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Cited by 165Autism Spectrum Disorder ResearchChild Nutrition and Feeding IssuesFamily and Disability Support Research

Early Identification of Autism Spectrum Disorder Among Children Aged 4 Years — Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2018

Open access
Shaw, Kelly A., Maenner, Matthew J., Bakian, Amanda V., Bilder, Deborah A., Durkin, Maureen S., Furnier, Sarah M., Hughes, Michelle M., Patrick, Mary +30 more·2021·MMWR. Surveillance Summaries
DOI 10.15585/mmwr.ss7010a1PMC PMC8639027
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Abstract

PROBLEM/CONDITION: Autism spectrum disorder (ASD). PERIOD COVERED: 2018. DESCRIPTION OF SYSTEM: The Autism and Developmental Disabilities Monitoring Network is an active surveillance program that estimates ASD prevalence and monitors timing of ASD identification among children aged 4 and 8 years. This report focuses on children aged 4 years in 2018, who were born in 2014 and had a parent or guardian who lived in the surveillance area in one of 11 sites (Arizona, Arkansas, California, Georgia, Maryland, Minnesota, Missouri, New Jersey, Tennessee, Utah, and Wisconsin) at any time during 2018. Children were classified as having ASD if they ever received 1) an ASD diagnostic statement (diagnosis) in an evaluation, 2) a special education classification of ASD (eligibility), or 3) an ASD International Classification of Diseases (ICD) code. Suspected ASD also was tracked among children aged 4 years. Children who did not meet the case definition for ASD were classified as having suspected ASD if their records contained a qualified professional's statement indicating a suspicion of ASD. RESULTS: For 2018, the overall ASD prevalence was 17.0 per 1,000 (one in 59) children aged 4 years. Prevalence varied from 9.1 per 1,000 in Utah to 41.6 per 1,000 in California. At every site, prevalence was higher among boys than girls, with an overall male-to-female prevalence ratio of 3.4. Prevalence of ASD among children aged 4 years was lower among non-Hispanic White (White) children (12.9 per 1,000) than among non-Hispanic Black (Black) children (16.6 per 1,000), Hispanic children (21.1 per 1,000), and Asian/Pacific Islander (A/PI) children (22.7 per 1,000). Among children aged 4 years with ASD and information on intellectual ability, 52% met the surveillance case definition of co-occurring intellectual disability (intelligence quotient ≤70 or an examiner's statement of intellectual disability documented in an evaluation). Of children aged 4 years with ASD, 72% had a first evaluation at age ≤36 months. Stratified by census-tract-level median household income (MHI) tertile, a lower percentage of children with ASD and intellectual disability was evaluated by age 36 months in the low MHI tertile (72%) than in the high MHI tertile (84%). Cumulative incidence of ASD diagnosis or eligibility received by age 48 months was 1.5 times as high among children aged 4 years (13.6 per 1,000 children born in 2014) as among those aged 8 years (8.9 per 1,000 children born in 2010). Across MHI tertiles, higher cumulative incidence of ASD diagnosis or eligibility received by age 48 months was associated with lower MHI. Suspected ASD prevalence was 2.6 per 1,000 children aged 4 years, meaning for every six children with ASD, one child had suspected ASD. The combined prevalence of ASD and suspected ASD (19.7 per 1,000 children aged 4 years) was lower than ASD prevalence among children aged 8 years (23.0 per 1,000 children aged 8 years). INTERPRETATION: Groups with historically lower prevalence of ASD (non-White and lower MHI) had higher prevalence and cumulative incidence of ASD among children aged 4 years in 2018, suggesting progress in identification among these groups. However, a lower percentage of children with ASD and intellectual disability in the low MHI tertile were evaluated by age 36 months than in the high MHI group, indicating disparity in timely evaluation. Children aged 4 years had a higher cumulative incidence of diagnosis or eligibility by age 48 months compared with children aged 8 years, indicating improvement in early identification of ASD. The overall prevalence for children aged 4 years was less than children aged 8 years, even when prevalence of children suspected of having ASD by age 4 years is included. This finding suggests that many children identified after age 4 years do not have suspected ASD documented by age 48 months. PUBLIC HEALTH ACTION: Children born in 2014 were more likely to be identified with ASD by age 48 months than children born in 2010, indicating increased early identification. However, ASD identification among children aged 4 years varied by site, suggesting opportunities to examine developmental screening and diagnostic practices that promote earlier identification. Children aged 4 years also were more likely to have co-occurring intellectual disability than children aged 8 years, suggesting that improvement in the early identification and evaluation of developmental concerns outside of cognitive impairments is still needed. Improving early identification of ASD could lead to earlier receipt of evidence-based interventions and potentially improve developmental outcomes.

