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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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MethodGu, T., Jin, C., Lin, L., Wang, X., Li, X., Jing, J., & Cao, M. (2024) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2024.1363406 · Cited by 7
Pillar Mothers: Perspective on the Adaptation Process of Mothers of Autistic Children
Périard-Larivée, D., Godbout, E., Bégin, J., St-Laurent, D., de Serres-Lafontaine, A., Pauw, S. S. W. D., & Bussières, È. (2024) · Journal of Child and Family Studies · doi:10.1007/s10826-024-02863-6 · Cited by 6
“Furthermore, the majority of autistic children have one or more co-occurring dif fi culties (e.g., attention de fi cit, anxiety, learning disabilities, epilepsy, etc.) (Maenner et al., 2021; Public Health Agency of Canada, 2021).”
Bhat, A. N. (2024) · Autism Research · doi:10.1002/aur.3189 · Cited by 5
“Autism spectrum disorder (ASD) is one the most prevalent developmental disorders with 1 in every 36 children in the US having an ASD diagnosis (Maenner et al., 2021).”
Omelańczuk, I., & Pisula, E. (2024) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-024-06517-w · Cited by 5
Casseus, M., Shoval, H. A., Erasmus, A. J., & Cheng, J. (2024) · Research in Autism · doi:10.1016/j.rasd.2024.102490 · Cited by 5
Parental Perceptions of Community and Professional Attitudes Toward Autism
Thayer, N. M., Marsack‐Topolewski, C. N., & Wilson, K. P. (2024) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-024-06554-5 · Cited by 5
Tian, Y., Qiao, H., Odamah, K., Zhu, L., & Man, H. (2025) · iScience · doi:10.1016/j.isci.2025.111868 · Cited by 6
Discovery of eQTL Alleles Associated with Autism Spectrum Disorder: A Case–Control Study
Hickman, A. R., Selee, B., Pauly, R., Husain, B., Hang, Y., & Feltus, F. A. (2022) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-022-05631-x · Cited by 5
Mobile and online consumer tools to screen for autism do not promote equity
Sanders, B., Bedrick, S. D., Broder‐Fingert, S., Brown, S. A., Dolata, J. K., Fombonne, E. J., Reeder, J. A., Vazquez, L. A. R., Fuchu, P., Morales, Y., et al. (2022) · Autism · doi:10.1177/13623613221114280 · Cited by 5
“Autism spectrum disorder (ASD) affects one in 44 children (Maenner et al., 2021) and early treatment can be very effective.”
BackgroundAn Intelligent Hybrid Ensemble Gene Selection Model for Autism Using DNN
Anurekha, G., & Geetha, P. (2022) · Intelligent Automation & Soft Computing · doi:10.32604/iasc.2023.029127 · Cited by 5
“The prevalence of the disease is increasing worldwide, and the estimated probability of occurrence in the United States is one in 44 children [2].”
BackgroundYang, S., Han, D., Zhou, H., Chen, Y., Zhang, K., Chen, S., Yang, R., Cao, X., Grodberg, D., Zhao, X., et al. (2022) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-022-05730-9 · Cited by 5
“…Autism and Developmental Disabilities Monitoring (ADDM) Network, the identified prevalence increased from 1 in 150 children in 2000 to 1 in 44 children in 2018 (https:// www. cdc. gov/ ncbddd/ autism/ data) (Maenner et al., 2021), which may represent a trend of increasing ASD prevalence globally.”
BackgroundEpidemiology of ASD in Preschool-age Children in Japan
Saito, M., Sakamoto, Y., & Terui, A. (2022) · IntechOpen eBooks · doi:10.5772/intechopen.108674 · Cited by 5
Dauchez, T., Camelot, G., Levy, C., Rajerison, T. A., Briot, K., Pizano, A., Geoffray, M., Landrieu, L., Bouvard, M. P., & Amestoy, A. (2022) · Children · doi:10.3390/children9121886 · Cited by 5
“3% [6] and a male-to-female ratio of approximately 3:1 [7].”
BackgroundEom, H., Kim, M., Yoo, J. K., Bae, E., Yi, J., & Lee, J. Y. (2022) · Annals of Child Neurology · doi:10.26815/acn.2022.00360 · Cited by 6
“…in ASD prevalence were monitored for many years, there was a slight difference in overall ASD prevalence in America among races, which were defined as including White (non-Hispanic) and Black (non-Hispanic), Hispanic, Asian/Pacific Islanders, and American Indian/Alaska Native children [14].”
