Prevalence, Socio-Demographic Characteristics, and Co-Morbidities of Autism Spectrum Disorder in US Children: Insights from the 2020-2021 National Survey of Children's Health.
Level 4 - case-series / case-control
Cross-sectional analysis of national survey data
PubMed 40150580 · doi:10.3390/children12030297
What was done
The authors analyzed data from the 2020–2021 National Survey of Children's Health (NSCH) covering 79,182 children and adolescents aged 3 to 17 years (mean age 10.1 ± 4.6 years). Univariate and multivariate regression models were used to estimate ASD prevalence and evaluate associations between ASD severity, socio-demographic factors, and co-occurring medical and psychiatric conditions.
What was found
The prevalence of ASD was 3.2%, with males comprising 78.7% of ASD cases. ASD was more prevalent in adolescents aged 11–17, children in lower-income households, and those with caregivers holding at most a high school education. Nearly all children with ASD (96.4%) had at least one comorbidity. Leading neuropsychiatric conditions were developmental delay (64%), behavioral/conduct problems (57.8%), and anxiety disorder (45.7%). Common medical comorbidities were allergies (32.4%), genetic disorders (26.2%), and asthma (12.6%). Females with ASD had higher rates of vision problems, cerebral palsy, epilepsy, depression, and intellectual disability, but lower odds of ADHD and anxiety. Greater ASD severity was significantly associated with intellectual disability (OR 5.8, p < 0.001), developmental delay (OR 5.0, p < 0.001), Down syndrome (OR 3.4, p < 0.001), vision problems (OR 2.5, p < 0.001), genetic disorders (OR 2.3, p < 0.001), and epilepsy.
Why it matters
This study updates US pediatric ASD prevalence estimates to 3.2% and documents that the vast majority of diagnosed youth present with complex medical or psychiatric comorbidities, with notable phenotypic divergence between males and females.
Limits
Data are cross-sectional, preventing causal or temporal conclusions. Diagnoses and severity ratings are based entirely on caregiver report rather than standardized direct clinical assessments or validated medical records, introducing potential recall and reporting bias.
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