ranged from 55% (Utah) to 92% (Arizona).

    “Combined data from these seven areas indicate that 79% of children with ASD had special education records; this percentage ranged from 55% (Utah) to 92% (Arizona).”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The ADDM ASD surveillance case criteria accurately identify children with ASD.

  • May combine two claims.

    Findingcitation

    In 2010, the percentage of children aged 8 years with ASD residing in the ADDM catchment area with an earliest known comprehensive evaluation by age 36 months was 43.8%, and the 2012 percentage was similar at 43%.

    “In 2010, the percentage of children aged 8 years with ASD residing the ADDM catchment area with an earliest known comprehensive evaluation by age 36 months was 43.8% (16), and the 2012 percentage was similar at 43%.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [16] Autism and Developmental Disabilities Monitoring Network Surveillance Year 2010 Principal Investigators, 2014, Prevalence of autism spectrum disorder among children aged 8 years—Autism and Developmental Disabilities Monitoring Network, 11 sites, United States, 2010., MMWR Surveill Summ

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Disparities by race/ethnicity in estimated ASD prevalence, particularly for Hispanic children, as well as disparities in the age of earliest comprehensive evaluation and presence of a previous ASD diagnosis or classification, suggest that access to treatment and services might be lacking or delayed for some children.

    “Disparities by race/ethnicity in estimated ASD prevalence, particularly for Hispanic children, as well as disparities in the age of earliest comprehensive evaluation and presence of a previous ASD diagnosis or classification, suggest that access to treatment and services might be lacking or delayed for some children.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Autism spectrum disorder is a developmental disability characterized by social and communication impairments and by restricted interests and repetitive behaviors.

    “Autism spectrum disorder (ASD) is a developmental disability characterized by social and communication impairments and by restricted interests and repetitive behaviors (1).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [1] American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. Text revision. Washington, DC: American Psychiatric Association; 2000.

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    Healthy People 2020 includes a goal to increase the percentage of children with ASD who receive their first comprehensive evaluation by age 36 months by 10%, from the baseline of 42.7% in 2006 to the goal of 47.0% in 2020.

    “To support and measure progress in early identification, the Healthy People 2020 initiative includes a goal to increase the percentage of children with ASD who receive their first comprehensive evaluation by age 36 months by 10%, from the baseline of 42.7% in 2006 to the goal of 47.0% in 2020 (22).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [22] US Department of Health and Human Services. Healthy people 2020. Washington, DC: US Department of Health and Human Services; 2010. http://www.healthypeople.gov

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Study design and conductcitation

    In the second phase of surveillance, abstracted composite evaluation records were deidentified and reviewed systematically by clinicians who had undergone standardized training to determine ASD case status using a coding scheme based on DSM-IV-TR criteria for ASD.

    “In the second phase of surveillance, referred to as “clinician review,” the abstracted composite evaluation records are deidentified and reviewed systematically by clinicians who have undergone standardized training to determine ASD case status using a coding scheme based on the DSM-IV-TR (1) criteria for ASD.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [1] American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. Text revision. Washington, DC: American Psychiatric Association; 2000.

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    In the first phase of case ascertainment, screening and abstraction of source records were monitored for accuracy by means of a 10% random sample of records to check the accuracy of data collection and the appropriate selection of the record for abstraction.

    “In the first phase of case ascertainment, screening and abstraction of source records are monitored for accuracy by means of a 10% random sample of records to check the accuracy of data collection as well as the appropriate selection of the record for abstraction.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    For the majority of children, one clinician reviews the composite record; if a child meets the surveillance case criteria but the reviewer is uncertain whether ASD is the most appropriate classification, a second independent review is done, and the two reviewers meet and come to a consensus on the child's case status.

    “For the majority of children, one clinician reviews the composite record. If a child meets the surveillance case criteria, but the reviewer is uncertain whether ASD is the most appropriate classification, a second, independent review is done. Following the second review, the two reviewers meet and come to a consensus on the child’s case status.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Among the reviewed records, the source records of 9,629 (19%) children met the criteria for abstraction and subsequently were reviewed by clinicians.