AutoENP: An Auto Rating Pipeline for Expressing Needs via Pointing Protocol
Chen, B., Ren, W., Liu, H., Li, H., Xu, X., Zhou, B., & Xu, Q. (2022) · Proceedings - International Conference on Pattern Recognition/Proceedings/International Conference on Pattern Recognition · doi:10.1109/icpr56361.2022.9956342 · Cited by 5
“According to the CDC’s report in 2021 [1], one in every 44 8-year-old children has ASD in America.”
MethodEn Route to Co-designing Inclusive Play With and For Autistic Children
Hijab, M. H. F., & Al‐Thani, D. (2022) · International Conference on Behavioral, Economic, and Socio-Cultural Computing · doi:10.1109/besc57393.2022.9995240 · Cited by 5
“The prevalence of autistic individuals is recently growing; in 2018, approximately 1 in 44 children in the United States were diagnosed with autism[4].”
BackgroundBefi, M., Bemmel, V., Samelson, D., Sneed, L., & Hoobing, J. (2023) · The Family Journal · doi:10.1177/10664807231157025 · Cited by 5
“This often-complicated journey has been found to be difficult and stressful for many families (Bravo-Benítez et al., 2019; Gentles et al., 2020; Heiman, 2021; Makino et al., 2021).”
BackgroundInfluentialIdentifying activity level related movement features of children with ASD based on ADOS videos
Jin, X., Zhu, H., Cao, W., Zou, X., & Chen, J. (2023) · Scientific Reports · doi:10.1038/s41598-023-30628-6 · Cited by 7
The influence of Spanish language on autism spectrum disorder screening: a systematic review
Morgan, C. H., Abdul-Chani, M. M., Sherrod, G., King, K. P., & Guest, K. C. (2023) · International Journal of Developmental Disabilities · doi:10.1080/20473869.2023.2193490 · Cited by 5
“ASD has a prevalence rate of 1 in 44 children, and prevalence is similar across racial and ethnic groups (Maenner et al. 2021).”
Autism Spectrum Disorder in Two Unrelated Patients with Homozygous Variants in Either ALG8 or ALG11
Uzunyayla‐Inci, G., Kıykım, E., Zübarioğlu, T., Yeşil, G., & Zeybek, A. Ç. A. (2023) · Molecular Syndromology · doi:10.1159/000530118 · Cited by 5
Resting-state EEG patterns of preschool-aged boys with autism spectrum disorder: A pilot study
Zhao, Q., Luo, Y., Mei, X., & Shao, Z. (2023) · Applied Neuropsychology Child · doi:10.1080/21622965.2023.2211702 · Cited by 6
“The rising prevalence of the disorder has brought tremendous pressure on affected families and society (Maenner et al., 2021).”
Akman, Ö. A., & Esnafoğlu, E. (2023) · International Journal of Developmental Disabilities · doi:10.1080/20473869.2023.2213923 · Cited by 5
Xiao, Q., Xu, H., Chu, Z., Feng, Q., & Zhang, Y. (2023) · IEEE Transactions on Biomedical Engineering · doi:10.1109/tbme.2023.3294223 · Cited by 5
“According to the report [2], about one in 44 children aged eight years were living with ASD in 2018, which is higher than their previous estimates.”
ResultSacrey, L.-A. R., Zwaigenbaum, L., Elshamy, Y., Smith, I. M., Brian, J. A., & Wass, S. V. (2023) · Autism Research · doi:10.1002/aur.2983 · Cited by 6
“Autism spectrum disorder (ASD) is a neurodevelopmental condition that is diagnosed in roughly 1 in 44 children (Maenner et al., 2021) and manifests as differences in social communication and the presence of patterns of restricted repetitive interests and/or behavior (American Psychiatric…”
BackgroundYoung, K., Harris, B., Hall‐Lande, J., & Esler, A. (2023) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-023-06059-7 · Cited by 7
“…for Disease Control and Pre-vention’s [CDC] Autism Developmental Disabilities Monitoring [ADDM] network reveal shifting demographic trends in autism identification suggesting racial/ethnic differences in autism prevalence have decreased over the past few years (Maenner et al., 2020, 2021, 2023).”
