The DOI matches its Crossref record; 22 of the 22 references it cites were found in a registry or an index; none of the 41 sources its claims cite is checked for support yet.
Early Identification of Autism Spectrum Disorder Among Children Aged 4 Years — Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2018
Open accessAbstract
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.
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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.
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Claims the paper makes
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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).”
§ Early Identification of Autism Spectrum Disorder Among Children Aged 4 Years — Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2018 > Results > Prevalence and Characteristics of Children Aged 4 Years with Suspected ASD
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Early Identification of Autism Spectrum Disorder Among Children Aged 4 Years — Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2018 > Results > Prevalence and Characteristics of Children Aged 4 Years with ASD
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passes- Also stated in: § Conclusion · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The percentage of children with co-occurring intellectual disability was not different between boys (51%) and girls (53%) with ASD (Table 4).”
§ Early Identification of Autism Spectrum Disorder Among Children Aged 4 Years — Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2018 > Results > Prevalence and Characteristics of Children Aged 4 Years with ASD
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Of children aged 4 years with ASD, 72% had a first evaluation at age ≤36 months.”
§ Early Identification of Autism Spectrum Disorder Among Children Aged 4 Years — Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2018 > Abstract > Results
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Trends were not observed among the other five sites.”
§ Early Identification of Autism Spectrum Disorder Among Children Aged 4 Years — Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2018 > Results > Prevalence and Characteristics of Children Aged 4 Years with ASD
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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).”
- Also stated in: § Prevalence and Characteristics of Children Aged 4 Years with ASD · plain
“Overall, prevalence was lower among White children than among Black children (prevalence ratio: 0.8), Hispanic children (prevalence ratio: 0.6), and A/PI children (prevalence ratio: 0.6) (Table 3).”
§ Early Identification of Autism Spectrum Disorder Among Children Aged 4 Years — Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2018 > Abstract > Results
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passes- Also stated in: § Prevalence and Characteristics of Children Aged 4 Years with ASD · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The percentage of children with earliest recorded evaluation by age 36 months was similar for children classified as having intellectual disability (78%) or not (80%) but was lower among children with unknown intellectual disability case status (63%).”
§ Early Identification of Autism Spectrum Disorder Among Children Aged 4 Years — Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2018 > Results > Prevalence and Characteristics of Children Aged 4 Years with ASD
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Cumulative incidence by age 48 months was higher with higher MHI in one site (Missouri).”
§ Early Identification of Autism Spectrum Disorder Among Children Aged 4 Years — Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2018 > Results > Prevalence and Characteristics of Children Aged 4 Years with ASD
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Across MHI tertiles, higher cumulative incidence of ASD diagnosis or eligibility received by age 48 months was associated with lower MHI.”
§ Early Identification of Autism Spectrum Disorder Among Children Aged 4 Years — Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2018 > Abstract > Results
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Across sites, six children met the ASD case definition for every child meeting the suspected case definition.”
§ Early Identification of Autism Spectrum Disorder Among Children Aged 4 Years — Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2018 > Results > Prevalence and Characteristics of Children Aged 4 Years with Suspected ASD
Tests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passes
- It may state two separate claims as one. 21
- Probably not a substantial claim. 17
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Early Identification of Autism Spectrum Disorder Among Children Aged 4 Years — Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2018 > Abstract > Results
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Evaluation by age 36 months was similar by sex and by racial and ethnic groups.”
§ Early Identification of Autism Spectrum Disorder Among Children Aged 4 Years — Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2018 > Results > Prevalence and Characteristics of Children Aged 4 Years with ASD
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Early Identification of Autism Spectrum Disorder Among Children Aged 4 Years — Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2018 > Results > Prevalence and Characteristics of Children Aged 4 Years with ASD
Tests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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).”
§ Early Identification of Autism Spectrum Disorder Among Children Aged 4 Years — Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2018 > Results > Prevalence and Characteristics of Children Aged 4 Years with ASD
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Prevalence of ASD was higher than prevalence of suspected ASD, although the magnitude varied across sites.”
§ Early Identification of Autism Spectrum Disorder Among Children Aged 4 Years — Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2018 > Discussion
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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).”
§ Early Identification of Autism Spectrum Disorder Among Children Aged 4 Years — Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2018 > Results > Prevalence and Characteristics of Children Aged 4 Years with Suspected ASD
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the 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).”
§ Early Identification of Autism Spectrum Disorder Among Children Aged 4 Years — Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2018 > Discussion
What the sources say
- Not checked yetcites [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 yetcites [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
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“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).”
