Early Identification of Autism Spectrum Disorder Among Children Aged 4 Years — Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2018
Autism spectrum disorder (ASD). 2018. The Autism and Developmental Disabilities Monitoring Network is an active surveillance program that estimates ASD prevalence and monitors timing of ASD identification among children aged 4 and 8 years. This report focuses on children aged 4 years in 2018, who we...
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| Veröffentlicht in: | MMWR. Surveillance summaries 2021-12, Vol.70 (10), p.1-14 |
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| creator | Shaw, Kelly A. Maenner, Matthew J. Bakian, Amanda V. Bilder, Deborah A. Durkin, Maureen S. Furnier, Sarah M. Hughes, Michelle M. Patrick, Mary Pierce, Karen Salinas, Angelica Shenouda, Josephine Vehorn, Alison Warren, Zachary Zahorodny, Walter Constantino, John N. DiRienzo, Monica Esler, Amy Fitzgerald, Robert T. Grzybowski, Andrea Hudson, Allison Spivey, Margaret H. Ali, Akilah Andrews, Jennifer G. Baroud, Thaer Gutierrez, Johanna Hallas, Libby Hall-Lande, Jennifer Hewitt, Amy Lee, Li-Ching Lopez, Maya Mancilla, Kristen Clancy McArthur, Dedria Pettygrove, Sydney Poynter, Jenny N. Schwenk, Yvette D. Washington, Anita Williams, Susan Cogswell, Mary E. |
| description | Autism spectrum disorder (ASD).
2018.
The Autism and Developmental Disabilities Monitoring Network is an active surveillance program that estimates ASD prevalence and monitors timing of ASD identification among children aged 4 and 8 years. This report focuses on children aged 4 years in 2018, who were born in 2014 and had a parent or guardian who lived in the surveillance area in one of 11 sites (Arizona, Arkansas, California, Georgia, Maryland, Minnesota, Missouri, New Jersey, Tennessee, Utah, and Wisconsin) at any time during 2018. Children were classified as having ASD if they ever received 1) an ASD diagnostic statement (diagnosis) in an evaluation, 2) a special education classification of ASD (eligibility), or 3) an ASD International Classification of Diseases (ICD) code. Suspected ASD also was tracked among children aged 4 years. Children who did not meet the case definition for ASD were classified as having suspected ASD if their records contained a qualified professional's statement indicating a suspicion of ASD.
For 2018, the overall ASD prevalence was 17.0 per 1,000 (one in 59) children aged 4 years. Prevalence varied from 9.1 per 1,000 in Utah to 41.6 per 1,000 in California. At every site, prevalence was higher among boys than girls, with an overall male-to-female prevalence ratio of 3.4. Prevalence of ASD among children aged 4 years was lower among non-Hispanic White (White) children (12.9 per 1,000) than among non-Hispanic Black (Black) children (16.6 per 1,000), Hispanic children (21.1 per 1,000), and Asian/Pacific Islander (A/PI) children (22.7 per 1,000). Among children aged 4 years with ASD and information on intellectual ability, 52% met the surveillance case definition of co-occurring intellectual disability (intelligence quotient ≤70 or an examiner's statement of intellectual disability documented in an evaluation). Of children aged 4 years with ASD, 72% had a first evaluation at age ≤36 months. Stratified by census-tract-level median household income (MHI) tertile, a lower percentage of children with ASD and intellectual disability was evaluated by age 36 months in the low MHI tertile (72%) than in the high MHI tertile (84%). Cumulative incidence of ASD diagnosis or eligibility received by age 48 months was 1.5 times as high among children aged 4 years (13.6 per 1,000 children born in 2014) as among those aged 8 years (8.9 per 1,000 children born in 2010). Across MHI tertiles, higher cumulative incidence of ASD diagnosis or eligibilit |
| doi_str_mv | 10.15585/mmwr.ss7010a1 |
| format | Article |
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2018.
The Autism and Developmental Disabilities Monitoring Network is an active surveillance program that estimates ASD prevalence and monitors timing of ASD identification among children aged 4 and 8 years. This report focuses on children aged 4 years in 2018, who were born in 2014 and had a parent or guardian who lived in the surveillance area in one of 11 sites (Arizona, Arkansas, California, Georgia, Maryland, Minnesota, Missouri, New Jersey, Tennessee, Utah, and Wisconsin) at any time during 2018. Children were classified as having ASD if they ever received 1) an ASD diagnostic statement (diagnosis) in an evaluation, 2) a special education classification of ASD (eligibility), or 3) an ASD International Classification of Diseases (ICD) code. Suspected ASD also was tracked among children aged 4 years. Children who did not meet the case definition for ASD were classified as having suspected ASD if their records contained a qualified professional's statement indicating a suspicion of ASD.
