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Prevalence and characteristics of autism spectrum disorder among children aged 8 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 (ADDM) Network conducts active surveillance of ASD. This report focuses on the prevalence and characteristics of ASD among children aged 8 years in 2018 whose parents or guardians lived in 11 ADDM Network sites in the United States (Arizona, Arkansas, California, Georgia, Maryland, Minnesota, Missouri, New Jersey, Tennessee, Utah, and Wisconsin). To ascertain ASD among children aged 8 years, ADDM Network staff review and abstract developmental evaluations and records from community medical and educational service providers. In 2018, children met the case definition if their records documented 1) an ASD diagnostic statement in an evaluation (diagnosis), 2) a special education classification of ASD (eligibility), or 3) an ASD International Classification of Diseases (ICD) code. RESULTS: For 2018, across all 11 ADDM sites, ASD prevalence per 1,000 children aged 8 years ranged from 16.5 in Missouri to 38.9 in California. The overall ASD prevalence was 23.0 per 1,000 (one in 44) children aged 8 years, and ASD was 4.2 times as prevalent among boys as among girls. Overall ASD prevalence was similar across racial and ethnic groups, except American Indian/Alaska Native children had higher ASD prevalence than non-Hispanic White (White) children (29.0 versus 21.2 per 1,000 children aged 8 years). At multiple sites, Hispanic children had lower ASD prevalence than White children (Arizona, Arkansas, Georgia, and Utah), and non-Hispanic Black (Black) children (Georgia and Minnesota). The associations between ASD prevalence and neighborhood-level median household income varied by site. Among the 5,058 children who met the ASD case definition, 75.8% had a diagnostic statement of ASD in an evaluation, 18.8% had an ASD special education classification or eligibility and no ASD diagnostic statement, and 5.4% had an ASD ICD code only. ASD prevalence per 1,000 children aged 8 years that was based exclusively on documented ASD diagnostic statements was 17.4 overall (range: 11.2 in Maryland to 29.9 in California). The median age of earliest known ASD diagnosis ranged from 36 months in California to 63 months in Minnesota. Among the 3,007 children with ASD and data on cognitive ability, 35.2% were classified as having an intelligence quotient (IQ) score ≤70. The percentages of children with ASD with IQ scores ≤70 were 49.8%, 33.1%, and 29.7% among Black, Hispanic, and White children, respectively. Overall, children with ASD and IQ scores ≤70 had earlier median ages of ASD diagnosis than children with ASD and IQ scores >70 (44 versus 53 months). INTERPRETATION: In 2018, one in 44 children aged 8 years was estimated to have ASD, and prevalence and median age of identification varied widely across sites. Whereas overall ASD prevalence was similar by race and ethnicity, at certain sites Hispanic children were less likely to be identified as having ASD than White or Black children. The higher proportion of Black children compared with White and Hispanic children classified as having intellectual disability was consistent with previous findings. PUBLIC HEALTH ACTION: The variability in ASD prevalence and community ASD identification practices among children with different racial, ethnic, and geographical characteristics highlights the importance of research into the causes of that variability and strategies to provide equitable access to developmental evaluations and services. These findings also underscore the need for enhanced infrastructure for diagnostic, treatment, and support services to meet the needs of all children.
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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 surveillance methods and case definitions used in 2018 and 2020 (6,13).”
In the citing paper
“No evidence of heterogeneity of the male-to-female ratio among children aged 4 years across sites was observed; however, the overall male-to-female ratio for children aged 4 years was lower than the 4.2 male-to-female ratio for children aged 8 years (11).”
In the citing paper
“The site in California had the highest cumulative incidence of ASD by age 48 months and the fewest cases of suspected ASD and was the only site where prevalence among children aged 4 years was higher than among children aged 8 years (11).”
In the citing paper
“The combined prevalence of ASD and suspected ASD (19.7 per 1,000 children aged 4 years) was still lower than ASD prevalence observed among children aged 8 years (23.0 per 1,000 children aged 8 years) (11).”
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).”