AI snapshot

Written from the paper’s full text.

TL;DR

For 2018 ADDM Network surveillance, ASD prevalence among children aged 4 years across 11 sites was 17.0 per 1,000 (1 in 59), ranging from 9.1 per 1,000 in Utah to 41.6 per 1,000 in California. Early identification improved compared with children born in 2010, but timely evaluation disparities persisted for children with ASD and intellectual disability in the low median household income tertile.

Key findings

  • Overall ASD prevalence was 17.0 per 1,000 children aged 4 years; male-to-female prevalence ratio was 3.4 (25.9 vs. 7.7 per 1,000). By race/ethnicity, prevalence was 12.9 per 1,000 among White children, 16.6 among Black children, 21.1 among Hispanic children, 22.7 among Asian/Pacific Islander children, and 11.5 among American Indian/Alaska Native children.
  • Among children with ASD and available intellectual ability information, 51.6% had co-occurring intellectual disability; 72% had their earliest recorded evaluation by age 36 months. Among children with ASD and intellectual disability, 72% in the low MHI tertile were evaluated by age 36 months versus 84% in the high MHI tertile.
  • Cumulative incidence of ASD diagnosis or eligibility by age 48 months was 13.6 per 1,000 for children born in 2014 versus 8.9 per 1,000 for children born in 2010, a 1.5 times higher incidence in the younger cohort. Suspected ASD prevalence was 2.6 per 1,000, and combined ASD plus suspected ASD prevalence was 19.7 per 1,000, still lower than ASD prevalence among children aged 8 years (23.0 per 1,000).
  • Cumulative incidence by age 48 months was 13.8, 12.8, and 11.7 per 1,000 among low, middle, and high MHI tertiles, respectively, indicating higher ASD identification with lower MHI.

Methods

  • Active population-based surveillance in 11 ADDM Network sites (Arizona, Arkansas, California, Georgia, Maryland, Minnesota, Missouri, New Jersey, Tennessee, Utah, and Wisconsin) among children aged 4 years in 2018, born in 2014, with a parent or guardian living in the surveillance area at least one day during 2018; total denominator was 220,394 and 3,754 children met the ASD case definition.
  • Children met the ASD case definition if they ever received an ASD diagnostic statement, special education classification of ASD, or ASD ICD-9 code 299.00–299.99 or ICD-10 F84 code; suspected ASD was classified when records contained a qualified professional’s statement indicating suspicion of ASD without meeting the ASD case definition. Records were linked to health, education, birth certificate, and census-tract median household income data.
  • Prevalence was calculated per 1,000 with Wilson 95% CIs; prevalence ratios compared sex and race/ethnicity groups; cumulative incidence by month of age compared children aged 4 years with children aged 8 years; risk ratios and Cochran-Armitage tests assessed differences and trends across MHI tertiles; analyses used R version 4.0.3.

Limitations

  • Stated in the paper: surveillance area populations are subsets of state populations and not necessarily generalizable to entire states or the United States; sample size, demographics, and practices/policies vary among sites; differences in sites or study areas complicate comparisons over time; data completeness varied across sites; and the surveillance case definition of intellectual disability is not the same as a clinical diagnosis, with IQ measurements potentially unstable and younger children possibly not receiving an intellectual disability diagnosis.
  • Evident from the text: the 2018 ASD case definition no longer required clinician review of records, which could affect prevalence estimates and comparisons, including possibly contributing to higher prevalence among Black and Hispanic children.
  • Evident from the text: the ADDM Network collected data about children evaluated for and identified with ASD but not about screening and referrals, limiting interpretation of barriers to timely and equitable identification.