For 2018, the overall ASD prevalence was 17.0 per 1,000 (one in 59) children aged 4 years. Prevalence varied from 9.1 per 1,000 in Utah to 41.6 per 1,000 in California. At every site, prevalence was higher among boys than girls, with an overall male-to-female prevalence ratio of 3.4. Prevalence of ASD among children aged 4 years was lower among non-Hispanic White (White) children (12.9 per 1,000) than among non-Hispanic Black (Black) children (16.6 per 1,000), Hispanic children (21.1 per 1,000), and Asian/Pacific Islander (A/PI) children (22.7 per 1,000). Among children aged 4 years with ASD and information on intellectual ability, 52% met the surveillance case definition of co-occurring intellectual disability (intelligence quotient ≤70 or an examiner's statement of intellectual disability documented in an evaluation). Of children aged 4 years with ASD, 72% had a first evaluation at age ≤36 months. Stratified by census-tract-level median household income (MHI) tertile, a lower percentage of children with ASD and intellectual disability was evaluated by age 36 months in the low MHI tertile (72%) than in the high MHI tertile (84%). Cumulative incidence of ASD diagnosis or eligibility received by age 48 months was 1.5 times as high among children aged 4 years (13.6 per 1,000 children born in 2014) as among those aged 8 years (8.9 per 1,000 children born in 2010). Across MHI tertiles, higher cumulative incidence of ASD diagnosis or eligibility received by age 48 months was associated with lower MHI. Suspected ASD prevalence was 2.6 per 1,000 children aged 4 years, meaning for every six children with ASD, one child had suspected ASD. The combined prevalence of ASD and suspected ASD (19.7 per 1,000 children aged 4 years) was lower than ASD prevalence among children aged 8 years (23.0 per 1,000 children aged 8 years).
Groups with historically lower prevalence of ASD (non-White and lower MHI) had higher prevalence and cumulative incidence of ASD among children aged 4 years in 2018, suggesting progress in identification among these groups. However, a lower percentage of children with ASD and intellectual disability in the low MHI tertile were evaluated by age 36 months than in the high MHI group, indicating disparity in timely evaluation. Children aged 4 years had a higher cumulative incidence of diagnosis or eligibility by age 48 months compared with children aged 8 years, indicating improvement in early identification of ASD. The overall prevalence for children aged 4 years was less than children aged 8 years, even when prevalence of children suspected of having ASD by age 4 years is included. This finding suggests that many children identified after age 4 years do not have suspected ASD documented by age 48 months.
Children born in 2014 were more likely to be identified with ASD by age 48 months than children born in 2010, indicating increased early identification. However, ASD identification among children aged 4 years varied by site, suggesting opportunities to examine developmental screening and diagnostic practices that promote earlier identification. Children aged 4 years also were more likely to have co-occurring intellectual disability than children aged 8 years, suggesting that improvement in the early identification and evaluation of developmental concerns outside of cognitive impairments is still needed. Improving early identification of ASD could lead to earlier receipt of evidence-based interventions and potentially improve developmental outcomes.