Prevalence and Early Identification of Autism Spectrum Disorder Among Children Aged 4 and 8 Years - Autism and Developmental Disabilities Monitoring Network, 16 Sites, United States, 2022.
Level 4 - case-series / case-control
Multi-site cross-sectional public health surveillance study
PubMed 40232988 · doi:10.15585/mmwr.ss7402a1
What was done
The CDC's Autism and Developmental Disabilities Monitoring (ADDM) Network conducted active surveillance across 16 US sites in 2022 to estimate ASD prevalence and timing of identification among children aged 4 and 8 years (and suspected ASD among 4-year-olds). Children were classified as having ASD if health or special education records contained an evaluator's diagnostic statement of ASD, autism special education eligibility, or specific ICD-9/ICD-10 ASD codes. Detailed record abstraction was completed at 15 sites for 8,613 children aged 8 years who met the case definition.
What was found
ASD prevalence among children aged 8 years in 2022 was 32.2 per 1,000 (1 in 31), ranging across sites from 9.7 (Texas: Laredo) to 53.1 (California). Prevalence was 3.4 times higher in boys (49.2 per 1,000) than girls (14.3 per 1,000). ASD prevalence was lower among White children (27.7 per 1,000) than Asian/Pacific Islander (38.2), American Indian/Alaska Native (37.5), Black (36.6), Hispanic (33.0), and multiracial children (31.9). Among 5,292 8-year-olds with cognitive data, 39.6% had intellectual disability, with higher rates among Black (52.8%) and American Indian/Alaska Native (50.0%) children than White children (32.7%). Median age at earliest diagnosis was 47 months. Cumulative incidence of diagnosis or eligibility by 48 months was 1.7 times higher in children born in 2018 than those born in 2014.
Why it matters
This report documents continued increases in ASD identification in the United States, driven in part by earlier screening and detection before age 4 and expanding identification among historically underserved racial and ethnic minority groups.
Limits
The 16 surveillance sites are not nationally representative. Case ascertainment relies on existing educational and medical records rather than direct universal screening, and record availability varied substantially across sites (e.g., formal autism testing documentation ranged from 24.7% to 93.5%). In addition, cognitive ability data were missing for 38.6% of identified 8-year-olds, and one site could not complete detailed record abstraction.
Cited by
- supports More than 1 in 100 children in the United States are diagnosed with autism.