In the citing paper
“Consistent with findings among children aged 8 years (11), a higher proportion of Black children aged 4 years with ASD have co-occurring intellectual disability.”
In the citing paper
“The 2018 estimate for children aged 4 years was lower than the 23.0 per 1,000 ASD prevalence among children aged 8 years (11), a finding consistent with previous reports (8,13).”
In the citing paper
“Adding the children identified with ASD to those suspected of having ASD at age 4 years is still less than the prevalence of ASD by age 8 years at all sites except California (11).”
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“While estimates in the general population have hovered between 1-2% over the past two decades (Maenner et al. 2021), estimates have varied from 1.9% (Szymanski et al. 2012) to 5.8% of the DHH population (Kancherla et al. 2013).”
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“According to the WHO (2021), one in 160 children worldwide have ASD, and one in 44 children in the United States have the disorder [1].”
BackgroundHealth Care for Autistic Children
Ames, J., Davignon, M. N., Hayes, E. A., & Croen, L. (2024) · Pediatric Clinics of North America · doi:10.1016/j.pcl.2024.01.002 · Cited by 4
Bandeira, L. V. S., Alves, F. D., Cezar, I. A. M., Oliveira, S. L. N., Oliveira, A. J. S., da Silva, V. B., Nunes, M. S., de Rezende, L. F., & Silveira, M. F. (2024) · Portuguese Journal of Public Health · doi:10.1159/000534840 · Cited by 4
“It was con fi rmed that children and adolescents with ASD had an approximately four-fold chance of being male, as well as in studies conducted with other ethnically different populations [20 – 22].”
ResultBarańczuk, U., Goncikowska, K., Pisula, E., & Pisula, W. (2024) · Health Psychology Report · doi:10.5114/hpr/183105 · Cited by 5
“Recent prevalence estimates indicate that ASD affects approximately 1-2% of the population (Kim et al., 2011; Maenner et al., 2021).”
Specific Phobia, Fear, and the Autism Spectrum in Children and Adolescents: Adapting OST for ASD
Davis, T. E., & Brennan, J. (2024) · Clinical Child and Family Psychology Review · doi:10.1007/s10567-024-00475-6 · Cited by 4
“…as a form of childhood schizophrenia), 4.5 out of 10,000 children were identified as being diagnosed with autism in 1966 (Lotter, 1967 Year, 2010 Principal Investigators, 2014), 1 in 59 in 2014 (Baio et al., 2018), 1 in 54 in 2016 (Maenner et al., 2020), and 1 in 44 in 2018 (Maenner et al., 2021).”
InfluentialAutism Spectrum Disorder and Grandmother’s Race, Ethnicity, and Nativity
Chow, T., Meng, Q., O’Sharkey, K., Liew, Z., & Ritz, B. R. (2024) · JAACAP Open · doi:10.1016/j.jaacop.2024.04.008 · Cited by 4
Keehn, R. M., Penner, M., Shannon, J., Sohl, K., Weitzman, C. C., & Zuckerman, K. E. (2024) · Journal of Developmental & Behavioral Pediatrics · doi:10.1097/dbp.0000000000001297 · Cited by 4
Wei, F., Chen, T., Huang, Y., Yang, Y., Cheng, X., & Yang, L. (2024) · Journal of Molecular Neuroscience · doi:10.1007/s12031-024-02243-1 · Cited by 4
“The prevalence of autism spectrum disorder in children has shown a steady increase, with rates escalating from 1.1% in 2008 to 2.3% in 2018 in the United States (Maenner et al. 2021).”
InfluentialPupillary response during social emotion tasks in autism spectrum disorder
Lee, J., Chang, Y., Tseng, Y., Chou, T., & Chien, Y. (2024) · Autism Research · doi:10.1002/aur.3206 · Cited by 6
“Autism spectrum disorder (ASD) is a common neurodevelopmental disorder with an estimated prevalence of 1 in 44 children (Maenner et al., 2021).”