</description><identifier>ISSN: 1546-0738</identifier><identifier>ISSN: 1545-8636</identifier><identifier>EISSN: 1545-8636</identifier><identifier>DOI: 10.15585/mmwr.ss7010a1</identifier><identifier>PMID: 34855727</identifier><language>eng</language><publisher>United States: Centers for Disease Control & Prevention (CDC)</publisher><subject>Autism Spectrum Disorder - diagnosis ; Autism Spectrum Disorder - epidemiology ; Child, Preschool ; Early Diagnosis ; Epidemiological Monitoring ; Female ; Humans ; Male ; Population Surveillance ; Surveillance Summaries ; United States - epidemiology</subject><ispartof>MMWR. Surveillance summaries, 2021-12, Vol.70 (10), p.1-14</ispartof><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c478t-53f72e6786f5a6578cd6ceee02d7c26f3c506d84a9fd93b33c72580073d17f1d3</citedby><cites>FETCH-LOGICAL-c478t-53f72e6786f5a6578cd6ceee02d7c26f3c506d84a9fd93b33c72580073d17f1d3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8639027/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8639027/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,881,27901,27902,53766,53768</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34855727$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Shaw, Kelly A.</creatorcontrib><creatorcontrib>Maenner, Matthew J.</creatorcontrib><creatorcontrib>Bakian, Amanda V.</creatorcontrib><creatorcontrib>Bilder, Deborah A.</creatorcontrib><creatorcontrib>Durkin, Maureen S.</creatorcontrib><creatorcontrib>Furnier, Sarah M.</creatorcontrib><creatorcontrib>Hughes, Michelle M.</creatorcontrib><creatorcontrib>Patrick, Mary</creatorcontrib><creatorcontrib>Pierce, Karen</creatorcontrib><creatorcontrib>Salinas, Angelica</creatorcontrib><creatorcontrib>Shenouda, Josephine</creatorcontrib><creatorcontrib>Vehorn, Alison</creatorcontrib><creatorcontrib>Warren, Zachary</creatorcontrib><creatorcontrib>Zahorodny, Walter</creatorcontrib><creatorcontrib>Constantino, John N.</creatorcontrib><creatorcontrib>DiRienzo, Monica</creatorcontrib><creatorcontrib>Esler, Amy</creatorcontrib><creatorcontrib>Fitzgerald, Robert T.</creatorcontrib><creatorcontrib>Grzybowski, Andrea</creatorcontrib><creatorcontrib>Hudson, Allison</creatorcontrib><creatorcontrib>Spivey, Margaret H.</creatorcontrib><creatorcontrib>Ali, Akilah</creatorcontrib><creatorcontrib>Andrews, Jennifer G.</creatorcontrib><creatorcontrib>Baroud, Thaer</creatorcontrib><creatorcontrib>Gutierrez, Johanna</creatorcontrib><creatorcontrib>Hallas, Libby</creatorcontrib><creatorcontrib>Hall-Lande, Jennifer</creatorcontrib><creatorcontrib>Hewitt, Amy</creatorcontrib><creatorcontrib>Lee, Li-Ching</creatorcontrib><creatorcontrib>Lopez, Maya</creatorcontrib><creatorcontrib>Mancilla, Kristen Clancy</creatorcontrib><creatorcontrib>McArthur, Dedria</creatorcontrib><creatorcontrib>Pettygrove, Sydney</creatorcontrib><creatorcontrib>Poynter, Jenny N.</creatorcontrib><creatorcontrib>Schwenk, Yvette D.</creatorcontrib><creatorcontrib>Washington, Anita</creatorcontrib><creatorcontrib>Williams, Susan</creatorcontrib><creatorcontrib>Cogswell, Mary E.</creatorcontrib><title>Early Identification of Autism Spectrum Disorder Among Children Aged 4 Years — Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2018</title><title>MMWR. Surveillance summaries</title><addtitle>MMWR Surveill Summ</addtitle><description>Autism spectrum disorder (ASD).
2018.
The Autism and Developmental Disabilities Monitoring Network is an active surveillance program that estimates ASD prevalence and monitors timing of ASD identification among children aged 4 and 8 years. This report focuses on children aged 4 years in 2018, who were born in 2014 and had a parent or guardian who lived in the surveillance area in one of 11 sites (Arizona, Arkansas, California, Georgia, Maryland, Minnesota, Missouri, New Jersey, Tennessee, Utah, and Wisconsin) at any time during 2018. Children were classified as having ASD if they ever received 1) an ASD diagnostic statement (diagnosis) in an evaluation, 2) a special education classification of ASD (eligibility), or 3) an ASD International Classification of Diseases (ICD) code. Suspected ASD also was tracked among children aged 4 years. Children who did not meet the case definition for ASD were classified as having suspected ASD if their records contained a qualified professional's statement indicating a suspicion of ASD.
