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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 (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
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
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“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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In the citing paper
“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).”
From Early Identification of Autism Spectrum Disorder Among Children Aged 4 Years — Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2018 (2021) · cites this paper as [9]
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“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]
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In the citing paper
“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 citing paper
“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]
In the citing paper
“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]
In the citing paper
“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]
In the citing paper
“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]
In the citing paper
“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]
In the citing paper
“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]
In the citing paper
“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 the citing paper
“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).”
In the citing paper
“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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Citations
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“Centers for Disease Control and Prevention (CDC), the prevalence of ASD has increased to 1 in 54 children [2].”
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“Currently, 1 in 44 children in the United States have been diagnosed with ASD, with males 4 times more likely to be affected than females [1,2].”
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“Although the sex ratio of participants in the ASD group was not balanced, it resembled the 4:1 sex ratio reported in recent prevalence estimates (Maenner et al., 2020).”
ResultRethinking autism spectrum disorder assessment for children during COVID ‐19 and beyond
Zwaigenbaum, L., Bishop, S. L., Stone, W. L., Ibañez, L. V., Halladay, A. K., Goldman, S., Kelly, A. M., Klaiman, C., Lai, M., Miller, M. R., et al. (2021) · Autism Research · doi:10.1002/aur.2615 · Cited by 58
“While ASD prevalence rates have increased steadily (Maenner et al., 2020), the number of professionals (especially those from diverse backgrounds) trained in conducting ASD assessments has not kept pace (Bridgemohan et al.”
BackgroundSelf-citationJameson, C., Boulton, K., Silove, N., Nanan, R. K. H., & Guastella, A. J. (2022) · Molecular Psychiatry · doi:10.1038/s41380-022-01829-8 · Cited by 49
“Interestingly, the global prevalence of these ‘atopic diseases’ has risen in parallel to childhood-onset ASD, recently reported to affect one in 54 children in the United States [4, 5].”
BackgroundWetie, A. G. N., Wormwood, K. L., Charette, L., Ryan, J. P., Woods, A. G., & Darie, C. C. (2015) · Journal of Cellular and Molecular Medicine · doi:10.1111/jcmm.12658 · Cited by 49
A Survey of Parents with Children on the Autism Spectrum: Experience with Services and Treatments
Becerra, T. A., Massolo, M. L., Yau, V. M., Owen-Smith, A. A., Lynch, F. L., Crawford, P. M., Pearson, K. A., Pomichowski, M. E., Quinn, V. P., Yoshida, C. K., et al. (2017) · The Permanente Journal · doi:10.7812/tpp/16-009 · Cited by 49
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“The SSP has good internal consistency, with coefficient alpha ranging from 0.70 to 0.90,67 and has been widely used with children diagnosed with ASD.46 2.2.6 Behavior Problems Inventory–Short Form.”
BackgroundInfluentialCitrigno, L., Muglia, M., Qualtieri, A., Spadafora, P., Cavalcanti, F., Pioggia, G., & Cerasa, A. (2020) · International Journal of Molecular Sciences · doi:10.3390/ijms21165785 · Cited by 51
Thanh, L. N., Nguyen, H.-P., Ngo, M., Bui, V. A., Dam, P. T. M., Bui, H. T. P., Ngo, D. V., Kiên, T. T., Dang, T. T. T., Duong, B. D., et al. (2020) · Stem Cells Translational Medicine · doi:10.1002/sctm.20-0102 · Cited by 49
Employing Evidence-Based Practices for Children with Autism in Elementary Schools
Sam, A. M., Odom, S. L., Tomaszewski, B. R., Perkins, Y., & Cox, A. W. (2020) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-020-04706-x · Cited by 49
The Autism Phenome Project: Toward Identifying Clinically Meaningful Subgroups of Autism
Nordahl, C. W., Andrews, D. S., Dwyer, P. S. R., Waizbard‐Bartov, E., Restrepo, B., Lee, J. K., Heath, B. E., Saron, C. D., Rivera, S. M., Solomon, M., et al. (2022) · Frontiers in Neuroscience · doi:10.3389/fnins.2021.786220 · Cited by 49
“Intellectual functioning is one of the most heterogeneous aspects of autism (Maenner, 2020).”
