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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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Achuthan, S. K., Stavrinos, D., Bednarz, H. M., Anteraper, S. A., & Kana, R. K. (2023) · Brain Connectivity · doi:10.1089/brain.2023.0006 · Cited by 8
“According to the National Survey of Children’s Health 2018–2019, 8.7% of children in the United States are diagnosed with ADHD (Bozinovic et al., 2021).”
InfluentialRusu, A., Chevalier, C., de Chaumont, F., Nalesso, V., Brault, V., Hérault, Y., & Ey, E. (2023) · Frontiers in Behavioral Neuroscience · doi:10.3389/fnbeh.2023.1294558 · Cited by 14
Autism spectrum disorder: Practice guidelines for pharmacists
Kadi, R., Gayed, F., Kauzman, P., Ali, Z. A., Dmitriev, I., Mikhael, V., Ghabi, R., Hamamji, J., Jabbour, S., Mrchak, M., et al. (2024) · Canadian Pharmacists Journal / Revue des Pharmaciens du Canada · doi:10.1177/17151635241228495 · Cited by 9
Li, Y., Tan, Z.-N., Li, X., Ma, B., Adu‐Nti, F., Lv, X.-Q., Tian, Z., Yan, R., Man, H., & Ma, X. (2024) · Molecular Psychiatry · doi:10.1038/s41380-024-02515-7 · Cited by 8
“%) of 8-year-old children in the United States have been diagnosed with ASDs [3, 4].”
BackgroundBritsch, E. R., & Iverson, J. M. (2024) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-024-06331-4 · Cited by 9
Strang, J. F., Fischbach, A. L., Rao, S., Clawson, A., Knauss, M., Bernstein, S. N., van der Miesen, A. I. R., Inge, A. P., Alonzo, K., Zeroth, J. A., et al. (2024) · The Clinical Neuropsychologist · doi:10.1080/13854046.2024.2318155 · Cited by 8
“A recent meta-analysis of available studies estimated the rate of autism spectrum disorder (ASD) diagnoses in gender-diverse people at 11% (Kallitsounaki & Williams, 2022); autism prevalence in the general population is estimated to be 2.78% (Maenner et al., 2021).”
InfluentialSeeing beyond words: Visualizing autism spectrum disorder biomarker insights
Xie, X., Zhou, R., Fang, Z., Zhang, Y., Wang, Q., & Liu, X. (2024) · Heliyon · doi:10.1016/j.heliyon.2024.e30420 · Cited by 9
Wah, Y. B., Nasir, N. N. M., Hadrawi, M. F., Kamaruddin, A. A., Jannoo, Z., & Afthanorhan, A. (2024) · Belitung Nursing Journal · doi:10.33546/bnj.3096 · Cited by 8
“According to reports, there are approximately four boys for every girl who has been diagnosed with autism (Fombonne, 2009; Maenner, 2021).”
Buro, A. W., Salinas‐Miranda, A., Marshall, J. T., Gray, H. L., & Kirby, R. S. (2022) · Research in Autism · doi:10.1016/j.rasd.2022.101927 · Cited by 11
Zhang, Q., Li, Q., Yang, T., Chen, L., Dai, Y., Wei, H., Wang, K., Jia, F., Wu, L., Hao, Y., et al. (2022) · BMC Psychiatry · doi:10.1186/s12888-022-04028-5 · Cited by 8
“3% in 8-year-old children in 2018 [2].”
BackgroundInfluentialLarsen, A., Schieltz, K. M., Barrett, A., & O’Brien, M. J. (2022) · Behavior Modification · doi:10.1177/01454455221106127 · Cited by 8
“During the COVID-19 pandemic, the use of telehealth skyrocketed across many health specialties (Demeke et al., 2021), including behavioral and psychological services (Pierce et al., 2021).”
BackgroundQureshi, F. A., & Hahn, J. (2022) · The Canadian Journal of Chemical Engineering · doi:10.1002/cjce.24594 · Cited by 8
A longitudinal study of cytochrome P450 2D6 (CYP2D6) activity during adolescence
Leeder, J. S., Gaedigk, A., Wright, K. J., Staggs, V. S., Soden, S. E., Lin, Y. S., & Pearce, R. E. (2022) · Clinical and Translational Science · doi:10.1111/cts.13380 · Cited by 8
“To choose a covariance structure, the model was fit three times: once with a random patient intercept and first- order autoregressive (AR (1)) structure specified, once with a random patient intercept and random patient age slope, and once with a random patient intercept, random patient slope, and AR (1) structure spe…”
MethodPurushotham, S. S., Reddy, N. M. N., D’Souza, M. N., Choudhury, N. R., Ganguly, A., Gopalakrishna, N., Muddashetty, R. S., & Clement, J. P. (2022) · Experimental Brain Research · doi:10.1007/s00221-022-06448-x · Cited by 8
“alone from 1 in 68 (2012) to 1 in 44 (2018) (Maenner et al. 2021) thereby projecting an increase in the economic costs of $461 billion by 2025, emphasizing the dire need to come up with more-effective interventions and support across the life span of an ASD/ID patients (Leigh and Du 2015).”