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

Integrity signals

Registry

Crossref · 10.15585/mmwr.ss7010a1

Cites

22 of 22 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 41 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    The prevalence of suspected ASD ranged from 0.4 per 1,000 in California to 4.9 per 1,000 in Arizona.

    “The overall prevalence of children without an ASD diagnosis, eligibility, or ICD code but who were suspected by a qualified professional of having ASD was 2.6 per 1,000 children aged 4 years (range: 0.4 per 1,000 in California to 4.9 per 1,000 in Arizona) (Table 7) (Supplementary Figure 4, https://stacks.cdc.gov/view/cdc/111177).”
    Quote in the paperNot a substantial claim
  • Findingown data

    An overall association of higher ASD identification by age 48 months with lower MHI was observed.

    “An overall association of higher ASD identification by age 48 months with lower MHI was observed.”
    • Also stated in: § Conclusion · plain
      “ASD prevalence among children aged 4 years was higher among Black, Hispanic, and A/PI children than among White children, and higher cumulative incidence of ASD diagnosis or eligibility by age 48 months was associated with lower census-tract–level MHI.”
    Quote in the paperSubstantial claim
  • Findingown data

    The percentage of children with co-occurring intellectual disability was not different between boys (51%) and girls (53%) with ASD.

    “The percentage of children with co-occurring intellectual disability was not different between boys (51%) and girls (53%) with ASD (Table 4).”
    Quote in the paperNot a substantial claim
  • Findingown data

    Of children aged 4 years with ASD, 72% had a first evaluation at age ≤36 months.

    “Of children aged 4 years with ASD, 72% had a first evaluation at age ≤36 months.”
    Quote in the paperSubstantial claim
  • Findingown data

    Trends were not observed among the other five sites.

    “Trends were not observed among the other five sites.”
    Quote in the paperNot a substantial claim
  • May combine two claims. 21
  • Classified as probably not a substantial claim. 17

  • May combine two claims.

    Findingown data

    Suspected ASD prevalence was 2.6 per 1,000 children aged 4 years, corresponding to one child with suspected ASD for every six children with ASD.

    “Suspected ASD prevalence was 2.6 per 1,000 children aged 4 years, meaning for every six children with ASD, one child had suspected ASD.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Evaluation by age 36 months was similar by sex and by racial and ethnic groups.

    “Evaluation by age 36 months was similar by sex and by racial and ethnic groups.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Co-occurring intellectual disability among children aged 4 years with ASD was associated with lower median household income; 41% in the high MHI tertile had intellectual disability compared with 60% in the low MHI tertile.

    “Co-occurring intellectual disability was associated with lower MHI; 41% of those in the high MHI tertile group had intellectual disability compared with 60% of those in the low MHI tertile group.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    At age 48 months, overall cumulative incidence was 13.6 per 1,000 children born in 2014 and 8.9 per 1,000 children born in 2010.

    “At age 48 months, overall cumulative incidence was 13.6 per 1,000 children born in 2014 and 8.9 per 1,000 children born in 2010, meaning ASD diagnosis or eligibility was 1.5 times as high in the group born in 2014 (Supplementary Table 5, https://stacks.cdc.gov/view/cdc/111177).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Prevalence of ASD was higher than prevalence of suspected ASD, although the magnitude varied across sites.

    “Prevalence of ASD was higher than prevalence of suspected ASD, although the magnitude varied across sites.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Differences were observed by race and ethnicity, with more White children (50%) and fewer A/PI children (5%) in the suspected ASD group than in the ASD group (43% White; 9% A/PI).

    “Differences were observed by race and ethnicity, with more White children (50%) and fewer A/PI children (5%) in the suspected ASD group than in the ASD group (43% White; 9% A/PI) (Table 8).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    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).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [9] Maenner, 2020, Prevalence of autism spectrum disorder among children aged 8 years—Autism and Developmental Disabilities Monitoring Network, 11 sites, United States, 2016., MMWR Surveill Summ source

      Not checked in the free run.

    • cites [17] Baio, 2018, Prevalence of autism spectrum disorder among children aged 8 years—Autism and Developmental Disabilities Monitoring Network, 11 sites, United States, 2014., MMWR Surveill Summ source

      Not checked in the free run.

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

    Premisecitation

    Early evaluation, diagnosis, and evidence-based interventions could enhance short-term and long-term developmental outcomes for young children with ASD.

