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

The DOI matches its Crossref record; 41 of the 46 references it cites were found in a registry or an index; none of the 47 sources its claims cite is checked for support yet.

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

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

Overview

AI snapshot

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.

Figures

FIGURE 1 Estimated prevalence* of autism spectrum disorder among children aged 8 years — Autism and Developmental Disabilities Monitoring Network, 11 sites, United States, 2012 Abbreviations: ADDM = Autism and Developmental Disabilities Monitoring Network; E+H = education and health records; HO = health records only. *Cases per 1,000 children aged 8 years. Bars represent 95% confidence intervals.
FIGURE 1 Estimated prevalence* of autism spectrum disorder among children aged 8 years — Autism and Developmental Disabilities Monitoring Network, 11 sites, United States, 2012 Abbreviations: ADDM = Autism and Developmental Disabilities Monitoring Network; E+H = education and health records; HO = health records only. *Cases per 1,000 children aged 8 years. Bars represent 95% confidence intervals.CC BY · PubMed Central
FIGURE 2 Scores of most recent intelligence quotient tests for children identified with autism spectrum disorder for whom test data were available — Autism and Developmental Disabilities Monitoring Network, nine sites,* United States, 2012 Abbreviations: ADDM = Autism and Developmental Disabilities Monitoring Network; ASD = autism spectrum disorder; E+H = education and health records; IQ = intelligence quotient. *Includes sites having information on intellectual ability available for ≥70% of children who met the ASD case definition (N = 3,353, excluding unknown IQ).
FIGURE 2 Scores of most recent intelligence quotient tests for children identified with autism spectrum disorder for whom test data were available — Autism and Developmental Disabilities Monitoring Network, nine sites,* United States, 2012 Abbreviations: ADDM = Autism and Developmental Disabilities Monitoring Network; ASD = autism spectrum disorder; E+H = education and health records; IQ = intelligence quotient. *Includes sites having information on intellectual ability available for ≥70% of children who met the ASD case definition (N = 3,353, excluding unknown IQ).CC BY · PubMed Central
FIGURE 3 Estimated prevalence* of autism spectrum disorder among children aged 8 years, by most recent intelligence quotient score and by site — Autism and Developmental Disabilities Monitoring Network, nine sites,† United States, 2012 Abbreviations: ADDM = Autism and Developmental Disabilities Monitoring Network; ASD = autism spectrum disorder; E+H = education and health records; IQ = intelligence quotient. *Cases per 1,000 children aged 8 years. †Includes sites having information on intellectual ability available for ≥70% of children who met the ASD case definition (N = 4,189, including unknown IQ). Maryland source type is education and health records.
FIGURE 3 Estimated prevalence* of autism spectrum disorder among children aged 8 years, by most recent intelligence quotient score and by site — Autism and Developmental Disabilities Monitoring Network, nine sites,† United States, 2012 Abbreviations: ADDM = Autism and Developmental Disabilities Monitoring Network; ASD = autism spectrum disorder; E+H = education and health records; IQ = intelligence quotient. *Cases per 1,000 children aged 8 years. †Includes sites having information on intellectual ability available for ≥70% of children who met the ASD case definition (N = 4,189, including unknown IQ). Maryland source type is education and health records.CC BY · PubMed Central
FIGURE 4 Estimated prevalence* of autism spectrum disorder among children aged 8 years, by most recent intelligence quotient score, by sex and race/ethnicity — Autism and Developmental Disabilities Monitoring Network, nine sites,† United States, 2012 Abbreviation: IQ = intelligence quotient. *Cases per 1,000 children aged 8 years. †Includes nine sites (Arizona, Arkansas, Colorado, Georgia, Maryland [education and health records], New Jersey, North Carolina, South Carolina, and Utah) having information on intellectual ability available for ≥70% of children who met the ASD case definition (N = 4,189, including unknown IQ).
FIGURE 4 Estimated prevalence* of autism spectrum disorder among children aged 8 years, by most recent intelligence quotient score, by sex and race/ethnicity — Autism and Developmental Disabilities Monitoring Network, nine sites,† United States, 2012 Abbreviation: IQ = intelligence quotient. *Cases per 1,000 children aged 8 years. †Includes nine sites (Arizona, Arkansas, Colorado, Georgia, Maryland [education and health records], New Jersey, North Carolina, South Carolina, and Utah) having information on intellectual ability available for ≥70% of children who met the ASD case definition (N = 4,189, including unknown IQ).CC BY · PubMed Central
FIGURE 5 Percentage of children with autism spectrum disorder at age 8 years who had previous autism spectrum disorder classification on record, suspicion of the disorder noted, or no mention of the disorder, by site — Autism and Developmental Disabilities Monitoring Network, 11 sites, United States, 2012 Abbreviations: ADDM = Autism and Developmental Disabilities Monitoring Network; ASD = autism spectrum disorder.
FIGURE 5 Percentage of children with autism spectrum disorder at age 8 years who had previous autism spectrum disorder classification on record, suspicion of the disorder noted, or no mention of the disorder, by site — Autism and Developmental Disabilities Monitoring Network, 11 sites, United States, 2012 Abbreviations: ADDM = Autism and Developmental Disabilities Monitoring Network; ASD = autism spectrum disorder.CC BY · PubMed Central

Verification

Claims the paper makes

112 Own result · 26 Own method · 25 Not checked yet · 19 Own interpretation · 7 No basis given

Verify all 47 references — free account

Show all 124 claims

  • It may state two separate claims as one. 37
  • Probably not a substantial claim. 41
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?

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.

2 of 2

Citations

Cites

Show all 46 references

Cited by

Sorted by citations

Items 801–900 of 1,005

Metadata

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.
Venue
MMWR. Surveillance Summaries
Published
2016-04-01
Volume
65
Issue
3
Pages
1-23
ISSN
  • 1545-8636 (ISSN-L)
  • 1546-0738
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
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.

A language model drew the claims from the paper on 2026-10-08, under version 3 of the claim definition (model deepseek-v4.1-flash, prompt extract-v3).

A second model labelled each claim on 2026-10-08 (model jev-1.13-20260917, definition revision gold-guideline-v0.2).

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.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review