§ Early Identification of Autism Spectrum Disorder Among Children Aged 4 Years — Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2018 > Introduction
What the sources say
- Not checked yetcites [2] Reichow, 2018, Early intensive behavioral intervention (EIBI) for young children with autism spectrum disorders (ASD)., Cochrane Database Syst Rev source
- Not checked yetcites [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 yetcites [4] Dawson, 2010, Randomized, controlled trial of an intervention for toddlers with autism: the Early Start Denver Model., Pediatrics source
- Not checked yetcites [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 yetcites [6] Anderson, 2014, Predicting young adult outcome among more and less cognitively able individuals with autism spectrum disorders., J Child Psychol Psychiatry source
Tests✓ Asserted: passes✗ Checkable: fails✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim. It may be too vague to check against evidence.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Early Identification of Autism Spectrum Disorder Among Children Aged 4 Years — Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2018 > Methods > Additional Data Sources and Variable Definitions
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“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).”
§ Early Identification of Autism Spectrum Disorder Among Children Aged 4 Years — Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2018 > Introduction
What the sources say
- Not checked yetcites [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
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the 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).”
§ Early Identification of Autism Spectrum Disorder Among Children Aged 4 Years — Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2018 > Introduction
What the sources say
- Not checked yetcites [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 yetcites [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
Strength:hedged· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“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).”
§ Early Identification of Autism Spectrum Disorder Among Children Aged 4 Years — Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2018 > Methods > Case Ascertainment and Surveillance Case Definition
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Improving early identification of ASD could lead to earlier receipt of evidence-based interventions and potentially improve developmental outcomes.”
§ Early Identification of Autism Spectrum Disorder Among Children Aged 4 Years — Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2018 > Abstract > Public Health Action
Tests✓ Asserted: passes✗ Checkable: fails✓ Load-bearing: passes✗ Based: failsProbably not a substantial claim. It may be too vague to check against evidence. The paper may give no reason why it holds. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Early Identification of Autism Spectrum Disorder Among Children Aged 4 Years — Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2018 > Methods > Surveillance Sites and Procedures
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
In the paper
“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).”
§ Early Identification of Autism Spectrum Disorder Among Children Aged 4 Years — Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2018 > Introduction
What the sources say
- Not checked yetcites [1] Hyman, 2020, Identification, evaluation, and management of children with autism spectrum disorder., Pediatrics source
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Early Identification of Autism Spectrum Disorder Among Children Aged 4 Years — Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2018 > Abstract > Interpretation
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
- Also stated in: § Public Health Action · hedged
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Early Identification of Autism Spectrum Disorder Among Children Aged 4 Years — Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2018 > Methods > Analytic Methods
Strength:plain· not yet calibratedn = 245Tests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
In the paper
“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).”
§ Early Identification of Autism Spectrum Disorder Among Children Aged 4 Years — Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2018 > Introduction
What the sources say
- Not checked yetcites [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
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“First, surveillance area populations are subsets of state populations and not necessarily generalizable to the entire state or United States.”
§ Early Identification of Autism Spectrum Disorder Among Children Aged 4 Years — Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2018 > Limitations
Strength:hedged· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
In the paper
“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).”
§ Early Identification of Autism Spectrum Disorder Among Children Aged 4 Years — Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2018 > Discussion
What the sources say
- Not checked yetcites [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
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Early Identification of Autism Spectrum Disorder Among Children Aged 4 Years — Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2018 > Limitations
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“An association of higher ASD prevalence and higher SES has been reported previously in ADDM Network data from surveillance years 2002–2010 (19).”
§ Early Identification of Autism Spectrum Disorder Among Children Aged 4 Years — Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2018 > Discussion
What the sources say
- Not checked yetcites [19] Durkin, 2017, Autism spectrum disorder among US children (2002–2010): socioeconomic, racial, and ethnic disparities., Am J Public Health source
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Second, sample size, demographics, and practices and policies vary among sites and could contribute to variability in findings.”
§ Early Identification of Autism Spectrum Disorder Among Children Aged 4 Years — Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2018 > Limitations
Strength:hedged· not yet calibratedCausal:conditional· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Third, differences in sites or study areas complicate comparisons over time.”
§ Early Identification of Autism Spectrum Disorder Among Children Aged 4 Years — Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2018 > Limitations
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Early Identification of Autism Spectrum Disorder Among Children Aged 4 Years — Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2018 > Limitations
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Early Identification of Autism Spectrum Disorder Among Children Aged 4 Years — Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2018 > Limitations
Strength:hedged· not yet calibratedCausal:conditional· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“The population of AI/AN children was small relative to other groups and thus could not be further stratified for comparisons.”