    “Early routine screening for ASD and other developmental concerns is recommended by the American Academy of Pediatrics (1) because early evaluation, diagnosis, and evidence-based interventions could enhance short-term and long-term developmental outcomes for young children with ASD (2–6).”
    Quote in the paperNot a substantial claim0 of 5 sources checked
    • cites [2] Reichow, 2018, Early intensive behavioral intervention (EIBI) for young children with autism spectrum disorders (ASD)., Cochrane Database Syst Rev source

      Not checked in the free run.

    • cites [3] 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.

    • cites [4] 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 [5] D’Elia, 2014, A longitudinal study of the teacch program in different settings: the potential benefits of low intensity intervention in preschool children with autism spectrum disorder., J Autism Dev Disord source

      Not checked in the free run.

    • cites [6] Anderson, 2014, Predicting young adult outcome among more and less cognitively able individuals with autism spectrum disorders., J Child Psychol Psychiatry source

      Not checked in the free run.

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

    Study design and conductown data

    Census-tract information to link to median household income was available for 94% of children aged 4 years.

    “Census-tract information to link to MHI was available for 94% of children aged 4 years; others met residency requirements on the basis of school attendance or receipt of services that required living in the surveillance area during 2018.”
    Quote in the paperNot a substantial claim

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

    Premisecitation

    Increasing the proportion of all children who receive a developmental screening by age 36 months and the proportion of children with ASD who receive special services by age 48 months are included as Healthy People 2030 goals.

    “Because of the potential to improve outcomes, increasing the proportion of all children who receive a developmental screening by age 36 months and the proportion of children with ASD who receive special services by age 48 months are included as Healthy People 2030 goals (7).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [7] US Department of Health and Human Services, Office of Disease Prevention and Health Promotion. Healthy People 2030 ASD goals. https://health.gov/healthypeople/custom-list?ids=31387+31386

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    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).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [8] Shaw, 2020, Early identification of autism spectrum disorder among children aged 4 years—Early Autism and Developmental Disabilities Monitoring Network, six sites, United States, 2016., MMWR Surveill Summ source

      Not checked in the free run.

    • cites [9] Maenner, 2020, Prevalence of autism spectrum disorder among children aged 8 years—Autism and Developmental Disabilities Monitoring Network, 11 sites, United States, 2016., MMWR Surveill Summ source

      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

    All sites had access to health records, and nine of 11 sites had access to education records covering their surveillance area (Wisconsin had partial access, and Missouri had none).

    “All sites had access to health records, and nine of 11 sites had access to education records covering their surveillance area (Wisconsin had partial access, and Missouri had none).”
    Quote in the paperNot a substantial claim

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

    Interpretationnone given

    Improving early identification of ASD could lead to earlier receipt of evidence-based interventions and potentially improve developmental outcomes.

    “Improving early identification of ASD could lead to earlier receipt of evidence-based interventions and potentially improve developmental outcomes.”
    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

    All ADDM Network sites functioned as public health authorities under the Health Insurance Portability and Accountability Act of 1996 Privacy Rule and met applicable local institutional review board, privacy, and confidentiality requirements under 45 CFR 46.

    “All sites functioned as public health authorities under the Health Insurance Portability and Accountability Act of 1996 Privacy Rule and met applicable local institutional review board, privacy, and confidentiality requirements under 45 CFR 46.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    Early routine screening for ASD and other developmental concerns is recommended by the American Academy of Pediatrics.

    “Early routine screening for ASD and other developmental concerns is recommended by the American Academy of Pediatrics (1) because early evaluation, diagnosis, and evidence-based interventions could enhance short-term and long-term developmental outcomes for young children with ASD (2–6).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [1] Hyman, 2020, Identification, evaluation, and management of children with autism spectrum disorder., Pediatrics source

      Not checked in the free run.

  • May combine two claims.

    Interpretationown data

    Children aged 4 years had a higher cumulative incidence of diagnosis or eligibility by age 48 months compared with children aged 8 years, indicating improvement in early identification of ASD.