    “Among these, the source records of 9,629 (19%) children met the criteria for abstraction and subsequently were reviewed by clinicians.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The American Academy of Pediatrics recommends that pediatric health care providers administer two ASD screenings, at ages 18 and 24 months, using a valid and reliable screening tool.

    “The American Academy of Pediatrics recommends that pediatric health care providers administer two ASD screenings, at ages 18 and 24 months, using a valid and reliable screening tool (21).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [21] Johnson, 2007, Identification and evaluation of children with autism spectrum disorders., Pediatrics source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Interrater reliability for clinician reviewers is monitored on an ongoing basis using a blinded, random 10% sample of abstracted records that are scored independently by two reviewers.

    “Subsequently, interrater reliability for clinician reviewers is monitored on an ongoing basis using a blinded, random 10% sample of abstracted records that are scored independently by two reviewers.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    All ADDM Network sites follow the same quality assurance protocol.

    “All ADDM Network sites follow the same quality assurance protocol.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Initial interrater reliability among ASD clinician reviewers was established to a minimum standard of 90% agreement on whether a child meets the ASD surveillance case definition prior to the beginning of the second phase of case ascertainment.

    “Initial interrater reliability among ASD clinician reviewers was established to a minimum standard of 90% agreement on their decision about whether the child meets the ASD surveillance case definition defined in the ADDM study protocol prior to the beginning of the second phase of case ascertainment.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The increase in estimated ASD prevalence since 2002 has been accompanied by a greater increase in ASD without intellectual disability than ASD with intellectual disability.

    “This is notable given that the increase in estimated ASD prevalence that has occurred since 2002 has been accompanied by a greater increase in ASD without intellectual disability than ASD with intellectual disability.”
    Quote in the paperNot a substantial claim0 of 5 sources checked
    • cites [16] Autism and Developmental Disabilities Monitoring Network Surveillance Year 2010 Principal Investigators, 2014, Prevalence of autism spectrum disorder among children aged 8 years—Autism and Developmental Disabilities Monitoring Network, 11 sites, United States, 2010., MMWR Surveill Summ

      Not checked in the free run.

    • cites [17] Autism and Developmental Disabilities Monitoring Network Surveillance Year 2008 Principal Investigators, 2012, Prevalence of autism spectrum disorders—Autism and Developmental Disabilities Monitoring Network, 14 sites, United States, 2008., MMWR Surveill Summ

      Not checked in the free run.

    • cites [18] Autism and Developmental Disabilities Monitoring Network Surveillance Year 2006 Principal Investigators, 2009, Prevalence of autism spectrum disorders—Autism and Developmental Disabilities Monitoring Network, United States, 2006., MMWR Surveill Summ

      Not checked in the free run.

    • cites [19] Autism and Developmental Disabilities Monitoring Network Surveillance Year 2002 Principal Investigators, 2007, Prevalence of autism spectrum disorders—Autism and Developmental Disabilities Monitoring Network, 14 sites, United States, 2002., MMWR Surveill Summ

      Not checked in the free run.

    • cites [20] Autism and Developmental Disabilities Monitoring Network Surveillance Year 2000 Principal Investigators, 2007, Prevalence of autism spectrum disorders—Autism and Developmental Disabilities Monitoring Network, six sites, United States, 2000., MMWR Surveill Summ

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    For the 2011-2012 NSCH, the prevalence of parent or caregiver-reported current ASD was 20 per 1,000 children aged 6-17 years.

    “For the 2011–2012 NSCH, the prevalence of parent or caregiver-reported current ASD was 20 per 1,000 children aged 6–17 years (11).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [11] Blumberg, 2013, Changes in prevalence of parent-reported autism spectrum disorder in school-aged U.S. children: 2007 to 2011–2012., Natl Health Stat Report

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    For the 2014 NHIS, the prevalence of parent or caregiver-reported ever ASD was 22.4 per 1,000 children aged 3-17 years.

    “For the 2014 NHIS, the prevalence of parent or caregiver-reported ever ASD was 22.4 per 1,000 children aged 3–17 years (26).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [26] Zablotsky, 2015, Estimated prevalence of autism and other developmental disabilities following questionnaire changes in the 2014 National Health Interview Study., Natl Health Stat Report

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    A previous analysis showed that 13% of parents who reported ever being told their child had ASD also reported the child did not currently have ASD; most attributed the lack of a current diagnosis to new information, suggesting that basing prevalence estimates on ever ASD might overestimate prevalence compared with current ASD.