BackgroundAfif, I. Y., Farkhan, M., Kurdi, O., Maula, M. I., Ammarullah, M. I., Setiyana, B., Jamari, J., & Winarni, T. I. (2022) · Bioengineering · doi:10.3390/bioengineering9020048 · Cited by 49
The Lag Structure of Intrinsic Activity is Focally Altered in High Functioning Adults with Autism
Mitra, A., Snyder, A. Z., Constantino, J. N., & Raichle, M. E. (2015) · Cerebral Cortex · doi:10.1093/cercor/bhv294 · Cited by 49
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Social communication disorder: a narrative review on current insights
Topal, Z., Demir, N., Taskiran, S. A., Tufan, A. E., & Semerci, B. (2018) · Neuropsychiatric Disease and Treatment · doi:10.2147/ndt.s121124 · Cited by 48
Relationship between Vitamin Deficiencies and Co-Occurring Symptoms in Autism Spectrum Disorder
Robea, M. A., Luca, A.-C., & Ciobica, A. S. (2020) · Medicina · doi:10.3390/medicina56050245 · Cited by 54
“A recent report added new insights regarding ASD prevalence for 2016 in United States, stating that one in 54 eight-year-olds was diagnosed with autism, according to Centers for Disease Control and Prevention [2].”
BackgroundTreatment of Folate Metabolism Abnormalities in Autism Spectrum Disorder
Frye, R. E., Rossignol, D. A., Scahill, L. D., McDougle, C. J., Huberman, H. S., & Quadros, E. V. (2020) · Seminars in Pediatric Neurology · doi:10.1016/j.spen.2020.100835 · Cited by 48
Treatment of Aggression in Adults with Autism Spectrum Disorder: A Review
Im, D. S. (2021) · Harvard Review of Psychiatry · doi:10.1097/hrp.0000000000000282 · Cited by 53
Liang, S., Sabri, A. Q. M., Alnajjar, F., & Loo, C. K. (2021) · IEEE Access · doi:10.1109/access.2021.3061455 · Cited by 55
“Disabilities Monitoring Network [1].”
Ebrahim, M. T., & Alothman, A. A. (2021) · Research in Developmental Disabilities · doi:10.1016/j.ridd.2021.103943 · Cited by 60
Human IPSC-Derived Model to Study Myelin Disruption
Chesnut, M., Paschoud, H., Repond, C., Smirnova, L., Härtung, T., Zurich, M., Högberg, H. T., & Pamies, D. (2021) · International Journal of Molecular Sciences · doi:10.3390/ijms22179473 · Cited by 56
“Centers for Disease Control and Prevention (CDC), for example, estimated that one in 54 children born in the US was diagnosed with autism spectrum disorder (ASD) [22], and reported that 9.”
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Allard, M., Bergeron, J. D., Baharnoori, M., Srivastava, L. K., Fortier, L., Poyart, C., & Sébire, G. (2017) · Autism Research · doi:10.1002/aur.1647 · Cited by 48
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Intensive Child‐Centered Play Therapy for Children on the Autism Spectrum: A Pilot Study
Schottelkorb, A. A., Swan, K. L., & Ogawa, Y. (2020) · Journal of Counseling & Development · doi:10.1002/jcad.12300 · Cited by 47
Loubersac, J., Michelon, C., Ferrando, L., Picot, M., & Baghdadli, A. (2021) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-021-01792-9 · Cited by 62
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Muscle strength and executive function in children and adolescents with autism spectrum disorder
Ludyga, S., Pühse, U., Gerber, M., & Mücke, M. (2021) · Autism Research · doi:10.1002/aur.2587 · Cited by 61
“A survey of the Autism and Developmental Disabilities Monitoring Network supports that the prevalence of autism spectrum disorder (ASD) increased from 1 in 150 cases in 2006 to 1 in 54 cases in 2016 (Maenner et al., 2020).”
BackgroundAdiani, D., Itzkovitz, A., Bian, D., Katz, H., Breen, M., Hunt, S., Swanson, A. R., Vogus, T. J., Wade, J. W., & Sarkar, N. (2022) · ACM Transactions on Accessible Computing · doi:10.1145/3505560 · Cited by 47
“Autism Spectrum Disorder (ASD) is a lifelong neurodevelopmental condition characterized by differences in social communication as well as restrictive or repetitive patterns of behavior or interests, with a current prevalence of 1 in 54 children (approximately 2% of the entire population) in the United States [1, 50].”