    “Children aged 4 years had a higher cumulative incidence of diagnosis or eligibility by age 48 months compared with children aged 8 years, indicating improvement in early identification of ASD.”
    • Also stated in: § Public Health Action · hedged
      “Children born in 2014 were more likely to be identified with ASD by age 48 months than children born in 2010, indicating increased early identification.”
    Quote in the paperSubstantial claim

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

    Study design and conductown data

    No children aged 4 years were lacking sex information; 245 children were of other (including multiracial) or unknown race and were excluded from analyses stratified by race and ethnicity.

    “No children aged 4 years were lacking sex information; 245 children were of other (including multiracial) or unknown race and were excluded from analyses stratified by race and ethnicity.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    ASD identification measured by cumulative incidence of diagnosis by age 48 months was higher among children aged 4 years (born in 2012) compared with children aged 8 years (born in 2008), suggesting increased early identification of ASD among the younger cohort.

    “In addition, ASD identification measured by cumulative incidence of diagnosis by age 48 months was higher among children aged 4 years (born in 2012) compared with children aged 8 years (born in 2008), suggesting increased early identification of ASD among the younger cohort (8).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [8] Shaw, 2020, Early identification of autism spectrum disorder among children aged 4 years—Early Autism and Developmental Disabilities Monitoring Network, six sites, United States, 2016., MMWR Surveill Summ source

      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

    Surveillance area populations are subsets of state populations and not necessarily generalizable to the entire state or United States.

    “First, surveillance area populations are subsets of state populations and not necessarily generalizable to the entire state or United States.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductcitation

    Comparisons with previous reports among children aged 4 years were limited by small numbers among non-White groups in surveillance year 2010 and a lack of aggregate estimates for surveillance years 2012 and 2014.

    “Comparisons with previous reports among children aged 4 years were limited by small numbers among non-White groups in surveillance year 2010 and a lack of aggregate estimates for surveillance years 2012 and 2014 (13).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [13] Christensen, 2019, Prevalence and characteristics of autism spectrum disorder among children aged 4 years—Early Autism and Developmental Disabilities Monitoring Network, seven sites, United States, 2010, 2012, and 2014., MMWR Surveill Summ source

      Not checked in the free run.

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

    Study design and conductreasoning

    The surveillance case definition of intellectual disability is not the same as a clinical diagnosis of intellectual disability.

    “Finally, the surveillance case definition of intellectual disability is not the same as a clinical diagnosis of intellectual disability; IQ measurements might lack stability and children might not receive a diagnosis of intellectual disability at younger ages.”
    Quote in the paperNot a substantial claim

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

    Premisecitation

    An association of higher ASD prevalence and higher SES has been reported previously in ADDM Network data from surveillance years 2002-2010.

    “An association of higher ASD prevalence and higher SES has been reported previously in ADDM Network data from surveillance years 2002–2010 (19).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [19] Durkin, 2017, Autism spectrum disorder among US children (2002–2010): socioeconomic, racial, and ethnic disparities., Am J Public Health source

      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

    Sample size, demographics, and practices and policies vary among sites and could contribute to variability in findings.

    “Second, sample size, demographics, and practices and policies vary among sites and could contribute to variability in findings.”
    Quote in the paperNot a substantial claim

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

    Study design and conductnone given

    Differences in sites or study areas complicate comparisons over time.

    “Third, differences in sites or study areas complicate comparisons over time.”
    Quote in the paperNot a substantial claim

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

    Study design and conductreasoning

    Assessing ASD identification among children aged 4 years and children aged 8 years in a single area in a single year addresses the limitation of differences in sites or study areas by making these groups directly comparable.

    “One way this limitation has been addressed is by assessing ASD identification among children aged 4 years and children aged 8 years in a single area in a single year so that these groups are directly comparable.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductreasoning

    Data completeness varied across sites, which could result in incomplete or biased ascertainment of ASD or other characteristics such as intellectual disability.

    “Fourth, data completeness varied across sites (either because of lack of data sharing agreements, pandemic-related disruption, or incomplete information), which could result in incomplete or biased ascertainment of ASD or other characteristics such as intellectual disability.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductown data

    The population of AI/AN children was small relative to other groups and thus could not be further stratified for comparisons.

