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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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Trajectory of depressive symptoms over adolescence in autistic and neurotypical youth
Corbett, B. A., Muscatello, R. A., McGonigle, T., Vandekar, S., Burroughs, C., & Sparks, S. (2024) · Molecular Autism · doi:10.1186/s13229-024-00600-w · Cited by 28
Sales-Millán, A. D., Reyes-Ferreira, P., Garrido, J. F. A., Guillé, I. C., Barrientos-Ríos, R., & Velázquez-Aragón, J. A. (2024) · International Journal of Molecular Sciences · doi:10.3390/ijms25126701 · Cited by 22
Leifler, E., Borg, A., & Bölte, S. (2022) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-022-05643-7 · Cited by 20
“The coming into effect of these policies has been paralleled by an increasing number of children diagnosed with autism, attention-deficit hyper-activity disorder (ADHD), and other neurodevelopmental disorders (NDDs) (Danielson et al., 2016; Maenner et al., 2021 ).”
BackgroundThe Early Childhood Signs of Autism in Females: a Systematic Review
Chellew, T., Barbaro, J., & Freeman, N. C. (2022) · Review Journal of Autism and Developmental Disorders · doi:10.1007/s40489-022-00337-3 · Cited by 26
“The prevalence of autism is estimated to be one in 44 children (Maenner et al., 2021), with approximately four males to every female receiving a diagnosis of autism (Fombonne, 2009; Maenner et al., 2021).”
Stallworthy, I. C., Berry, D. J., Davis, S. C., Wolff, J. J., Burrows, C. A., Swanson, M. R., Grzadzinski, R., Botteron, K. N., Dager, S. R., Estes, A. M., et al. (2022) · Developmental Science · doi:10.1111/desc.13336 · Cited by 23
“Although the median age of diagnosis in the USA is 38 months of age (Maenner, 2021), the social behavioral signs of ASD likelihood may emerge within the first year of life (e.g., W. Jones & Klin, 2013; M. Miller, Iosif, et al., 2017; Nyström et al., 2019; I. Stallworthy et al., 2021).”
BackgroundHustyi, K. M., Ryan, A., & Hall, S. S. (2022) · Research in Autism · doi:10.1016/j.rasd.2022.102074 · Cited by 22
The combination of autism and exceptional cognitive ability increases risk for suicidal ideation
Casten, L. G., Thomas, T., Doobay, A. F., Foley‐Nicpon, M., Kramer, S., Nickl‐Jockschat, T., Abel, T. G., Assouline, S. G., & Michaelson, J. J. (2022) · Neurobiology of Learning and Memory · doi:10.1016/j.nlm.2022.107698 · Cited by 22
Hughes, M. M., Shaw, K. A., Patrick, M., DiRienzo, M., Bakian, A. V., Bilder, D. A., Durkin, M. S., Hudson, A., Spivey, M. H., DaWalt, L. S., et al. (2023) · Journal of Adolescent Health · doi:10.1016/j.jadohealth.2022.12.010 · Cited by 20
Self-citationDevelopmental pyrethroid exposure causes a neurodevelopmental disorder phenotype in mice
Curtis, M. A., Dhamsania, R. K., Branco, R. C., Guo, J., Creeden, J. F., Neifer, K. L., Black, C. A., Winokur, E. J., Andari, E., Dias, B. G., et al. (2023) · PNAS Nexus · doi:10.1093/pnasnexus/pgad085 · Cited by 21
Girolamo, T. M., Shen, L., Monroe‐Gulick, A., Rice, M. L., & Eigsti, I. (2023) · Autism · doi:10.1177/13623613231166749 · Cited by 21
“Although language in autistic individuals is widely heterogeneous (Magiati et al., 2014), knowledge gaps about the language abilities of autistic individuals with language impairment (LI) limit the ability to develop and provide supports (Interagency Autism Coordinating Committee [IACC], 2020;…”
BackgroundComportamento alimentar de crianças com transtorno do espectro autista
Lemes, M. A., Garcia, G. P., do Carmo, B. L., Santiago, B. A., Teixeira, D. D. B., Agostinho, F., & Cola, P. C. (2023) · Jornal Brasileiro de Psiquiatria · doi:10.1590/0047-2085000000414 · Cited by 20
Yuan, G., Zhu, Z., Guo, H., Yang, H., Zhang, J., Zhang, K., Zhang, X., Lu, X., Du, J., Shi, H., et al. (2026) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-024-06665-z · Cited by 20
Meijer, J., Vieira, B. H., Elleaume, C., Baranczuk‐Turska, Z., Langer, N., & Floris, D. L. (2024) · Journal of Psychopathology and Clinical Science · doi:10.1037/abn0000914 · Cited by 19
Wang, X.-N., Zhang, T., Han, B.-C., Luo, W., Liu, W.-H., Yang, Z., Disi, A., Sun, Y., & Yang, J.-C. (2024) · Current Medical Science · doi:10.1007/s11596-024-2938-3 · Cited by 22
Altered Blood Brain Barrier Permeability and Oxidative Stress in Cntnap2 Knockout Rat Model
Memis, I., Mittal, R., Furar, E., White, I., Eshraghi, R. S., Mittal, J., & Eshraghi, A. A. (2022) · Journal of Clinical Medicine · doi:10.3390/jcm11102725 · Cited by 21
“According to the US Centers of Disease Control and Prevention (CDC), the incidence of ASD is about 1 in 44 children and is steadily increasing [4].”