For 2018, the overall ASD prevalence was 17.0 per 1,000 (one in 59) children aged 4 years. Prevalence varied from 9.1 per 1,000 in Utah to 41.6 per 1,000 in California. At every site, prevalence was higher among boys than girls, with an overall male-to-female prevalence ratio of 3.4. Prevalence of ASD among children aged 4 years was lower among non-Hispanic White (White) children (12.9 per 1,000) than among non-Hispanic Black (Black) children (16.6 per 1,000), Hispanic children (21.1 per 1,000), and Asian/Pacific Islander (A/PI) children (22.7 per 1,000). Among children aged 4 years with ASD and information on intellectual ability, 52% met the surveillance case definition of co-occurring intellectual disability (intelligence quotient ≤70 or an examiner's statement of intellectual disability documented in an evaluation). Of children aged 4 years with ASD, 72% had a first evaluation at age ≤36 months. Stratified by census-tract-level median household income (MHI) tertile, a lower percentage of children with ASD and intellectual disability was evaluated by age 36 months in the low MHI tertile (72%) than in the high MHI tertile (84%). Cumulative incidence of ASD diagnosis or eligibility received by age 48 months was 1.5 times as high among children aged 4 years (13.6 per 1,000 children born in 2014) as among those aged 8 years (8.9 per 1,000 children born in 2010). Across MHI tertiles, higher cumulative incidence of ASD diagnosis or eligibility received by age 48 months was associated with lower MHI. Suspected ASD prevalence was 2.6 per 1,000 children aged 4 years, meaning for every six children with ASD, one child had suspected ASD. The combined prevalence of ASD and suspected ASD (19.7 per 1,000 children aged 4 years) was lower than ASD prevalence among children aged 8 years (23.0 per 1,000 children aged 8 years).
Groups with historically lower prevalence of ASD (non-White and lower MHI) had higher prevalence and cumulative incidence of ASD among children aged 4 years in 2018, suggesting progress in identification among these groups. However, a lower percentage of children with ASD and intellectual disability in the low MHI tertile were evaluated by age 36 months than in the high MHI group, indicating disparity in timely evaluation. Children aged 4 years had a higher cumulative incidence of diagnosis or eligibility by age 48 months compared with children aged 8 years, indicating improvement in early identification of ASD. The overall prevalence for children aged 4 years was less than children aged 8 years, even when prevalence of children suspected of having ASD by age 4 years is included. This finding suggests that many children identified after age 4 years do not have suspected ASD documented by age 48 months.
Children born in 2014 were more likely to be identified with ASD by age 48 months than children born in 2010, indicating increased early identification. However, ASD identification among children aged 4 years varied by site, suggesting opportunities to examine developmental screening and diagnostic practices that promote earlier identification. Children aged 4 years also were more likely to have co-occurring intellectual disability than children aged 8 years, suggesting that improvement in the early identification and evaluation of developmental concerns outside of cognitive impairments is still needed. Improving early identification of ASD could lead to earlier receipt of evidence-based interventions and potentially improve developmental outcomes.