Autism spectrum disorder: difficulties in diagnosis and microRNA biomarkers
Martinez, B., & Peplow, P. V. (2024) · Neural Regeneration Research · doi:10.4103/nrr.nrr-d-24-00712 · Cited by 4
Impact of an Auditory Processing Training Program on Individuals With Autism Spectrum Disorder
Schafer, E. C., Gopal, K. V., Mathews, L., Miller, S. E., & Lam, B. P. W. (2024) · American Journal of Audiology · doi:10.1044/2024_aja-24-00134 · Cited by 4
Abu-Doleh, A., Abu-Qasmieh, I. F., Alquran, H., Masad, I. S., Banyissa, L. R., & Ahmad, M. A. (2024) · International Journal of Medical Informatics · doi:10.1016/j.ijmedinf.2024.105707 · Cited by 4
Tooth brushing behavior and oral health care of people with early childhood autism in Germany
Kraus, H., Schulte, A. G., Fricke, O., & Schmidt, P. (2025) · Clinical Oral Investigations · doi:10.1007/s00784-025-06194-8 · Cited by 4
“Maenner et al., for example, report a prevalence rate of 14.6 per 1000 people, or of 0.5–1% of the population, for ASD or, expressed differently, that one in 68 children show behaviors typical for ASD [ 6].”
InfluentialProgress in rehabilitation equipment for autism spectrum disorder
Hou, R., Yang, C., Tao, C., & Fan, Y. (2025) · Medicine in Novel Technology and Devices · doi:10.1016/j.medntd.2025.100365 · Cited by 4
Coles‐White, D., Abubakare, O., Alexander, S. H., & Fannin, D. K. (2025) · Perspectives of the ASHA Special Interest Groups · doi:10.1044/2024_persp-24-00172 · Cited by 7
The effect of omega-3 fatty acid supplementation on autism spectrum disorder: A meta-analysis
Jia, S.-J., Jing, J.-Q., Yi, L., & Yang, C.-J. (2025) · Research in Autism · doi:10.1016/j.reia.2025.202642 · Cited by 4
Neurodivergent Voices in the Classroom: Acquired or Innate, Still a Student
Brice, A. E., & Dwan, S. (2025) · Perspectives of the ASHA Special Interest Groups · doi:10.1044/2025_persp-24-00156 · Cited by 7
Assessment knowledge and attitude among caregivers of children with autism spectrum disorders
Alkazam, Z. T. A., & Al-Dujaili, A. H. (2022) · International Journal of Health Sciences · doi:10.53730/ijhs.v6ns2.7987 · Cited by 4
Lerner, M. D., Brown, C. E., Sridhar, A., Tschida, J. E., Felsman, P., Libsack, E. J., Kerns, C. M., Moskowitz, L. J., Soorya, L. V., Wainer, A., et al. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.923025 · Cited by 4
“Results: The EFA yielded a three-factor solution: (1) environmental modifications/antecedent strategies; (2) behavior analytic strategies; and (3) cognitive strategies, with overall familiarity ranked in this order.”
BackgroundInfluentialLawan, A. A., & Çavuş, N. (2022) · OBM Neurobiology · doi:10.21926/obm.neurobiol.2203138 · Cited by 4
Song, C., Wu, L., Hong, Y., Chen, X., & Zhu, Z.-W. (2022) · BMC Medical Education · doi:10.1186/s12909-022-03770-4 · Cited by 5
“27%, demonstrating that 1 in 44 children are diagnosed with ASD (based on 11 surveillance sites in the United States, 8-year-old children) [3].”
BackgroundEvaluation of Race and Ethnicity Across a Statewide System of Early Autism Evaluation
Martin, A. M., Ciccarelli, M. R., Swigonski, N. L., & Keehn, R. M. (2022) · The Journal of Pediatrics · doi:10.1016/j.jpeds.2022.10.023 · Cited by 4
Wang, M., Schuck, R. K., & Baiden, K. M. P. (2022) · IntechOpen eBooks · doi:10.5772/intechopen.108124 · Cited by 4
Pham, C., Bacon, E. C., Grzybowski, A., Barnes, C. C., Arias, S. J., Xu, R., Lopez, L., Courchesne, E., & Pierce, K. (2023) · Autism · doi:10.1177/13623613221147416 · Cited by 5
“This is consistent with the Centers for Disease Control and Prevention’s (CDC) most recent prevalence report that noted, for the first time, a lack of significant differences in ASD prevalence between racial and ethnic groups (Maenner et al., 2021).”