MethodGray, H. L., Pang, T., Agazzi, H. C., Shaffer‐Hudkins, E., Kim, E., Miltenberger, R. G., Waters, K. A., Jiménez, C., Harris, M., & Stern, M. (2022) · Contemporary Clinical Trials · doi:10.1016/j.cct.2022.106814 · Cited by 23
Angrand, L., Masson, J.-D., Rubio‐Casillas, A., Nosten‐Bertrand, M., & Crépeaux, G. (2022) · Toxics · doi:10.3390/toxics10090518 · Cited by 20
“data are more than three times higher than the first prevalence estimation of 1 in 150 children between 2000 and 2002 [36].”
BackgroundKim, J. I., Kim, B.-N., Lee, Y. A., Shin, C. H., Hong, Y., & Lim, Y. (2022) · International Journal of Hygiene and Environmental Health · doi:10.1016/j.ijheh.2022.114047 · Cited by 20
Wang, L., Zhang, H., Shang, C., Liang, H., Liu, W., Han, B., Xia, W. T., Zou, M., & Sun, C. (2022) · Autism Research · doi:10.1002/aur.2836 · Cited by 19
“ASD is one of the most common worldwide neurodevelopmental disorders with deficits in social communication and limited and repetitive behaviors (Maenner et al., 2021).”
BackgroundLate diagnosis of autism spectrum disorder—Journey, parents' concerns, and sex influences
Davidovitch, M., Gazit, S., Patalon, T., Leitner, Y., & Rotem, R. S. (2022) · Autism Research · doi:10.1002/aur.2869 · Cited by 22
“The prevalence of autism spectrum disorder (ASD) has increased dramatically over the last three decades and reached more than 1% worldwide (Zeidan et al., 2022) and more than 2% in the United States (Maenner et al., 2021).”
BackgroundPersonal victimization experiences of autistic and non-autistic children
Libster, N., Knox, A., Engin, S., Geschwind, D. H., Parish‐Morris, J., & Kasari, C. L. (2022) · Molecular Autism · doi:10.1186/s13229-022-00531-4 · Cited by 28
Cary, E. L., Pacheco, D., Kaplan‐Kahn, E. A., McKernan, E. P., Matsuba, E. S. M., Prieve, B. A., & Russo, N. N. (2023) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-022-05866-8 · Cited by 26
“…behav - ioral challenges (e.g., children putting their hands over their Autism 1 is a neurodevelopmental disorder that affects 1 in 44 children (Maenner, 2021) and is characterized by persistent deficits in social communication and interaction, and the presence of restricted, repetitive…”
Prenatal Sex Hormone Exposure Is Associated with the Development of Autism Spectrum Disorder
Li, M., Usui, N., & Shimada, S. (2023) · International Journal of Molecular Sciences · doi:10.3390/ijms24032203 · Cited by 24
“ASD development and sex differences in ASD and ASD-like behaviors The prevalence and characteristics of ASD Children aged 8 years in 2018 whose parents or guardians lived in 11 ADDM Network sites in the United States The overall ASD prevalence estimate was one in 44 children aged 8 years in 2018 [7]”
Classification of Autism Spectrum Disorder Using rs-fMRI data and Graph Convolutional Networks
Yang, T., Alduailij, M. A., Bozdag, S., & Saeed, F. (2022) · IEEE International Conference on Big Data (BigData) · doi:10.1109/bigdata55660.2022.10021070 · Cited by 19
“…the early interventional measures such as applied behavioral analysis (ABA) – in addition to being satisfactory to parents, and medical staff alike – more optimistically, can and does, modify the ASD patterns to improve the health, level of functioning and well-being of the children [10], [11].”
BackgroundKim, D. H. J., Iosif, A.-M., Ramirez-Celis, A., Ashwood, P., Ames, J., Lyall, K., Berger, K., Croen, L., & van de Water, J. A. (2023) · Brain, behavior, and immunity · doi:10.1016/j.bbi.2023.05.002 · Cited by 14
“Autism spectrum disorder (ASD) is a complex neurodevelopmental disorder with a 4:1 male-to-female ratio (Maenner, 2021; Werling and Geschwind, 2013).”
Preeclampsia promotes autism in offspring via maternal inflammation and fetal NFκB signaling
Liu, X., Liu, H., Gu, N.-H., Pei, J., Lin, X.-H., & Zhao, W. (2023) · Life Science Alliance · doi:10.26508/lsa.202301957 · Cited by 19
“increasing each year, with rates reaching ~1 in 44 children in the US (3, 5).”