</description><subject>Autism Spectrum Disorder - diagnosis</subject><subject>Autism Spectrum Disorder - epidemiology</subject><subject>Child, Preschool</subject><subject>Early Diagnosis</subject><subject>Epidemiological Monitoring</subject><subject>Female</subject><subject>Humans</subject><subject>Male</subject><subject>Population Surveillance</subject><subject>Surveillance Summaries</subject><subject>United States - epidemiology</subject><issn>1546-0738</issn><issn>1545-8636</issn><issn>1545-8636</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpVkc1uEzEUhUcIREthyw7kJYtOao_HP7NBitIfKrWwCF2wshz7TuoyMw62p1V3PEQfos_Fk-AmTQQr2zrnfr46pyjeEzwhjEl21Pd3YRKjwARr8qLYJ6xmpeSUv1zfeYkFlXvFmxhvMMY1pfJ1sUdryZioxH7xeKJDd4_OLQzJtc7o5PyAfIumY3KxR_MVmBTGHh276IOFgKa9H5Zodu06G2BA0yVYVKMfoENEf34_bAf1YNEx3ELnV31m6-6JoBeuc8lBRJd-cMkHl1FfId358PMQEYLmLkE8RFdZzNh50utnhYl8W7xqdRfh3fN5UFydnnyffSkvvp2dz6YXpamFTCWjraiAC8lbpjkT0lhuAABXVpiKt9QwzK2sddPahi4oNaJiEueQLBEtsfSg-LzhrsZFD9bk3YPu1Cq4Xod75bVT_yuDu1ZLf6ty5g2uRAZ8egYE_2uEmFTvooGu0wP4MaqKY95QWpMmWycbqwk-xgDt7huC1bpe9VSv2tabBz7-u9zOvu0zGz5sDDcxp7vTK0Gw4FTSv7IXryc</recordid><startdate>20211203</startdate><enddate>20211203</enddate><creator>Shaw, Kelly A.</creator><creator>Maenner, Matthew J.</creator><creator>Bakian, Amanda V.</creator><creator>Bilder, Deborah A.</creator><creator>Durkin, Maureen S.</creator><creator>Furnier, Sarah M.</creator><creator>Hughes, Michelle M.</creator><creator>Patrick, Mary</creator><creator>Pierce, Karen</creator><creator>Salinas, Angelica</creator><creator>Shenouda, Josephine</creator><creator>Vehorn, Alison</creator><creator>Warren, Zachary</creator><creator>Zahorodny, Walter</creator><creator>Constantino, John N.</creator><creator>DiRienzo, Monica</creator><creator>Esler, Amy</creator><creator>Fitzgerald, Robert T.</creator><creator>Grzybowski, Andrea</creator><creator>Hudson, Allison</creator><creator>Spivey, Margaret H.</creator><creator>Ali, Akilah</creator><creator>Andrews, Jennifer G.</creator><creator>Baroud, Thaer</creator><creator>Gutierrez, Johanna</creator><creator>Hallas, Libby</creator><creator>Hall-Lande, Jennifer</creator><creator>Hewitt, Amy</creator><creator>Lee, Li-Ching</creator><creator>Lopez, Maya</creator><creator>Mancilla, Kristen Clancy</creator><creator>McArthur, Dedria</creator><creator>Pettygrove, Sydney</creator><creator>Poynter, Jenny N.</creator><creator>Schwenk, Yvette D.</creator><creator>Washington, Anita</creator><creator>Williams, Susan</creator><creator>Cogswell, Mary E.</creator><general>Centers for Disease Control & Prevention (CDC)</general><general>Centers for Disease Control and Prevention</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20211203</creationdate><title>Early Identification of Autism Spectrum Disorder Among Children Aged 4 Years — Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2018</title><author>Shaw, Kelly A. ; Maenner, Matthew J. ; Bakian, Amanda V. ; Bilder, Deborah A. ; Durkin, Maureen S. ; Furnier, Sarah M. ; Hughes, Michelle M. ; Patrick, Mary ; Pierce, Karen ; Salinas, Angelica ; Shenouda, Josephine ; Vehorn, Alison ; Warren, Zachary ; Zahorodny, Walter ; Constantino, John N. ; DiRienzo, Monica ; Esler, Amy ; Fitzgerald, Robert T. ; Grzybowski, Andrea ; Hudson, Allison ; Spivey, Margaret H. ; Ali, Akilah ; Andrews, Jennifer G. ; Baroud, Thaer ; Gutierrez, Johanna ; Hallas, Libby ; Hall-Lande, Jennifer ; Hewitt, Amy ; Lee, Li-Ching ; Lopez, Maya ; Mancilla, Kristen Clancy ; McArthur, Dedria ; Pettygrove, Sydney ; Poynter, Jenny N. ; Schwenk, Yvette D. ; Washington, Anita ; Williams, Susan ; Cogswell, Mary E.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c478t-53f72e6786f5a6578cd6ceee02d7c26f3c506d84a9fd93b33c72580073d17f1d3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Autism Spectrum Disorder - diagnosis</topic><topic>Autism Spectrum Disorder - epidemiology</topic><topic>Child, Preschool</topic><topic>Early Diagnosis</topic><topic>Epidemiological Monitoring</topic><topic>Female</topic><topic>Humans</topic><topic>Male</topic><topic>Population Surveillance</topic><topic>Surveillance Summaries</topic><topic>United States - epidemiology</topic><toplevel>online_resources</toplevel><creatorcontrib>Shaw, Kelly A.