    “A previous analysis showed that 13% of parents who reported ever being told that the child had ASD also reported that the child did not currently have ASD; most of these parents attributed the lack of a current ASD diagnosis to new information, suggesting that basing prevalence estimates on ever ASD might overestimate prevalence compared with current ASD (25).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [25] Blumberg, 2015, Diagnosis lost: differences between children who had and who currently have an autism spectrum disorder diagnosis., Autism

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationnone given

    Changes in record retention associated with migration to electronic health records could limit the availability of historical evaluations at some sources.

    “In addition, changes in record retention associated with migration to electronic health records could limit the availability of historical evaluations at some sources.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Interpretationreasoning

    Observed differences in estimated ASD prevalence by child characteristics such as sex and race/ethnicity might indicate areas where ASD identification is incomplete and can provide data to inform policies and efforts to improve identification of ASD among subgroups, particularly female and nonwhite children who have historically had lower identified prevalence compared with male and non-Hispanic白

    “Observed differences in estimated ASD prevalence by child characteristics such as sex and race/ethnicity might indicate areas where ASD identification is incomplete and can provide data to inform policies and efforts to improve identification of ASD among subgroups, particularly female and nonwhite children who have historically had lower identified prevalence compared with male and non-Hispanic”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    Data were limited to the information available in the source records.

    “First, data were limited to the information available in the source records.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductreasoning

    Data on intellectual ability were not available for all children, and the distribution of intellectual ability among children with these data might not be generalizable to all children with ASD.

    “In particular, data on intellectual ability were not available for all children, and the distribution of intellectual ability among the children with these data might not be generalizable to all children with ASD.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    For the Hispanic population, studies have identified lack of awareness of ASD, stigma associated with disability, lack of access to health care services due to noncitizenship or low income, and language barriers as factors that might reduce identification of ASD among Hispanic children.

    “For the Hispanic population, studies have identified lack of awareness of ASD, stigma associated with disability, lack of access to health care services due to noncitizenship or low income, and language barriers as factors that might reduce the identification of ASD among Hispanic children (31–35).”
    Quote in the paperNot a substantial claim0 of 5 sources checked
    • cites [31] Flores, 2006, Why are Latinos the most uninsured racial/ethnic group of US children? A community-based study of risk factors for and consequences of being an uninsured Latino child., Pediatrics source

      Not checked in the free run.

    • cites [32] Jo, 2015, Age at autism spectrum disorder (ASD) diagnosis by race, ethnicity, and primary household language among children with special health care needs, United States, 2009–2010., Matern Child Health J source

      Not checked in the free run.

    • cites [33] Zuckerman, 2013, Pediatrician identification of Latino children at risk for autism spectrum disorder., Pediatrics source

      Not checked in the free run.

    • cites [34] Zuckerman, 2014, Conceptualization of autism in the Latino community and its relationship with early diagnosis., J Dev Behav Pediatr source

      Not checked in the free run.

    • cites [35] Zuckerman, 2014, Latino parents’ perspectives on barriers to autism diagnosis., Acad Pediatr source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Interpretationnone given

    Results from comprehensive evaluations performed through school systems might not be reported to the health care provider or included in health care provider records.

    “However, results from these evaluations might not be reported to the health care provider or included in the health care provider records.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing). May combine two claims.

    Interpretationreasoning

    Lowering the age at first evaluation is important because when impairments are identified through a comprehensive evaluation, referrals for specific services can be made, often without a formal diagnosis.

    “Lowering the age at first evaluation is important because when impairments are identified through a comprehensive evaluation, referrals for specific services can be made, often without a formal diagnosis.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

    Interpretationreasoning

    If lower prevalence in non-Hispanic black and Hispanic children indicates that not all such children with ASD are being evaluated and/or diagnosed in the community, the children who are not identified might not receive ASD-related services and supports, including school supports to facilitate educational progress.

