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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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“Accepted for publication June 9, 2022 Rates of autism spectrum disorder (ASD) have increased exponentially over the last 20 years, from 1 in 150 in 20001 to current estimates of 1 in 44 children in the United States.2 In addition to core deficits in socialcommunication and restricted repetitive behaviors,3 many childr…”
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BackgroundInfluentialMicroglial involvement in autism spectrum disorder: insights from human data and iPSC models
Michels, S., Mali, A. S., Jäntti, H., Rezaie, M., & Malm, T. (2025) · Brain Behavior and Immunity · doi:10.1016/j.bbi.2025.106071 · Cited by 16
Sohl, K., Kilian, R., Curran, A. B., Mahurin, M. A., Nanclares-Nogués, V., Liu-Mayo, S., Salomon, C., Shannon, J., & Taraman, S. (2022) · JMIR Research Protocols · doi:10.2196/37576 · Cited by 21
“Despite well-documented bottlenecks in ASD diagnosis and treatment initiation in the United States [11,45], to date, very few diagnostic tools have been designed to enhance primary care diagnostic capacity.”
BackgroundInfluentialGarcía-Zambrano, S., Orozco-Barrios, L. G., & Jacobs, E. (2022) · Research in Autism · doi:10.1016/j.rasd.2022.102045 · Cited by 17
Matsuba, E. S. M., Prieve, B. A., Cary, E. L., Pacheco, D., Madrid, A. M., McKernan, E. P., Kaplan‐Kahn, E. A., & Russo, N. N. (2022) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-022-05773-y · Cited by 16
“Further, because autism is a low incidence disorder (Maenner, 2018), sample sizes tend to be small and restricted to a subsection of autistic individuals (i.e., those with higher IQs and fewer support needs).”
Soyer‐Gobillard, M., Gaspari, L., Courtet, P., & Sultan, C. (2022) · Frontiers in Endocrinology · doi:10.3389/fendo.2022.1034959 · Cited by 15
“(12), support the hypothesis formulated by Kim Strifert (55, 56) on the link between oral contraceptives and higher ASD risk in children (in 2015, 1 in 68 (56) vs in 2018, 1 in 44 children (57) were diagnosed with ASD in the USA.”
BackgroundLocke, J. J., Hernandez, A. M., Joshi, M., Hugh, M. L., Bravo, A., Osuna, A., & Pullmann, M. D. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.961219 · Cited by 15
“One in 44 youth in the United States has autism spectrum disorder [ASD; (1)].”
BackgroundMethodInfluentialThe impact of autism spectrum disorder on parent employment: Results from the r‐Kids study
Lynch, F. L., Bulkley, J. E., Varga, A. M., Crawford, P. M., Croen, L., Daida, Y. G., Fombonne, E. J., Hatch, B., Massolo, M. L., & Dickerson, J. F. (2022) · Autism Research · doi:10.1002/aur.2882 · Cited by 16
“2023;16:642–652.wileyonlinelibrary.com/journal/aur ASD in the USA (Maenner et al., 2021).”
Druitt, F., Smith, D., Spaaij, R., Kernot, D., & Laver, A. (2023) · Journal of Policing Intelligence and Counter Terrorism · doi:10.1080/18335330.2022.2158361 · Cited by 15
“…reports that comorbidities are common in ASD and can include ‘schizophrenia (25%), depression (12.5%), and attention-deficit disorder (18.75%)’ (p. 25) (see also Chown, Beardon, & Cossburn, 2018, p. 59; Inderberg et al., 2019, p. 1; Maenner et al., 2021, p. 1; Murphy, 2010, © 2023 The Author(s).”
InfluentialLin, X., Su, X., Huang, S., Liu, Z., Yu, H. Y., Wang, X., Lin, L., Cao, M., Li, X., & Jin, J. (2023) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2023.1107719 · Cited by 20
“Currently, ASD affects 1 in 44 children in the United States (2).”
BackgroundResultLee, C.-M., Snyder, L. G., Carpenter, L. A., Harris, J. F., Kanne, S. M., Taylor, C. M., Sarver, D. E., Stephenson, K. G., Shulman, L. H., Wodka, E. L., et al. (2023) · Autism Research · doi:10.1002/aur.2934 · Cited by 15
“Initiated in 2015, SPARK involves collaboration among 31 university-affiliated research clinics in 26 states across the United States.”