BackgroundSwimming exercise is a promising early intervention for autism‐like behavior in Shank3 deletion rats
Xu, D., Meng, Y., An, S., Meng, W., Li, H., Zhang, W., Xue, Y., Lan, X., Wang, X., Li, M., et al. (2022) · CNS Neuroscience & Therapeutics · doi:10.1111/cns.13920 · Cited by 8
How are games for autistic children being evaluated?
de Carvalho, A. P., Braz, C. S., & Prates, R. O. (2022) · Brazilian Symposium on Human Factors in Computing Systems (IHC) · doi:10.1145/3554364.3559127 · Cited by 8
Kim, Y., Kim, M.-K., Park, C., & You, J. H. (2022) · Children · doi:10.3390/children9121971 · Cited by 8
“Autism spectrum disorder (ASD) presents with multiple domains of functional and structural impairments, physical activity limitations, and associated social participation and integration restrictions, affecting 1 in 44 children in the United States [1].”
BackgroundMorphometric analysis of Corpus Callosum in autistic and typically developing Indian children
Berkins, S., Koshy, B., Livingstone, R. S., Jasper, A., Grace, H., Ravibabu, P., & Rai, E. (2022) · Psychiatry Research Neuroimaging · doi:10.1016/j.pscychresns.2022.111580 · Cited by 8
Statewide county-level autism spectrum disorder prevalence estimates—seven U.S. states, 2018
Shaw, K. A., Williams, S., Hughes, M. M., Warren, Z. E., Bakian, A. V., Durkin, M. S., Esler, A., Hall‐Lande, J., Salinas, A., Vehorn, A. C., et al. (2023) · Annals of Epidemiology · doi:10.1016/j.annepidem.2023.01.010 · Cited by 8
Self-citationKonstantin, G. E., Nordgaard, J., & Henriksen, M. G. (2023) · Psychological Medicine · doi:10.1017/s0033291723001095 · Cited by 10
Developmentally-Trained Primary Care Clinicians: A Pipeline to Improved Access?
Doss, M., Christiansen, A., O’Hagan, B., Jansen, E. M., & Augustyn, M. C. (2023) · Journal of Developmental & Behavioral Pediatrics · doi:10.1097/dbp.0000000000001178 · Cited by 8
“Earlier diagnosis has been shown to be associated with improved treatment outcomes.(4) Despite this recommendation, the average age of diagnosis varies widely across the United States, ranging from 36 to 63 months.”
BackgroundFurnier, S. M., Gangnon, R. E., Daniels, J. L., Weismer, S. E., Nadler, C. B., Pazol, K., Reyes, N., Rosenberg, S. A., Rubenstein, E., Wiggins, L. D., et al. (2024) · Autism Research · doi:10.1002/aur.3107 · Cited by 11
“…deviations (SD) below the population mean without considering adaptive scores (CDC, 2023; Fombonne, 2003; Fombonne, 2009; Hughes et al., 2023; Maenner et al., 2021; Zeidan et al., 2022), often because adaptive test scores are less likely to be available for review in children ’ s health and…”
BackgroundMethodSelf-citationZhang, H., Hu, S., Qu, S.-T., Lv, M., Wang, J., Liu, X.-T., Yao, J.-H., Ding, Y., & Xu, G. (2024) · Current Issues in Molecular Biology · doi:10.3390/cimb46030121 · Cited by 8
“The current international prevalence is 1 in 44, and there are no effective therapeutic drugs available [7].”
BackgroundMaternal separation induces autism spectrum disorder in young rhesus monkeysPreprint
Ren, X., Wu, S., Zhou, H., Lv, L., Qiu, Z., Feng, X., & Hu, X. (2022) · bioRxiv (Cold Spring Harbor Laboratory) · doi:10.1101/2022.03.17.484827 · Cited by 8
Serving the underserved: How can we reach autism families who systemically miss out on support?
Hoekstra, R. A. (2022) · Autism · doi:10.1177/13623613221105389 · Cited by 12
“…children from the cultural majority (Begeer et al., 2009) and in some contexts autism identification rates in ethnic or racial minority children (Begeer et al., 2009; Maenner et al., 2021) or children from Indigenous backgrounds (Bailey & Arciuli, 2020) lag behind identification in White children.”
BackgroundScreening Success in the Age of Autism
Lipkin, P. H. (2023) · Archives of Pediatrics and Adolescent Medicine · doi:10.1001/jamapediatrics.2022.5972 · Cited by 8
Ismail, N., Isa, K. A. M., & Wan Mokhtar, I. (2022) · Children · doi:10.3390/children9101526 · Cited by 6
“This is well reported by Centres for Disease Control (CDC) in 2018 where most of the children diagnosed with autism spectrum disorder (ASD) are boys, four times more likely than girls [19].”
BackgroundReynoso, M., McLeigh, J. D., Malthaner, L., & Stone, K. E. (2022) · Journal of Developmental & Behavioral Pediatrics · doi:10.1097/dbp.0000000000001126 · Cited by 7
“Being female was associated with decreased odds of having a developmental diagnosis, which is consistent with lower prevalence estimates of ADHD and autism in girls.(25,26) However, this has not previously been reported for children in foster care.”
ResultDetecting Time Concept Competence in Children with Autism Spectrum and Attention Disorders
Hus, Y. (2022) · Neuropsychiatric Disease and Treatment · doi:10.2147/ndt.s331985 · Cited by 7
“The upward prevalence trajectory continues due to improved identification efforts such as supplying parents with digital applications facilitating inputs of their children’s progress, report the Centre for Disease Control (CDC) and its autism monitoring and tracking arm (ADDM).(5,44) Children with ASD face considerabl…”
Background
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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