In 2022, the Autism and Developmental Disabilities Monitoring (ADDM) Network conducted an extensive surveillance study on Autism Spectrum Disorder (ASD) across diverse geographic sites in the United States, including Arizona, Arkansas, California, Georgia, Indiana, Maryland, Minnesota, Missouri, New Jersey, Pennsylvania, Puerto Rico, Tennessee, Texas, Utah, and Wisconsin.
This report provided significant insights into the prevalence of ASD among children aged 4 and 8 years, as well as the methodologies and practices surrounding its identification.
ASD prevalence varied widely depending on the location, from 9.7 cases per 1,000 children in Texas (Laredo) to 53.1 cases per 1,000 children in California.
The overall observed ASD prevalence for children aged 8 years was 32.2 per 1,000, which translates to about one in 31 children being diagnosed with the disorder.
To ensure compliance with local privacy laws and institutional review board requirements, all sites operated as public health authorities under the Health Insurance Portability and Accountability Act of 1996.
The process for identifying children with ASD involved linking health and education records, utilizing ICD-9 and ICD-10 diagnostic codes, and reviewing special education eligibility data.
The surveillance case definition stipulated that children aged 8 years (born in 2014) or 4 years (born in 2018) must have lived in the surveillance area at any time in 2022 and met specific criteria to be classified as having ASD or suspected ASD.
Overall, the findings highlighted significant differences in community practices for identifying ASD, underscoring the variability in where and how children were diagnosed.
The percentage of children identified with ASD who had documented diagnostic statements, special education eligibility, or ICD codes showed considerable variability across the different sites involved in the study.
Notably, 68.4% of children with ASD had an official diagnostic statement identifying their condition, with state-specific variations such as 41.2% in Texas (Austin) and 95.0% in Puerto Rico.
Data on cognitive ability for children with ASD revealed that 39.6% of those assessed were classified as having intellectual disabilities at their most recent evaluation, a statistic that differed widely across various geographic sites.
The study also examined age at first evaluation and ASD diagnosis among the subjects, revealing that only 50.3% of children with ASD were evaluated by the age of 36 months.
The report emphasized the importance of early identification of ASD, revealing that children born in 2018 (aged 4 years) had a cumulative incidence of diagnosis that was 1.7 times higher than children born in 2014 (aged 8 years).
The sustained impacts of the COVID-19 pandemic on early evaluation and identification were analyzed, with findings indicating little disruption overall in the months following the pandemic’s onset, demonstrating resilience in the identification process for children born in 2018.
Despite the increase in evaluations and identifications, a concerning issue remained: the prevalence of suspected ASD was significantly lower than the prevalence of diagnosed ASD, raising questions about the effectiveness of early developmental monitoring in primary care settings.
Variability in ASD identification practices suggests that community efforts vary significantly regarding the availability of diagnostic services and early intervention resources.
The findings indicated a reversal of the previously observed trend that displayed the highest ASD prevalence among White children compared with A/PI, Black, and multiracial groups.
In 2022, ASD prevalence was consistently higher among A/PI, Black, Hispanic, and multiracial children than among their White peers, suggesting improvements in the access to and provision of identification services for these previously underserved populations.
Simultaneously, the patterns of ASD prevalence associated with neighborhood median household income (MHI) also showed significant changes, with higher rates of identification observed in communities with lower socioeconomic status—a reversal from historical patterns that indicated a correlation between higher SES and higher prevalence of ASD.
Among the 15 sites surveyed through record abstraction, the overall findings pointed to the critical requirement of establishing equitable access to ASD identification services across different community types.
The study made it evident that the process of evaluating and diagnosing ASD is multifaceted, often influenced by broader social determinants of health.
Continued disparities in access to early intervention services and diagnostic evaluations underscore the necessity for purposeful outreach and supportive resources tailored to the needs of diverse communities.
The analysis also highlighted that while the male-to-female prevalence ratio for ASD has narrowed from previous years, the overall number of cases remains significantly higher in boys, leading to implications for potential gender biases in recognition and diagnosis.
Such findings underline the complexity of ASD identification and the vital role of public health initiatives in fostering awareness and understanding within communities.
Collaboration among health care providers, educators, and policymakers is critical for diminishing barriers to ASD identification and ensuring that affected children receive the necessary support early in life.
Importantly, ongoing reforms regarding pediatricians’ ability to diagnose autism could provide a more accessible path for families seeking evaluation and intervention services.
In conclusion, the 2022 ADDM Network report serves as an essential resource for understanding ASD prevalence and diagnosis across varied communities in the U.S., revealing promising upward trends in early identification alongside persistent challenges that need to be addressed.
The findings stress the urgency of implementing effective identification strategies to ensure equitable access to necessary diagnostic and therapeutic services, ultimately fostering better developmental outcomes for children with ASD and their families.
image source from：https://www.cdc.gov/mmwr/volumes/74/ss/ss7402a1.htm