    “If lower prevalence in non-Hispanic black and Hispanic children indicates that not all non-Hispanic black and Hispanic children with ASD are being evaluated and/or diagnosed in the community, the children who are not identified might not receive ASD-related services and supports, including school supports to facilitate educational progress.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductreasoning

    The types of source records varied across sites, and the inability to review education records at some sites might have led to an underestimate of ASD prevalence in those sites.

    “Second, the types of source records varied across sites, and the inability to review education records at some sites might have led to an underestimate of ASD prevalence in those sites.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S4 (based). May combine two claims.

    Premisereasoning

    The Individuals with Disabilities Education Act mandates that states and school districts identify, locate, and evaluate all children with disabilities at no cost to the family, so comprehensive evaluations provided through school systems might be more accessible and affordable compared with evaluations performed through the health care system.

    “The Individuals with Disabilities Education Act mandates that states and school districts identify, locate, and evaluate all children with disabilities at no cost to the family, so comprehensive evaluations provided through school systems might be more accessible and affordable compared with evaluations performed through the health care system.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S4 (based). May combine two claims.

    Interpretationnone given

    ASD surveillance informs providers, particularly public schools, of upcoming service needs, and provides feedback on progress made toward early identification goals.

    “ASD surveillance informs providers, particularly public schools, of upcoming service needs, and provides feedback on progress made toward early identification goals.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

    Interpretationnone given

    Language differences could affect the administration and interpretation of developmental screening and monitoring, impede communication of parental concerns or provider recommendations, and limit access to programs and campaigns aimed at increasing awareness of ASD.

    “Language differences could affect the administration and interpretation of developmental screening and monitoring, impede communication of parental concerns about a child’s development or a health care provider’s recommendation for further evaluation, and limit access to programs and campaigns aimed at increasing awareness of ASD.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductcitation

    The ADDM Network methodology was validated compared with direct examination of children, and the methods were found to result in a prevalence estimate that is likely conservative.

    “This methodology was validated, compared with direct examination of children, and the methods were found to result in a prevalence estimate that is likely conservative (41).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [41] Nonkin Avchen, 2011, Evaluation of a records-review surveillance system used to determine the prevalence of autism spectrum disorders., J Autism Dev Disord source

      Not checked in the free run.

  • May combine two claims.

    Premiseown data

    ADDM Network data are used to measure the goal that 47% of children with ASD have a first evaluation by age 36 months; the baseline percentage for this goal is 42.7%, as measured by ADDM Network data in 2006.

    “ADDM Network data are used to measure the goal that 47% of children with ASD have a first evaluation by age 36 months; the baseline percentage for this goal is 42.7%, as measured by ADDM Network data in 2006.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    The age cohort represented in this report was born in 2004, and therefore findings regarding the percentage of children with an earliest known evaluation by age 36 months reflect practices during 2004-2007.

    “Of note, the age cohort represented here was born in 2004 and therefore the findings regarding the percentage of children with an earliest known evaluation by age 36 months reflect practices during 2004–2007.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    The early identification of ASD is a priority of the American Academy of Pediatrics, which recommends universal ASD screening at ages 18 and 24 months, and by the U.S. Department of Health and Human Services through the Healthy People 2020 goal of a 10% increase in the percentage of children with ASD who receive their first evaluation by age 36 months.

    “The early identification of ASD is a priority of the American Academy of Pediatrics, which recommends universal ASD screening at ages 18 and 24 months, and by the U.S. Department of Health and Human Services through the Healthy People 2020 goal of a 10% increase in the percentage of children with ASD who receive their first evaluation by age 36 months (22).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [22] US Department of Health and Human Services. Healthy people 2020. Washington, DC: US Department of Health and Human Services; 2010. http://www.healthypeople.gov

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    Race and ethnicity were defined broadly for this surveillance population, and results for a specific race or ethnic group might not be representative of results for all children in these groups.

    “Finally, race and ethnicity were defined broadly for this surveillance population, and results for a specific race or ethnic group might not be representative of results for all children in these groups.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Premisenone given

    No intervention has been shown to reduce the prevalence of ASD.