    “The population of AI/AN children was small relative to other groups and thus could not be further stratified for comparisons.”
    Quote in the paperNot a substantial claim

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

    Premisecitation

    The "Get SET Early" program has trained hundreds of pediatricians to developmentally screen children at well-baby examinations and refer them for evaluation when indicated.

    “For example, the “Get SET Early” program has trained hundreds of pediatricians to developmentally screen children at well-baby examinations and refer them for evaluation when indicated (16).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [16] Pierce, 2021, Get SET Early to identify and treatment refer autism spectrum disorder at 1 year and discover factors that influence early diagnosis., J Pediatr source

      Not checked in the free run.

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

    Premisecitation

    One of the California site's data sources was a state-funded regional center that serves persons with developmental disabilities and their families, including providing evaluations and service coordination.

    “One of the site’s data sources was a state-funded regional center that serves persons with developmental disabilities and their families, including providing evaluations and service coordination (15).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [15] California Department of Developmental Services [Internet]. Sacramento, CA: California Department of Developmental Services; 2020. https://www.dds.ca.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 conductreasoning

    IQ measurements might lack stability and children might not receive a diagnosis of intellectual disability at younger ages.

    “Finally, the surveillance case definition of intellectual disability is not the same as a clinical diagnosis of intellectual disability; IQ measurements might lack stability and children might not receive a diagnosis of intellectual disability at younger ages.”
    Quote in the paperNot a substantial claim
30 of 30

  • The paper relies on this without support.

    Non-White and lower median household income groups have historically had lower ASD prevalence.

    “Groups with historically lower prevalence of ASD (non-White and lower MHI) had higher prevalence and cumulative incidence of ASD among children aged 4 years in 2018, suggesting progress in identification among these groups.”
1 of 1

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Authors
Shaw, K. A., Maenner, M. J., Bakian, A. V., Bilder, D. A., Durkin, M. S., Furnier, S. M., Hughes, M. M., Patrick, M., Pierce, K., Salinas, A., Shenouda, J., Vehorn, A., Warren, Z., Zahorodny, W., Constantino, J. N., DiRienzo, M., Esler, A., Fitzgerald, R. T., Grzybowski, A., Hudson, A., Spivey, M. H., Ali, A., Andrews, J. G., Baroud, T., Gutierrez, J., Hallas, L., Hall-Lande, J., Hewitt, A., Lee, L.-C., Lopez, M., Mancilla, K. C., McArthur, D., Pettygrove, S., Poynter, J. N., Schwenk, Y. D., Washington, A., Williams, S., & Cogswell, M. E.
Affiliations
  • Centers for Disease Control and Prevention (US)
  • University of Utah (US)
  • University of Wisconsin–Madison (US)
  • University of California San Diego (US)
  • Rutgers New Jersey Medical School (US)
  • Vanderbilt University Medical Center (US)
  • Washington University in St. Louis (US)
  • University of Minnesota (US)
  • University of Arkansas for Medical Sciences (US)
  • Johns Hopkins University (US)
  • University of Arizona (US)
Corresponding author
Shaw, Kelly A.
ORCID
Venue
MMWR. Surveillance Summaries
Publisher
Centers for Disease Control MMWR Office
Published
2021-12-03
Volume
70
Issue
10
Pages
1-14
ISSN
  • 1545-8636 (ISSN-L)
  • 1546-0738
DOI
10.15585/mmwr.ss7010a1
PMC
PMC8639027
OpenAlex
W3216090687
Semantic Scholar
df608850c56451ca698c05b395e62b4fce952bd2
Cited by
165
References
22
Citations by year
2026: 7 · 2025: 50 · 2024: 31 · 2023: 48 · 2022: 28 · 2021: 1
FWCI
14.20
Type
journal article
Language
en
Open access
Licence
public-domain
Locations
  • MMWR Surveillance Summaries (publishedVersion, public-domain)
  • PubMed Central (publishedVersion, public-domain)
  • PubMed (publishedVersion)
Funders
Eunice Kennedy Shriver National Institute of Child Health and Human Development (P50HD103537)
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, early detection, racial and ethnic disparities, sex differences, household income, special education eligibility, intellectual disability
MeSH terms
Autism Spectrum Disorder, Child, Preschool, Female, Humans, Male, Population Surveillance, United States, Early Diagnosis, Epidemiological Monitoring

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