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CRISPR activation for SCN2A-related neurodevelopmental disorders
Tamura, S., Nelson, A. D., Spratt, P. W. E., Hamada, E. C., Zhou, X., Kyoung, H., Li, Z., Arnould, C., Barskyi, V., Krupkin, B., et al. (2025) · Nature · doi:10.1038/s41586-025-09522-w · Cited by 52
Characteristics of prisoners with neurodevelopmental disorders and difficulties
McCarthy, J. M., Chaplin, E., Underwood, L., Forrester, A., Hayward, H., Sabet, J., Young, S., Asherson, P. J., Mills, R., & Murphy, D. (2015) · Journal of Intellectual Disability Research · doi:10.1111/jir.12237 · Cited by 47
Global Data on Autism Spectrum Disorders Prevalence: A Review of Facts, Fallacies and Limitations
Onaolapo, A. Y., & Onaolapo, O. J. (2017) · Universal Journal of Clinical Medicine · doi:10.13189/ujcm.2017.050202 · Cited by 53
Natural language markers of social phenotype in girls with autism
Song, A. Y., Cola, M., Plate, S. N., Petrulla, V., Yankowitz, L. D., Pandey, J., Schultz, R. T., & Parish‐Morris, J. (2020) · Journal of Child Psychology and Psychiatry · doi:10.1111/jcpp.13348 · Cited by 55
Gluten and Autism Spectrum Disorder
Croall, I. D., Hoggard, N., & Hadjivassiliou, M. (2021) · Nutrients · doi:10.3390/nu13020572 · Cited by 50
“As the name implies its phenotype exists on a spectrum, and overall it is estimated to affect as many as one in 69 children [2].”
BackgroundKisbu‐Sakarya, Y., & Doenyas, C. (2021) · Research in Developmental Disabilities · doi:10.1016/j.ridd.2021.103941 · Cited by 46
Samuel, P., Yew, R. Y., Hooley, M., Hickey, M., & Stokes, M. A. (2021) · Archives of Gynecology and Obstetrics · doi:10.1007/s00404-021-06109-4 · Cited by 46
Wu, S., Zhao, J. H., de Villiers, J., Liu, X. L., Rolfhus, E. L., Sun, X., Li, X., Pan, H., Wang, H., Zhu, Q., et al. (2023) · The Lancet Regional Health - Western Pacific · doi:10.1016/j.lanwpc.2023.100713 · Cited by 46
Autism Spectrum Disorder and Medical Cannabis: Review and Clinical Experience
Mostafavi, M., & Gaitanis, J. N. (2020) · Seminars in Pediatric Neurology · doi:10.1016/j.spen.2020.100833 · Cited by 56
VLDL-specific increases of fatty acids in autism spectrum disorder correlate with social interaction
Usui, N., Iwata, K., Miyachi, T., Takagai, S., Wakusawa, K., Nara, T., Tsuchiya, K. J., Matsumoto, K., Kurita, D., Kameno, Y., et al. (2020) · EBioMedicine · doi:10.1016/j.ebiom.2020.102917 · Cited by 45
“Worldwide, the prevalence of children diagnosed with ASD has increased significantly over recent decades [1,2].”
BackgroundItskovich, E., Zyga, O., Libove, R. A., Phillips, J. M., Garner, J. P., & Parker, K. J. (2020) · Autism Research · doi:10.1002/aur.2409 · Cited by 53
“Third, although we endeavored to include as many female participants in this study as possible, ASD is male-biased [Maenner et al., 2020], and our study cohort composition roughly reflects its prevalence.”
Early and Repeated Screening Detects Autism Spectrum Disorder
Wieckowski, A. T., Hamner, T., Nanovic, S., Porto, K. S., Coulter, K. L., Eldeeb, S. Y., Chen, C. A., FEIN, D. A., Barton, M. L., Adamson, L. B., et al. (2021) · The Journal of Pediatrics · doi:10.1016/j.jpeds.2021.03.009 · Cited by 46
A Convolutional Neural Network Model for Early-Stage Detection of Autism Spectrum Disorder
Rabbi, M. F., Hasan, S. M. M., Champa, A. I., & Zaman, M. A. (2021) · International Conference on Information and Communication Technology for Sustainable Development (ICICT4SD) · doi:10.1109/icict4sd50815.2021.9397020 · Cited by 46
Metadata
- 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
- 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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