BackgroundIwamoto, B. K., Neece, C. L., Nair, A., Rockwood, N., Fenning, R. M., Krantz, M. L., & Dyk, T. R. V. (2023) · Research in Autism · doi:10.1016/j.rasd.2023.102197 · Cited by 19
Gentilini, D., Cavagnola, R., Possenti, I., Calzari, L., Ranucci, F., Nola, M., Olivola, M., Brondino, N., & Politi, P. (2023) · Current Neuropharmacology · doi:10.2174/1570159x21666230725142338 · Cited by 21
Faruk, M. O., Rahman, M. S., Rana, M. S., Mahmud, S., Neyma, M. A., Karim, M. S., & Alam, N. (2023) · PLoS ONE · doi:10.1371/journal.pone.0289220 · Cited by 21
“in 44 youngsters has an ASD diagnosis, and all socioeconomic, racial, and ethnic groups can be affected by this disorder [6].”
BackgroundHassen, I. B., Abid, R., Waer, F. B., Masmoudi, L., Sahli, S., Driss, T., & Hammouda, O. (2023) · Children · doi:10.3390/children10091480 · Cited by 19
“In 2020, the Centers for Disease Control and Prevention reported that approximately 1 in 54 children is diagnosed with ASD, according to 2016 data based on tracking within 11 communities in the United States [2].”
BackgroundIuzzini-Seigel, J., Delaney, A. L., & Kent, R. D. (2022) · Perspectives of the ASHA Special Interest Groups · doi:10.1044/2021_persp-20-00283 · Cited by 19
Xie, X., Lei, X., Xiao, C.-Y., Li, Y., & Lei, X. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.982696 · Cited by 18
Transparent deep learning to identify autism spectrum disorders (ASD) in EHR using clinical notes
Gondy Leroy, A., Andrews, J., Preece, M., Jaswani, A., Song, H., Galindo, M. K., Rice, S. A., & Rice, S. A. (2024) · Journal of the American Medical Informatics Association · doi:10.1093/jamia/ocae080 · Cited by 21
Self-citationKilmer, M., & Ames, A. J. (2022) · Journal of Pediatric Nursing · doi:10.1016/j.pedn.2022.04.014 · Cited by 19
Prkn knockout mice show autistic-like behaviors and aberrant synapse formation
Huo, Y., Lü, W., Tian, Y., Hou, Q., & Man, H. (2022) · iScience · doi:10.1016/j.isci.2022.104573 · Cited by 19
Chenausky, K. V., Norton, A. C., Tager-Flusberg, H. B., & Gottfried Schlaug, A. (2022) · Annals of the New York Academy of Sciences · doi:10.1111/nyas.14817 · Cited by 19
Amer, Y. S., Alenezi, S., Bashiri, F. A., Alawami, A. H., Alhazmi, A. S., Aladamawi, S. A., Alnemary, F., Alqahtani, Y. J., Buraik, M. W., AlSuwailem, S. S., et al. (2022) · Children · doi:10.3390/children9071050 · Cited by 18
Behavioral Skills Training with Adult Interventionists: a Systematic Review
Smith, S. G., Mattson, S. L., Aguilar, J., Pyle, N., & Higbee, T. S. (2022) · Review Journal of Autism and Developmental Disorders · doi:10.1007/s40489-022-00339-1 · Cited by 18
“I Was Like a Bird Without Wings”: Autistic Women’s Retrospective Experiences in General Schools
Zakai-Mashiach, M. (2022) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-022-05717-6 · Cited by 28
“Autism Spectrum Disorder (ASD) is described as the most prevalent of all neurodevelopmental disorders with one in 44 children estimated to have ASD in the U.S. (Maenner et al., 2021).”
BackgroundSociodemographic Changes and Oral Health Inequities: Dental Workforce Considerations
Inglehart, M. R., Albino, J. E. N., Feine, J. S., & Okunseri, C. E. (2022) · JDR Clinical & Translational Research · doi:10.1177/23800844221116832 · Cited by 18
“…for patients with special health care needs, such as for the 23% of US citizens 12 y and older who experience hearing loss (Goman and Lin 2016), the 1 in 44 children in the United States with autism spectrum disorder diagnoses (Maenner et al. 2021), and the 1 in 9 people aged 65 y and older (11”
BackgroundEcholalia from a transdiagnostic perspective
McFayden, T., Kennison, S., & Bowers, J. M. (2022) · Autism & Developmental Language Impairments · doi:10.1177/23969415221140464 · Cited by 13
“In such cases of atypical or interfering echolalia presentations in early childhood,many clinicians view this behavior as a key indicator of autism spectrum disorder (i.e., autism; Ganos et al., 2012), a neurodevelopmental disorder that affects as many as 1 in 44 individuals (Maenner et al., 2021).”
BackgroundSpicer‐Cain, H., Camilleri, B., Hasson, N., & Botting, N. (2023) · American Journal of Speech-Language Pathology · doi:10.1044/2022_ajslp-22-00040 · Cited by 18
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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