    “No intervention has been shown to reduce the prevalence of ASD; however, early treatment might maximize the ability of children to function and participate in their community.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    County-level population counts for children by sex and race/ethnicity are not available by single year of age in nondecennial census years; population estimates published by the National Center for Health Statistics are used instead.

    “Fifth, county-level population counts for children by sex and race/ethnicity are not available by single year of age in nondecennial census years. Population estimates published by the National Center for Health Statistics are used instead.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Study design and conductreasoning

    The amount and quality of the data define the potential to determine whether a child meets the ASD surveillance case definition and the extent to which the characteristics of the identified population can be described.

    “The amount and quality of the data define the potential to determine whether a child meets the ASD surveillance case definition and the extent to which the characteristics of the identified population can be described.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    The consistently greater ASD prevalence estimated with data from sites that reviewed education and health source type records underscores the role that public schools play in the equitable provision of comprehensive evaluations to children with developmental concerns.

    “The consistently greater ASD prevalence estimated with data from sites that reviewed education and health source type records underscores the role that public schools play in the equitable provision of comprehensive evaluations to children with developmental concerns.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    A similar male-to-female ASD prevalence ratio was found among school-age children in data from the 2010-2011 NSCH.

    “A similar male-to-female ASD prevalence ratio was found among school-age children in data from the 2010–2011 NSCH (11).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [11] Blumberg, 2013, Changes in prevalence of parent-reported autism spectrum disorder in school-aged U.S. children: 2007 to 2011–2012., Natl Health Stat Report

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    This finding suggests that a number of nonwhite children with ASD are not being identified and evaluated, and for those children who are evaluated, a later age at the first comprehensive evaluation likely delays initiation of services for these children.

    “This finding suggests that a number of nonwhite children with ASD are not being identified and evaluated, and for those children who are evaluated, a later age at the first comprehensive evaluation likely delays initiation of services for these children.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Previous analyses have suggested that fewer children will meet the behavioral criteria of DSM-5 compared with DSM-IV-TR.

    “Previous analyses have suggested that fewer children will meet the behavioral criteria of DSM-5 compared with DSM-IV-TR (43).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [43] Maenner, 2014, Potential impact of DSM-5 criteria on autism spectrum disorder prevalence estimates., JAMA Psychiatry source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    In 2013, revised diagnostic criteria for ASD were published by the American Psychiatric Association in the DSM-5.

    “In 2013, revised diagnostic criteria for ASD were published by the American Psychiatric Association in the DSM-5 (5).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [5] American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington, VA: American Psychiatric Association; 2013. source

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductnone given

    The surveillance areas were selected through a competitive process and were not selected to be representative of children aged 8 years in the United States or the state where the surveillance site was located.

    “Fourth, the surveillance areas were selected through a competitive process and were not selected to be representative of children aged 8 years in the United States or the state where the surveillance site was located.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Interpretationcitation

    The higher estimated prevalence among boys might result from sex-specific differences in ASD risk or differences in identification of girls with ASD arising from less well-recognized symptom profiles, or both.

    “The higher estimated prevalence among boys might result from sex-specific differences in ASD risk (27,28) or differences in identification of girls with ASD arising from less well-recognized symptom profiles (29), or both.”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [27] Lai, 2013, Biological sex affects the neurobiology of autism., Brain source

      Not checked in the free run.

    • cites [28] Werling, 2013, Understanding sex bias in autism spectrum disorder., Proc Natl Acad Sci U S A source

      Not checked in the free run.

    • cites [29] Andersson, 2013, Pre-school children with suspected autism spectrum disorders: do girls and boys have the same profiles?, Res Dev Disabil source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    At least for the initial years following publication of DSM-5, ASD prevalence estimates based on DSM-5 criteria should include children with a DSM-IV-TR-based diagnosis in order to accurately represent the number of children being treated and served for ASD by community providers.

    “Therefore, at least for the initial years following the publication of DSM-5, ASD prevalence estimates that are based on DSM-5 criteria should include the children with a DSM-IV-TR-based diagnosis in order to accurately represent the number of children who are being treated and served for ASD by community providers.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    Although the overall prevalence estimate is virtually unchanged from surveillance year 2010, prevalence ranged widely across the ADDM Network and prevalence increases were reported at two sites, suggesting that it is premature to conclude that the rising prevalence of ASD observed during the first decade of the 21st century might be slowing.

