Prevalence of Autism Spectrum Disorder Among Children Aged 8 Years — Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2016
Open accessAbstract
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.
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The U.S. reports a consistent pattern of increased ASD prevalence among higher socioeconomic status families.
“The U.S. reports a consistent pattern of increased ASD prevalence among higher socioeconomic status (SES) families (Baio et al. 2018; Durkin et al. 2010, 2017; Maenner et al. 2020; Pedersen et al. 2012), while European countries report increased prevalence among lower SES families (Delobel-Ayoub et al. 2015; Emerson 2012; Rai et al. 2012).”
From The Diagnosis of Autism: From Kanner to DSM-III to DSM-5 and Beyond (2021) · cites this paper as Maenner et al. 2020
The Introduction says previous ADDM surveillance years reported higher ASD prevalence among more socioeconomically advantaged groups. The Discussion specifies that the positive association was with neighborhood SES, not the SES of individual families; it also suggests differences in ASD identification may contribute to the pattern. (LLM, conf=0.83)
Experimental — accuracy not yet measuredIn the U.S., African American, Hispanic, and Asian children are more likely to receive a diagnosis at a later age than Caucasian children.
“In the U.S., African American, Hispanic, and Asian children are more likely to receive a diagnosis at a later age than Caucasian children (Maenner et al. 2020; Mandell et al. 2009; Palmer et al. 2010).”
From The Diagnosis of Autism: From Kanner to DSM-III to DSM-5 and Beyond (2021) · cites this paper as Maenner et al. 2020
The Age at First Evaluation and ASD Diagnosis section reports a later median diagnosis for Black than white children with ASD and IQ ≤70 (48 versus 42 months). Table 5 does not establish the broader claim: the overall median is 53 versus 51 months for Black and white children, but 51 months for both Hispanic and white children; it provides no diagnosis-age comparison for Asian children. (LLM, conf=0.87)
Experimental — accuracy not yet measuredWhile prevalence of ASD likely does not differ across racial and ethnic groups, the average age of diagnosis continues to differentiate these groups.
“While prevalence of ASD likely does not differ across racial and ethnic groups (Fombonne 2003; Maenner et al. 2020), the average age of diagnosis continues to differentiate these groups.”
From The Diagnosis of Autism: From Kanner to DSM-III to DSM-5 and Beyond (2021) · cites this paper as Maenner et al. 2020
The citation is attached to the prevalence clause, not the subsequent claim about age at diagnosis. The ASD Prevalence section reports similar prevalence among white, black, and Asian/Pacific Islander children, but lower prevalence among Hispanic children; it therefore does not support the claim across racial and ethnic groups generally (page not provided). (LLM, conf=0.88)
Experimental — accuracy not yet measuredWhile the percentage of children diagnosed with ASD and intellectual disability is higher among African American and Hispanic children compared to Caucasian children in the U.S., African American and Hispanic children are nevertheless diagnosed at a later age on average than Caucasian children.
“Lastly, while the percentage of children diagnosed with ASD and intellectual disability is higher among African American and Hispanic children compared to Caucasian children in the U.S., African American and Hispanic children are nevertheless diagnosed at a later age on average than Caucasian children (Maenner et al. 2020).”
From The Diagnosis of Autism: From Kanner to DSM-III to DSM-5 and Beyond (2021) · cites this paper as Maenner et al. 2020
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Experimental — accuracy not yet measuredASD diagnosis typically occurs later in Europe (3.5 years), the USA (4 years), and Canada (6 years).
“however, diagnosis typically occurs later in Europe (3.5 years), USA (4 years), and Canada (6 years), exposing an opportunity to decrease the age at diagnosis and accelerate access to specialized healthcare.”
From Tackling healthcare access barriers for individuals with autism from diagnosis to adulthood (2022) · cites this paper as [58]
The Age at First Evaluation and ASD Diagnosis section reports a median US diagnosis age of 51 months (about 4.25 years), broadly supporting the USA figure. The Comparison with Other Autism Data Systems section discusses Canadian and Danish diagnoses but does not give a typical diagnosis age of 6 years for Canada or 3.5 years for Europe. (LLM, conf=0.88)
Experimental — accuracy not yet measured
ASD is approximately 4 times more prevalent in boys than in girls.
“ASD is ~4 times more prevalent in boys than in girls (16, 31).”
From Where Sex Meets Gender: How Sex and Gender Come Together to Cause Sex Differences in Mental Illness (2022) · cites this paper as [16]
In the US, ASD prevalence was 1.85% (CI95% 1.80-1.91%) in children aged 8 years.
“and 1.85% (CI95%: 1.80–1.91%) in children aged eight year old (26).”
From Prevalence of Autism Spectrum Disorder and Co-morbidities in Children and Adolescents: A Systematic Literature Review (2021) · cites this paper as [26]
Christensen et al. and Maenner et al. assessed ID prevalence in ASD children aged 4y and 8y based on the ADDM network and reported rates of 46.10% and 33.00%, respectively.
“In the US, Christensen et al. (15) and Maenner et al. (26) assessed the prevalence of ID in ASD children aged 4y and 8y respectively based on the ADDM network and reported rates of 46.10% and 33.00%.”
From Prevalence of Autism Spectrum Disorder and Co-morbidities in Children and Adolescents: A Systematic Literature Review (2021) · cites this paper as [26]
ASD prevalence has increased over 30-fold over the last four decades, primarily due to diagnostic expansion.
“The estimated prevalence of ASD has increased over 30-fold over the last four decades,18 primarily due to diagnostic expansion.19,20”
From The female protective effect against autism spectrum disorder (2022) · cites this paper as [20]
Members of previous generations, particularly those able to live independently as adults, were far less likely to receive an ASD diagnosis in childhood than children born as of writing.