Self-citationAutism Spectrum Disorder in Children With Perinatal Ischemic Stroke Varies by Stroke Type
Wu, C., Zhang, B., Trenor, C. C., Rivkin, M. J., Danehy, A. R., & Lehman, L. L. (2023) · Journal of Child Neurology · doi:10.1177/08830738231188395 · Cited by 5
“We found an approximately 3-fold higher prevalence of autism spectrum disorder in our perinatal ischemic stroke population compared to the general US population, consistent with a Swedish National Registry.15 Among our cohort of children with perinatal ischemic stroke, the average age at autism spectrum disorder diagn…”
BackgroundResultInfluentialConnective differences between patients with depression with and without ASD: A case-control study
Kaneko, T., Nakamura, T., Ryokawa, A., Washizuka, S., Kitoh, Y., & Fujinaga, Y. (2023) · PLoS ONE · doi:10.1371/journal.pone.0289735 · Cited by 5
Chihuri, S., Blanchard, A., DiGuiseppi, C. G., & Li, G. (2024) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-023-06091-7 · Cited by 5
“On average, children are diagnosed with ASD around age 4 to 5 years even though ASD can be accurately diagnosed at 24 months (Maenner et al., 2021 ; McNally Keehn et al., 2020) Later diagnosis, particularly among minority, low income, and rural children (McNally Keehn et al., 2020), may result in…”
Autism spectrum disorder and Coffin–Siris syndrome—Case report
Milutinovic, L., Grujičić, R., Mandić-Maravić, V., Joksić, I., Ljubomirovic, N., & Pejovic-Milovancevic, M. M. (2023) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2023.1199710 · Cited by 5
“In 2018, one in 44 children aged 8 years was estimated to have ASD (1).”
BackgroundRispoli, M. J., Richards, C. D., Borosh, A. M., Shannon, E. N., & Mason, R. (2023) · Journal of Behavioral Education · doi:10.1007/s10864-023-09527-3 · Cited by 5
Novianto, A., & Anasanti, M. D. (2023) · IJCCS (Indonesian Journal of Computing and Cybernetics Systems) · doi:10.22146/ijccs.83585 · Cited by 5
“ASD has been reported in people of all races, ethnic, and economic and social groups and is more significant than four times as typical in boys than in girls [6].”
BackgroundMethodGoodson, R., Wagner, J. A., Sandritter, T. L., Staggs, V. S., Soden, S. E., & Nadler, C. B. (2023) · Journal of Developmental & Behavioral Pediatrics · doi:10.1097/dbp.0000000000001215 · Cited by 5
Elangovan, P., Ramasamy, G., Sundaram, M., & Ramasamy, M. (2023) · Cureus · doi:10.7759/cureus.47128 · Cited by 5
“Furthermore, it was observed that ASD was notably more prevalent among boys, with a rate 4.2 times higher compared to girls [2].”
ResultInfluentialBarzotto, M. B. M., Gonçalves, M. M. D. Q., Bueno, F. G., Virtuoso, S., & Sanches, A. C. C. (2023) · Cuadernos de Educación y Desarrollo · doi:10.55905/cuadv15n12-112 · Cited by 7
Early autism diagnosis based on path signature and Siamese unsupervised feature compressor
Yin, Z., Ding, X., Zhang, X., Wu, Z., Wang, L., Xu, X., & Li, G. (2024) · Cerebral Cortex · doi:10.1093/cercor/bhae069 · Cited by 8
Mohammadi, A., Ghazavi, Z., & Moghadam, M. F. (2024) · Iranian Journal of Nursing and Midwifery Research · doi:10.4103/ijnmr.ijnmr_20_22 · Cited by 5
Hsiao, M., Chien, Y., Tai, Y., Chen, H., Shih, H.-H., Chen, L., Chen, Y., Soong, W., Chiu, Y., Tsai, W., et al. (2024) · Autism Research · doi:10.1002/aur.3213 · Cited by 7
“%) neurodevelopmental disorder characterized by social communication and interaction impairments and the presence of restricted/repetitive behavior and interests (APA, 2013; Chen et al., 2019; Maenner et al., 2021; Zeidan et al., 2022).”
Simcoe, K., Stainbrook, J. A., Chazin, K. T., Schnelle, E., Wagner, L., Hooper, M. A., Juárez, A. O. R., & Warren, Z. E. (2024) · Autism · doi:10.1177/13623613241273081 · Cited by 5
Self-citationBurkett, K., Brown, C. L., Pickler, R. H., Stanton‐Chapman, T. L., Sharps, P. W., Jacquez, F., Smith, T. C., Holland, A., Heeman, A., & Froehlich, T. E. (2024) · Journal of Developmental & Behavioral Pediatrics · doi:10.1097/dbp.0000000000001327 · Cited by 5
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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