BackgroundInfluentialSelf-citationA Practice Pathway for the Treatment of Night Wakings in Children with Autism Spectrum Disorder
Galion, A. W., Farmer, J. G., Connolly, H. V., Allhusen, V. D., Bennett, A., Coury, D. L., Lam, J., Neumeyer, A. M., Sohl, K., Witmans, M., et al. (2024) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-023-06026-2 · Cited by 15
“Approximately 1 in 44 children have autism spectrum disorder (ASD), defined by diagnostic criteria that include deficits in social communication and social interaction, and restricted or repetitive patterns of behavior, interests, or activities (Maenner et al., 2021).”
BackgroundThe prevalence and developmental course of auditory processing differences in autistic children
Lau, B. K., Emmons, K. A., Lee, A. K. C., MUNSON, J. A., Dager, S. R., & Estes, A. M. (2023) · Autism Research · doi:10.1002/aur.2961 · Cited by 15
Current trends of high-risk gene Cul3 in neurodevelopmental disorders
Lin, P., Yang, J., Wu, S., Ye, T., Zhuang, W., Wang, W., & Tan, T. (2023) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2023.1215110 · Cited by 14
Dietary Factors Impact Developmental Trajectories in Young Autistic Children
Acosta, A., Khokhlovich, E., Reis, H. I. D. S., & Vyshedskiy, A. (2023) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-023-06074-8 · Cited by 15
Tamayo, J. M., Osman, H. C., Schwartzer, J. J., Pinkerton, K. E., & Ashwood, P. (2023) · Journal of Neuroinflammation · doi:10.1186/s12974-023-02930-7 · Cited by 15
Neuronal knockdown of Cullin3 as a Drosophila model of autism spectrum disorder
Tener, S. J., Lin, Z., Park, S. J., Oraedu, K., Ulgherait, M., van Beek, E., Martínez-Muñiz, A., Pantalia, M., Gatto, J. A., Volpi, J., et al. (2024) · Scientific Reports · doi:10.1038/s41598-024-51657-9 · Cited by 14
Transcranial photobiomodulation for neurodevelopmental disorders: a narrative review
Coelho, D. R. A., Renet, C., López-Rodríguez, S., Cassano, P., & Vieira, W. F. (2024) · Photochemical & Photobiological Sciences · doi:10.1007/s43630-024-00613-7 · Cited by 16
Kuodza, G. E., Kawai, R., & LaSalle, J. M. (2024) · Current Zoology · doi:10.1093/eep/dvae023 · Cited by 15
Uncertainty Inspired Early Autism Spectrum Disorder Screening via Contrastive Image-Viewing Paradigm
Zhang, Y., Huang, Y., Qi, J., Zhang, S., Tian, M., Tian, Y., Meng, F., Guan, L., & Chang, T.-H. (2024) · IEEE Transactions on Neural Systems and Rehabilitation Engineering · doi:10.1109/tnsre.2024.3518693 · Cited by 16
“According to the latest report by the Autism and Developmental Disabilities Monitoring (ADDM) Networks across the United States, the overall ASD prevalence has increased from 23 per 1,000 in 2018 [25] all the way up to 27.6 per 1,000 in 2020 [24].”
InfluentialAutism spectrum disorder in the fragile X premutation state: possible mechanisms and implications
Aishworiya, R., Protic, D. D., & Hagerman, R. J. (2022) · Journal of Neurology · doi:10.1007/s00415-022-11209-5 · Cited by 15
Trowbridge, J., Goin, D. E., Abrahamsson, D., Sklar, R. S., & Woodruff, T. J. (2022) · International Journal of Gynecology & Obstetrics · doi:10.1002/ijgo.14408 · Cited by 16
Feldman, J. I., Garla, V., Dunham, K., Markfeld, J. E., Bowman, S. M., Golden, A. J., Daly, C., Kaiser, S., Mailapur, N., Raj, S. V., et al. (2022) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-022-05817-3 · Cited by 20
“Autism is a neurodevelopmental condition that affects approximately two million people in the United States and tens of millions of people worldwide (Baio et al., 2018; Maenner et al., 2021).”