BackgroundResultInfluentialSelf-citationKlin, A. J. (2023) · PubMed · Cited by 4
Chang, X., Sun, L., & Li, R. (2023) · BMC Psychiatry · doi:10.1186/s12888-023-04647-6 · Cited by 5
The Use of the Alberta Infant Motor Scale (AIMS) as a Diagnostic Scale for Infants with Autism
Kochav-Lev, M., Bennett-Back, O., Lotan, M., & Stein‐Zamir, C. (2023) · Diagnostics · doi:10.3390/diagnostics13061045 · Cited by 4
Efficacy of coping mechanisms used during COVID-19 as reported by parents of children with autism
Wang, F., Memis, I., Durocher, J. S., Furar, E., Cavalcante, L., Eshraghi, R. S., Samson, A. C., Herwegen, J. V., Dukes, D., Alessandri, M., et al. (2023) · PLoS ONE · doi:10.1371/journal.pone.0283494 · Cited by 7
“The prevalence of ASD in children within the United States is currently 1 in 44 [4].”
BackgroundJara, R. L. R., Franco, N. M., Jara, L. R. R., Franco, F., Leiva, E. G., Salinas, D. V., Chromey, N., Torales, J. C., & Báez, D. (2023) · Revista científica ciencias de la salud · doi:10.53732/rccsalud/2023.e5108 · Cited by 4
Data‐driven dissection of the fever effect in autism spectrum disorder
Muller, E., Shalev, I., Bachmat, E., & Eran, A. (2023) · Autism Research · doi:10.1002/aur.2935 · Cited by 4
“Today, ASD remains one of the most debilitating childhood disorders: It affects 2.27% of the US population (Maenner et al., 2021), and requires chronic management (Harrington & Allen, 2014).”
BackgroundInfluentialAnalysis of potential biomarkers and immune infiltration in autism based on bioinformatics analysis
Cao, W., Luo, C., Fan, Z., Lei, M., Cheng, X., Shi, Z., Mao, F., Xu, Q., Fu, Z., & Zhang, Q. (2023) · Medicine · doi:10.1097/md.0000000000033340 · Cited by 4
“2:1).[3] With the continuous increase in the number of ASD, the demand for lifelong support in education, healthcare, life, family, and other fields has also increased, making the disease a major international public health problem.”
BackgroundProspects for Leveling the Playing Field for Black Children With Autism
Constantino, J. N., Abbacchi, A. M., May, B. K., Klaiman, C., Zhang, Y., Lowe, J. K., Marrus, N. M., Klin, A., & Geschwind, D. H. (2023) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1016/j.jaac.2023.05.005 · Cited by 4
Self-citationMotor differences in autism during a human-robot imitative gesturing task
Fears, N. E., Sherrod, G., Blankenship, D., Patterson, R. M., Hynan, L. S., Wijayasinghe, I. B., Popa, D. O., Bugnariu, N., & Miller, H. L. (2021) · Clinical Biomechanics · doi:10.1016/j.clinbiomech.2023.105987 · Cited by 6
CARES: an Inclusive Personalized Touristic System for Autism
Cena, F., Mauro, N., Ardissono, L., Ferrero, F., Ferrigno, S., Rapp, A., Mattutino, C., & Keller, R. (2023) · ACM Conference on User Modeling, Adaptation and Personalization (UMAP) · doi:10.1145/3563359.3596665 · Cited by 4
“In the US, about 1 in 44 children has autism according to CDC’s Autism and Developmental Disabilities Monitoring (ADDM) Network [15].”