§ Early Identification of Autism Spectrum Disorder Among Children Aged 4 Years — Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2018 > Discussion
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
In the paper
“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).”
§ Early Identification of Autism Spectrum Disorder Among Children Aged 4 Years — Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2018 > Discussion
What the sources say
- Not checked yetcites [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
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“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).”
§ Early Identification of Autism Spectrum Disorder Among Children Aged 4 Years — Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2018 > Discussion
What the sources say
- Not checked yetcites [15] California Department of Developmental Services [Internet]. Sacramento, CA: California Department of Developmental Services; 2020. https://www.dds.ca.gov/
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Early Identification of Autism Spectrum Disorder Among Children Aged 4 Years — Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2018 > Limitations
Strength:hedged· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
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.”
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?
In the citing paper
“Although prevalence has been lower among children aged 4 years than aged 8 years in each reporting year, comparing cumulative incidence of identification by age 48 months has consistently indicated higher rates of ASD identification in younger cohorts (i.e., children born more recently) (9–11).”
In the citing paper
“California has had the highest prevalence among children aged 4 years and 8 years since joining the ADDM Network in 2018 (6,10,11,13)”
In the citing paper
“Surveillance was conducted using the same methods as in 2018 (7,10).”
In the citing paper
“Prevalence in 2020 among children aged 4 years was 24.3% higher among boys and 34.5% higher among girls than prevalence in 2018 (7), but the male-to-female ratios were similar between years.”
In the citing paper
“Prevalence of suspected ASD increased from 2018 at five sites (Arizona, Arkansas, Maryland, New Jersey, and Utah) and was similar between years at other sites (7)”
In the citing paper
“ASD is beginning to be identified more in lower-SES groups than previously (7,11); however, barriers to services still exist for lower-SES families of children with ASD (e.g., transportation, childcare, and job accommodations) (18–26).”
Citations
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“Comparisons were made with the group of children aged 8 years for the same 11 sites (11).”
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Cited by
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Items 101–162 of 162
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Castelin, S., Okorodudu, J., & Smith, T. C. (2024) · Journal of Developmental & Behavioral Pediatrics · doi:10.1097/dbp.0000000000001276 · Cited by 4
Mead, J., Lee, T.-J., & Bullot, A. (2024) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-024-06606-w · Cited by 3
Serrano, F., Guffey, D., Shekerdemian, L. S., Noll, L. M., Voigt, R. G., & Monteiro, S. A. (2023) · Cardiology in the Young · doi:10.1017/s1047951123001701 · Cited by 3
Wang, K., Zhang, S., Wang, Y., Wu, X., Wen, L., Meng, T., Jin, X., Li, S., Hong, Y., Jia, K., et al. (2024) · Journal of Neuroinflammation · doi:10.1186/s12974-024-03300-7 · Cited by 2
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Involvement of Kir4.1 in pain insensitivity of the BTBR mouse model of autism spectrum disorder
Li, X., Li, Q., Xu, L., Ma, Z., Shi, Y., Zhang, X., Yang, Y., Wang, J., Fan, L., & Wu, L. (2023) · Biochimica et Biophysica Acta (BBA) - Molecular Basis of Disease · doi:10.1016/j.bbadis.2023.166700 · Cited by 2
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Decoding the Support Needs of Parents of Children with Autism in Kenya
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Evaluating the Efficiency and Equity of Autism Diagnoses via Telehealth During COVID-19
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Metadata
- 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
- Maenner, Matthew J.
- Bakian, Amanda V.
- Bilder, Deborah A.
- Durkin, Maureen S.
- Furnier, Sarah M.
- Hughes, Michelle M.
- Patrick, Mary
- Pierce, Karen
- Shenouda, Josephine
- Warren, Zachary
- Zahorodny, Walter
- Constantino, John N.
- DiRienzo, Monica
- Esler, Amy
- Fitzgerald, Robert T.
- Ali, Akilah
- Andrews, Jennifer G.
- Lee, Li-Ching
- Lopez, Maya
- McArthur, Dedria
- Pettygrove, Sydney
- Poynter, Jenny N.
- Washington, Anita
- Cogswell, Mary E.
- Venue
- MMWR. Surveillance Summaries
- Published
- 2021-12-03
- Volume
- 70
- Issue
- 10
- Pages
- 1-14
- ISSN
- 1545-8636 (ISSN-L)
- 1546-0738
- 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
- diamond
- doi.org
- 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
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 2026-10-06, under version 3 of the claim definition (model deepseek-v4.1-flash, prompt extract-v3).
A second model labelled each claim on 2026-10-06 (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 ›
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