“Members of previous generations, particularly those able to live independently as adults, were far less likely to receive an ASD diagnosis in childhood than children born as of writing.19,20”
From The female protective effect against autism spectrum disorder (2022) · cites this paper as [20]
Females are on average diagnosed later than males.
“For example, females are on average diagnosed later than males.20”
From The female protective effect against autism spectrum disorder (2022) · cites this paper as [20]
If consistent with the rate of ID in ASD cases in the United States or the United Kingdom, the true ID rate would be approximately 40% over this diagnostic period.
“If consistent with the rate of ID in ASD cases in the United States or the United Kingdom, it would be approximately 40% over this diagnostic period.20”
From The female protective effect against autism spectrum disorder (2022) · cites this paper as [20]
Surveillance among children aged 4 years in 2016 indicated similar ASD prevalence among children of different racial and ethnic groups, consistent with trends among children aged 8 years.
“Surveillance among children aged 4 years in 2016 (8) indicated similar prevalence among children of different racial and ethnic groups, consistent with trends among children aged 8 years (9).”
The sex ratio of boys to girls was higher at age 8 years than at age 4 years.
“The sex ratio is one example of how differences in identification of children without intellectual disability can affect patterns observed at older ages, with a higher ratio of boys to girls at age 8 years than at age 4 years, consistent with previous reports (8,9).”
In surveillance year 2018, ASD prevalence among Black children was higher than among White children at five of 11 sites and overall.
“In surveillance year 2018, ASD prevalence among Black children was higher than among White children at five of 11 sites and overall, the opposite of the pattern before surveillance year 2016 among children aged 8 years (9,17).”
Children with co-occurring intellectual disability are more likely to be identified earlier than children without intellectual disability.
“Children with co-occurring intellectual disability are more likely to be identified earlier than children without intellectual disability, as indicated by an earlier median age at identification among this group (11) as well as the consistently higher proportion of children with intellectual disability at age 4 years (8,13) than at age 8 years (9,11,17).”
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“(26) assessed the prevalence of ID in ASD children aged 4y and 8y respectively based on the ADDM network and reported rates of 46.”
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- Authors
- Maenner, M. J., Shaw, K. A., Baio, J., EdS1, Washington, A., Patrick, M., DiRienzo, M., Christensen, D. L., Wiggins, L. D., Pettygrove, S., Andrews, J. G., Lopez, M., Hudson, A., Baroud, T., Schwenk, Y., White, T., Rosenberg, C. R., Lee, L.-C., Harrington, R. A., Huston, M., Hewitt, A., PhD-7, Esler, A., Hall-Lande, J., Poynter, J. N., Hallas-Muchow, L., Constantino, J. N., Fitzgerald, R. T., Zahorodny, W., Shenouda, J., Daniels, J. L., Warren, Z., Vehorn, A., Salinas, A., Durkin, M. S., & Dietz, P. M.
- Affiliations
- Centers for Disease Control and Prevention (US)
- University of North Carolina at Chapel Hill (US)
- University of Arizona (US)
- University of Arkansas for Medical Sciences (US)
- Colorado Department of Public Health and Environment (US)
- Johns Hopkins University (US)
- University of Minnesota (US)
- Washington University in St. Louis (US)
- Rutgers New Jersey Medical School (US)
- University of Wisconsin–Madison (US)
- Corresponding author
- Maenner, Matthew J.
- ORCID
- Maenner, Matthew J.
- Shaw, Kelly A.
- Washington, Anita
- Patrick, Mary
- DiRienzo, Monica
- Wiggins, Lisa D.
- Pettygrove, Sydney
- Andrews, Jennifer G.
- Lopez, Maya
- Rosenberg, Cordelia Robinson
- Lee, Li-Ching
- Esler, Amy
- Poynter, Jenny N.
- Constantino, John N.
- Fitzgerald, Robert T.
- Zahorodny, Walter
- Shenouda, Josephine
- Daniels, Julie L.
- Warren, Zachary
- Durkin, Maureen S.
- Dietz, Patricia M.
- Venue
- MMWR. Surveillance Summaries
- Published
- 2020-03-27
- Volume
- 69
- Issue
- 4
- Pages
- 1-12
- ISSN
- 1545-8636 (ISSN-L)
- 1546-0738
- PMC
- PMC7119644
- OpenAlex
- W3027179734
- Semantic Scholar
- ddeb34dc450a7cdc9fd11cdb896b266be9fa1f05
- Cited by
- 3,780
- References
- 34
- Citations by year
- 2026: 107 · 2025: 199 · 2024: 335 · 2023: 473 · 2022: 732 · 2021: 904 · 2020: 393 · 2019: 99 · 2018: 101 · 2017: 124 · 2016: 140 · 2015: 112 · 2014: 55 · 2013: 1 · 2012: 1
- FWCI
- 336.19
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Licence
- public-domain
- Locations
- MMWR Surveillance Summaries (publishedVersion, public-domain)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- UA Campus Repository (The University of Arizona) (acceptedVersion, public-domain)
- Funders
- Centers for Disease Control and Prevention
- 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, autism prevalence, sex differences, racial and ethnic disparities, intellectual disability, age at diagnosis, autism epidemiology, Black children, Hispanic children, white children, regional variation in prevalence, United States states and territories
- MeSH terms
- Autism Spectrum Disorder, Child, Female, Humans, Male, Population Surveillance, United States, Prevalence, Diagnostic and Statistical Manual of Mental Disorders
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