    “Although the overall prevalence estimate is virtually unchanged from surveillance year 2010, prevalence ranged widely across the ADDM Network and prevalence increases were reported at two sites, suggesting that it is premature to conclude that the rising prevalence of ASD observed during the first decade of the 21st century might be slowing.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

    Interpretationcitation

    On the basis of evidence linking early treatment to improved outcomes, it is important that children with developmental concerns be evaluated and referred to services as soon as possible.

    “On the basis of evidence linking early treatment to improved outcomes (36–39), it is important that children with developmental concerns be evaluated and referred to services as soon as possible.”
    Quote in the paperNot a substantial claim0 of 4 sources checked
    • cites [36] Dawson, 2010, Randomized, controlled trial of an intervention for toddlers with autism: the Early Start Denver Model., Pediatrics source

      Not checked in the free run.

    • cites [37] Eapen, 2013, Clinical outcomes of an early intervention program for preschool children with Autism Spectrum Disorder in a community group setting., BMC Pediatr source

      Not checked in the free run.

    • cites [38] Reichow, 2012, Early intensive behavioral intervention (EIBI) for young children with autism spectrum disorders (ASD)., Cochrane Database Syst Rev

      Not checked in the free run.

    • cites [39] Rogers, 2012, Effects of a brief Early Start Denver model (ESDM)-based parent intervention on toddlers at risk for autism spectrum disorders: a randomized controlled trial., J Am Acad Child Adolesc Psychiatry source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisenone given

    DSM-5 criteria include a provision that children with a well-established diagnosis of one of the three autism spectrum disorder subtypes under DSM-IV-TR criteria are considered to have ASD under DSM-5 criteria.

    “However, DSM-5 criteria include a provision that children with a well-established diagnosis of one of the three autism spectrum disorder subtypes under DSM-IV-TR criteria are considered to have ASD under DSM-5 criteria.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S4 (based).

    Interpretationnone given

    Early treatment might maximize the ability of children to function and participate in their community.

    “No intervention has been shown to reduce the prevalence of ASD; however, early treatment might maximize the ability of children to function and participate in their community.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S4 (based).

    Interpretationnone given

    Initiation of school-based services prior to formal school entry might help to facilitate optimal educational progress.

    “Initiation of school-based services prior to formal school entry might help to facilitate optimal educational progress.”
    Quote in the paperNot a substantial claim
65 of 65

  • The paper relies on this without support.

    The ADDM ASD surveillance case criteria accurately identify children with ASD.

    “Of these 9,629 children, 5,021 (52%) met the ASD surveillance case criteria.”

  • The paper relies on this without support.

    Children with ASD who had data on intellectual ability are representative of all children with ASD in the nine areas.

    “In these nine areas, 3,353 (80%) of 4,189 children with ASD had data on intellectual ability”

  • The paper relies on this without support.

    Missing records would have had a similar ASD case yield to reviewed records, so the estimated potential increase is valid.

    “An evaluation of the effect of missing records suggested that estimated ASD prevalence might have increased by 0.1% (in Wisconsin) to 3.3% (in Utah) if missing records had been available for review.”
3 of 3

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Impaired executive functions are commonly observed in autism spectrum disorder and attention-deficit/hyperactivity disorder.

    “Impaired EFs are commonly observed in two prevalent neurodevelopmental disorders8: autism spectrum disorder (ASD, 1 in 68 children diagnosed with ASD9) and attention-deficit/hyperactivity disorder (ADHD, up to 1 in 15 children diagnosed with ADHD10).”

    From Heterogeneity of executive functions among comorbid neurodevelopmental disorders (2016) · cites this paper as [9]

    Citation 9 is attached to the ASD prevalence figure, not the statement about impaired executive functions. The Discussion reports a 2010 estimate of one in 68 children aged 8 years, but this paper’s 2012 estimate is one in 69; both are surveillance prevalence estimates, not counts of children diagnosed with ASD. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • Most children with ASD begin showing symptoms in the age range of 2 to 5 years and typically receive an ASD diagnosis by age four.