Natraj, S., Kojovic, N., Maillart, T., & Schaer, M. (2024) · PLoS ONE · doi:10.1371/journal.pone.0308388 · Cited by 14
Río, J. P. D., Tsompanidis, A., Gaspar, P. A., Maturana, A., Rojas, G., Dagnino‐Subiabre, A., Olea, A., Maliqueo, M. A., Echiburú, B., de Guevara, A. L., et al. (2025) · Frontiers in Neuroendocrinology · doi:10.1016/j.yfrne.2025.101188 · Cited by 15
Good business: creating an autism-friendly community using the SERVICE principles
Garner, A., Burns, P., Carolan, L., Price, T., & Pearson, Z. (2022) · Disability & Society · doi:10.1080/09687599.2022.2077174 · Cited by 20
“With the estimated prevalence of autism in Australia to be one in 70 people (May et al. 2017), one in 44 people in the US (Maenner et al. 2021) and one in 100 people in the UK (BMA 2020), an exploration of ways to decrease barriers and improve access and inclusivity within communities is not only…”
BackgroundFujishiro, S., Tsuji, S., Akagawa, S., Akagawa, Y., Yamanouchi, S., Ishizaki, Y., Hashiyada, M., Akane, A., & Kaneko, K. (2022) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-022-05682-0 · Cited by 14
Wang, T., Feng, J., Yang, X., Shan, L., Jia, F., & Yue, X. (2022) · Frontiers in Pediatrics · doi:10.3389/fped.2022.860947 · Cited by 20
“%) had moderate ASD, 9 children (11”
BackgroundMethodResultInfluentialQi, X., Yang, T., Chen, J., Dai, Y., Chen, L., Wu, L., Hao, Y., Li, L., Zhang, J., Ke, X., et al. (2022) · Psychiatry Research · doi:10.1016/j.psychres.2022.114807 · Cited by 14
Pickard, K. E., Wainer, A., Broder‐Fingert, S., Sheldrick, R. C., & Stahmer, A. C. (2022) · Autism · doi:10.1177/13623613221133641 · Cited by 14
“Thus, the EI system serves as an entry point to services and a delivery context for first-line interventions during a critical window of early development and often prior to children receiving a medical diagnosis of autism spectrum disorder (Maenner et al., 2021).”
BackgroundGuo, X., Cao, Y., Liu, J., Zhang, X., Zhai, G., Chen, H., & Gao, L. (2022) · Cerebral Cortex · doi:10.1093/cercor/bhac454 · Cited by 14
Oxidative stress and neuroimmune proteins in a mouse model of autism
Uddin, M. N., Mondal, T. K., Yao, Y., MANLEY, K. M., & Lawrence, D. A. (2023) · Cell Stress and Chaperones · doi:10.1007/s12192-023-01331-2 · Cited by 17
Bhat, R. S., Alonazi, M. A., Al-Daihan, S., & El-Ansary, A. K. (2023) · Metabolites · doi:10.3390/metabo13020310 · Cited by 14
“Recently, in the US, the Centers for Disease Control and Prevention (CDC) and Autism and Developmental Disabilities Monitoring (ADDM) Network reported that 1 in 44 children is autistic [25].”
BackgroundFreire, J. M. D. S., & Nogueira, G. S. (2023) · Revista Foco · doi:10.54751/revistafoco.v16n3-009 · Cited by 14
Lan, X.-Y., Gu, Y., Li, M., Song, T.-J., Zhai, F.-J., Zhang, Y., Zhan, J., Böckers, T. M., Yue, X.-N., Wang, J., et al. (2023) · Frontiers in Cell and Developmental Biology · doi:10.3389/fcell.2023.1054381 · Cited by 16
Hantman, R. M., Choi, B., Hartwick, K., Nadler, Z., & Luk, G. (2023) · Frontiers in Psychology · doi:10.3389/fpsyg.2023.1095164 · Cited by 14
“Prevalence of ASD varies, as reported in the literature, estimated to be 1–2% worldwide (Elsabbagh et al., 2012; Baxter et al., 2015) and 2.3% in the United States (Maenner, 2021).”
BackgroundInfluentialAutism diagnosis in females by eating disorder professionals
Parsons, M. A. (2023) · Journal of Eating Disorders · doi:10.1186/s40337-023-00785-0 · Cited by 14
Contemplating syndromic autism
Vorstman, J. A. S., & Scherer, S. W. (2023) · Genetics in Medicine · doi:10.1016/j.gim.2023.100919 · Cited by 17
Wall, D. P., Liu-Mayo, S., Salomon, C., Shannon, J., & Taraman, S. (2023) · Intelligence-Based Medicine · doi:10.1016/j.ibmed.2023.100102 · Cited by 14
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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