</creatorcontrib><creatorcontrib>Maenner, Matthew J.</creatorcontrib><creatorcontrib>Bakian, Amanda V.</creatorcontrib><creatorcontrib>Bilder, Deborah A.</creatorcontrib><creatorcontrib>Durkin, Maureen S.</creatorcontrib><creatorcontrib>Furnier, Sarah M.</creatorcontrib><creatorcontrib>Hughes, Michelle M.</creatorcontrib><creatorcontrib>Patrick, Mary</creatorcontrib><creatorcontrib>Pierce, Karen</creatorcontrib><creatorcontrib>Salinas, Angelica</creatorcontrib><creatorcontrib>Shenouda, Josephine</creatorcontrib><creatorcontrib>Vehorn, Alison</creatorcontrib><creatorcontrib>Warren, Zachary</creatorcontrib><creatorcontrib>Zahorodny, Walter</creatorcontrib><creatorcontrib>Constantino, John N.</creatorcontrib><creatorcontrib>DiRienzo, Monica</creatorcontrib><creatorcontrib>Esler, Amy</creatorcontrib><creatorcontrib>Fitzgerald, Robert T.</creatorcontrib><creatorcontrib>Grzybowski, Andrea</creatorcontrib><creatorcontrib>Hudson, Allison</creatorcontrib><creatorcontrib>Spivey, Margaret H.</creatorcontrib><creatorcontrib>Ali, Akilah</creatorcontrib><creatorcontrib>Andrews, Jennifer G.</creatorcontrib><creatorcontrib>Baroud, Thaer</creatorcontrib><creatorcontrib>Gutierrez, Johanna</creatorcontrib><creatorcontrib>Hallas, Libby</creatorcontrib><creatorcontrib>Hall-Lande, Jennifer</creatorcontrib><creatorcontrib>Hewitt, Amy</creatorcontrib><creatorcontrib>Lee, Li-Ching</creatorcontrib><creatorcontrib>Lopez, Maya</creatorcontrib><creatorcontrib>Mancilla, Kristen Clancy</creatorcontrib><creatorcontrib>McArthur, Dedria</creatorcontrib><creatorcontrib>Pettygrove, Sydney</creatorcontrib><creatorcontrib>Poynter, Jenny N.</creatorcontrib><creatorcontrib>Schwenk, Yvette D.</creatorcontrib><creatorcontrib>Washington, Anita</creatorcontrib><creatorcontrib>Williams, Susan</creatorcontrib><creatorcontrib>Cogswell, Mary E.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>MMWR. Surveillance summaries</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Shaw, Kelly A.</au><au>Maenner, Matthew J.</au><au>Bakian, Amanda V.</au><au>Bilder, Deborah A.</au><au>Durkin, Maureen S.</au><au>Furnier, Sarah M.</au><au>Hughes, Michelle M.</au><au>Patrick, Mary</au><au>Pierce, Karen</au><au>Salinas, Angelica</au><au>Shenouda, Josephine</au><au>Vehorn, Alison</au><au>Warren, Zachary</au><au>Zahorodny, Walter</au><au>Constantino, John N.</au><au>DiRienzo, Monica</au><au>Esler, Amy</au><au>Fitzgerald, Robert T.</au><au>Grzybowski, Andrea</au><au>Hudson, Allison</au><au>Spivey, Margaret H.</au><au>Ali, Akilah</au><au>Andrews, Jennifer G.</au><au>Baroud, Thaer</au><au>Gutierrez, Johanna</au><au>Hallas, Libby</au><au>Hall-Lande, Jennifer</au><au>Hewitt, Amy</au><au>Lee, Li-Ching</au><au>Lopez, Maya</au><au>Mancilla, Kristen Clancy</au><au>McArthur, Dedria</au><au>Pettygrove, Sydney</au><au>Poynter, Jenny N.</au><au>Schwenk, Yvette D.</au><au>Washington, Anita</au><au>Williams, Susan</au><au>Cogswell, Mary E.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Early Identification of Autism Spectrum Disorder Among Children Aged 4 Years — Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2018</atitle><jtitle>MMWR. Surveillance summaries</jtitle><addtitle>MMWR Surveill Summ</addtitle><date>2021-12-03</date><risdate>2021</risdate><volume>70</volume><issue>10</issue><spage>1</spage><epage>14</epage><pages>1-14</pages><issn>1546-0738</issn><issn>1545-8636</issn><eissn>1545-8636</eissn><abstract>Autism spectrum disorder (ASD).
2018.