BackgroundEkas, N. V., Kouros, C. D., Rigsby, B. A., Madison, S., Hymel, J., & Filippi, M. (2023) · Autism · doi:10.1177/13623613231182180 · Cited by 5
“Autistic children’s autism-related behaviors and co-occurring behavior problems also served as sources of psychological distress for parents in France (Miniarikova et al., 2021) and the United States (Manning et al., 2021).”
BackgroundInfluentialAkdağ, B. (2023) · Ege Üniversitesi Hemşirelik Fakültesi Dergisi · doi:10.53490/egehemsire.1231521 · Cited by 4
Medical Home, Developmental Monitoring/Screening, and Early Autism Identification
Barger, B. D., Salmon, A., & Moore, Q. (2023) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-023-06044-0 · Cited by 4
“This contrasts with historical trends indicating that while Black children are ultimately identified at similar rates by age 8, these children are typically identified later than White children (Maenner et al., 2021).”
Shariatpanahi, M., Sojoudi, Z., Khodagholi, F., Rahmati, H., Jameie, S. B., Eftekharzadeh, M., Karizmeh, M. S., Shabani, M., & Zamani, E. (2023) · International Journal of Developmental Neuroscience · doi:10.1002/jdn.10286 · Cited by 4
“Additionally, population-based surveys have stated that males are more liable to ASD than females, reporting mean prevalence ratios of 4:1 (Maenner et al., 2021).”
Metadata
- Authors
- Maenner, M. J., Shaw, K. A., Bakian, A. V., Bilder, D. A., Durkin, M. S., Esler, A., Furnier, S. M., Hallas, L., Hall-Lande, J., Hudson, A., Hughes, M. M., Patrick, M., Pierce, K., Poynter, J. N., Salinas, A., Shenouda, J., Vehorn, A., Warren, Z., Constantino, J. N., DiRienzo, M., Fitzgerald, R. T., Grzybowski, A., Spivey, M. H., Pettygrove, S., Zahorodny, W., Ali, A., Andrews, J. G., Baroud, T., Gutierrez, J., Hewitt, A., Lee, L.-C., Lopez, M., Mancilla, K. C., McArthur, D., 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 Minnesota (US)
- University of Arkansas for Medical Sciences (US)
- University of California San Diego (US)
- Rutgers New Jersey Medical School (US)
- Vanderbilt University Medical Center (US)
- Washington University in St. Louis (US)
- Johns Hopkins University (US)
- University of Arizona (US)
- United States Department of Health and Human Services (US)
- Corresponding author
- Maenner, Matthew J.
- ORCID
- Maenner, Matthew J.
- Bakian, Amanda V.
- Bilder, Deborah A.
- Durkin, Maureen S.
- Esler, Amy
- Furnier, Sarah M.
- Hughes, Michelle M.
- Patrick, Mary
- Pierce, Karen
- Poynter, Jenny N.
- Shenouda, Josephine
- Warren, Zachary
- Constantino, John N.
- DiRienzo, Monica
- Fitzgerald, Robert T.
- Pettygrove, Sydney
- Zahorodny, Walter
- Ali, Akilah
- Andrews, Jennifer G.
- Lee, Li-Ching
- Lopez, Maya
- McArthur, Dedria
- Washington, Anita
- Cogswell, Mary E.
- Venue
- MMWR. Surveillance Summaries
- Published
- 2021-12-03
- Volume
- 70
- Issue
- 11
- Pages
- 1-16
- ISSN
- 1545-8636 (ISSN-L)
- 1546-0738
- PMC
- PMC8639024
- OpenAlex
- W3216151710
- Cited by
- 1,818
- References
- 37
- Citations by year
- 2026: 101 · 2025: 270 · 2024: 438 · 2023: 553 · 2022: 438 · 2021: 8
- FWCI
- 193.23
- 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, special education eligibility, ICD-10 codes, sex differences, racial and ethnic disparities, American Indian and Alaska Native children, median household income, neighborhood socioeconomic status, United States states and territories
- MeSH terms
- Autism Spectrum Disorder, Race Factors, Child, Ethnicity, Female, Geography, Humans, Male, Population Surveillance, United States, Prevalence, Racial Groups, Health Status Disparities, Epidemiological Monitoring
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