    “This idea is interesting in the context of autism, because most children with ASD begin showing symptoms in this age range and typically receive an ASD diagnosis by age four53.”

    From Effect of age and autism spectrum disorder on oxytocin receptor density in the human basal forebrain and midbrain (2018) · cites this paper as [53]

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Arkansas falls below the stated IQ-data inclusion threshold

    Minor

    Arkansas is included among the nine areas used for the intellectual-ability analysis, although the text says data were available for only 68% of its ASD cases. The figure caption says those nine areas each had data for at least 70%.

  • Percentage of reviewed children meeting abstraction criteria is incorrect

    Minor

    The paper says 9,629 of 38,038 children met the criteria for abstraction. That is 25.3%, not 19%.

    Reported 19 · recomputed 25.31416

2 of 2

Cites

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5 of the 46 references couldn’t be matched to a known paper.

Cited by

Sorted by citations

Related

Authors
Christensen, D. L., Baio, J., Braun, K. V. N., Bilder, D., Charles, J., Constantino, J. N., Daniels, J., Durkin, M. S., Fitzgerald, R. T., Kurzius-Spencer, M., Lee, L.-C., Pettygrove, S., Robinson, C., Schulz, E., Wells, C., Wingate, M. S., Zahorodny, W., & Yeargin-Allsopp, M.
Affiliations
  • National Center on Birth Defects and Developmental Disabilities (US)
  • University of Utah (US)
  • Medical University of South Carolina (US)
  • Washington University in St. Louis (US)
  • University of North Carolina at Chapel Hill (US)
  • University of Wisconsin–Madison (US)
  • University of Arizona, Tucson
  • Johns Hopkins University (US)
  • University of Arizona (US)
  • University of Colorado Denver (US)
  • University of Arkansas for Medical Sciences (US)
  • Colorado Department of Public Health and Environment (US)
  • University of Alabama at Birmingham (US)
  • Rutgers, The State University of New Jersey (US)
  • Division of Congenital and Developmental Disorders, National Center on Birth Defects and Developmental Disabilities, CDC
Corresponding author
Christensen, Deborah L.
ORCID
Venue
MMWR. Surveillance Summaries
Publisher
Centers for Disease Control MMWR Office
Published
2016-04-01
Volume
65
Issue
3
Pages
1-23
ISSN
  • 1545-8636 (ISSN-L)
  • 1546-0738
DOI
10.15585/mmwr.ss6503a1
PMC
PMC6237390
OpenAlex
W2318996262
Cited by
1,964
References
46
Citations by year
2026: 15 · 2025: 85 · 2024: 111 · 2023: 118 · 2022: 147 · 2021: 194 · 2020: 199 · 2019: 245 · 2018: 373 · 2017: 373 · 2016: 100 · 2014: 1 · 2012: 1
FWCI
231.42
Type
journal article
Language
en
Open access
Licence
public-domain
Locations
  • MMWR Surveillance Summaries (publishedVersion, public-domain)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
Funders
  • University of Wisconsin-Madison
  • Colorado Department of Public Health and Environment
  • Johns Hopkins University
  • University of Arkansas for Medical Sciences
  • University of South Carolina
  • University of South Florida
  • Centers for Disease Control and Prevention
  • University of North Carolina at Chapel Hill
  • National Institute of Environmental Health Sciences (P30ES010126)
  • National Center on Birth Defects and Developmental Disabilities
  • Eunice Kennedy Shriver National Institute of Child Health and Human Development (U54HD087011)
Topics
  • Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
  • Health Sciences › Medicine › Psychiatry and Mental health › Child Nutrition and Feeding Issues
  • Social Sciences › Psychology › Clinical Psychology › Family and Disability Support Research
Keywords
autism spectrum disorder, prevalence, sex differences, racial and ethnic disparities, intellectual disability, special education eligibility, ASD diagnosis, pervasive developmental disorders, Asperger syndrome
MeSH terms
Autism Spectrum Disorder, Child, Ethnicity, Female, Humans, Male, Population Surveillance, United States, Prevalence, Sex Distribution

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-08.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-08.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

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