The Autism and Developmental Disabilities Monitoring Network is an active surveillance program that estimates ASD prevalence and monitors timing of ASD identification among children aged 4 and 8 years. This report focuses on children aged 4 years in 2018, who were born in 2014 and had a parent or guardian who lived in the surveillance area in one of 11 sites (Arizona, Arkansas, California, Georgia, Maryland, Minnesota, Missouri, New Jersey, Tennessee, Utah, and Wisconsin) at any time during 2018. Children were classified as having ASD if they ever received 1) an ASD diagnostic statement (diagnosis) in an evaluation, 2) a special education classification of ASD (eligibility), or 3) an ASD International Classification of Diseases (ICD) code. Suspected ASD also was tracked among children aged 4 years. Children who did not meet the case definition for ASD were classified as having suspected ASD if their records contained a qualified professional's statement indicating a suspicion of ASD.
For 2018, the overall ASD prevalence was 17.0 per 1,000 (one in 59) children aged 4 years. Prevalence varied from 9.1 per 1,000 in Utah to 41.6 per 1,000 in California. At every site, prevalence was higher among boys than girls, with an overall male-to-female prevalence ratio of 3.4. Prevalence of ASD among children aged 4 years was lower among non-Hispanic White (White) children (12.9 per 1,000) than among non-Hispanic Black (Black) children (16.6 per 1,000), Hispanic children (21.1 per 1,000), and Asian/Pacific Islander (A/PI) children (22.7 per 1,000). Among children aged 4 years with ASD and information on intellectual ability, 52% met the surveillance case definition of co-occurring intellectual disability (intelligence quotient ≤70 or an examiner's statement of intellectual disability documented in an evaluation). Of children aged 4 years with ASD, 72% had a first evaluation at age ≤36 months. Stratified by census-tract-level median household income (MHI) tertile, a lower percentage of children with ASD and intellectual disability was evaluated by age 36 months in the low MHI tertile (72%) than in the high MHI tertile (84%). Cumulative incidence of ASD diagnosis or eligibility received by age 48 months was 1.5 times as high among children aged 4 years (13.6 per 1,000 children born in 2014) as among those aged 8 years (8.9 per 1,000 children born in 2010). Across MHI tertiles, higher cumulative incidence of ASD diagnosis or eligibility received by age 48 months was associated with lower MHI. Suspected ASD prevalence was 2.6 per 1,000 children aged 4 years, meaning for every six children with ASD, one child had suspected ASD. The combined prevalence of ASD and suspected ASD (19.7 per 1,000 children aged 4 years) was lower than ASD prevalence among children aged 8 years (23.0 per 1,000 children aged 8 years).
Groups with historically lower prevalence of ASD (non-White and lower MHI) had higher prevalence and cumulative incidence of ASD among children aged 4 years in 2018, suggesting progress in identification among these groups. However, a lower percentage of children with ASD and intellectual disability in the low MHI tertile were evaluated by age 36 months than in the high MHI group, indicating disparity in timely evaluation. Children aged 4 years had a higher cumulative incidence of diagnosis or eligibility by age 48 months compared with children aged 8 years, indicating improvement in early identification of ASD. The overall prevalence for children aged 4 years was less than children aged 8 years, even when prevalence of children suspected of having ASD by age 4 years is included. This finding suggests that many children identified after age 4 years do not have suspected ASD documented by age 48 months.
Children born in 2014 were more likely to be identified with ASD by age 48 months than children born in 2010, indicating increased early identification. However, ASD identification among children aged 4 years varied by site, suggesting opportunities to examine developmental screening and diagnostic practices that promote earlier identification. Children aged 4 years also were more likely to have co-occurring intellectual disability than children aged 8 years, suggesting that improvement in the early identification and evaluation of developmental concerns outside of cognitive impairments is still needed. Improving early identification of ASD could lead to earlier receipt of evidence-based interventions and potentially improve developmental outcomes.</abstract><cop>United States</cop><pub>Centers for Disease Control & Prevention (CDC)</pub><pmid>34855727</pmid><doi>10.15585/mmwr.ss7010a1</doi><tpages>14</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1546-0738 |
| ispartof | MMWR. Surveillance summaries, 2021-12, Vol.70 (10), p.1-14 |
| issn | 1546-0738 1545-8636 1545-8636 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_8639027 |
| source | Centers for Disease Control and Prevention; MEDLINE; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; PubMed Central; PubMed Central Open Access |
| subjects | Autism Spectrum Disorder - diagnosis Autism Spectrum Disorder - epidemiology Child, Preschool Early Diagnosis Epidemiological Monitoring Female Humans Male Population Surveillance Surveillance Summaries United States - epidemiology |
| title | Early Identification of Autism Spectrum Disorder Among Children Aged 4 Years — Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2018 |
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