Progress and Disparities in Early Identification of Autism Spectrum Disorder: Autism and Developmental Disabilities Monitoring Network, 2002-2016
- PMID: 34838692
- PMCID: PMC9353949
- DOI: 10.1016/j.jaac.2021.11.019
Progress and Disparities in Early Identification of Autism Spectrum Disorder: Autism and Developmental Disabilities Monitoring Network, 2002-2016
Abstract
Objective: Early identification can improve outcomes for children with autism spectrum disorder (ASD). We sought to assess changes in early ASD identification over time and by co-occurring intellectual disability (ID) and race/ethnicity.
Method: Using data for 2002-2016 from a biennial population-based ASD surveillance program among 8-year-old children in the United States, we defined identification as a child's earliest recorded ASD diagnosis or special education eligibility. Unidentified children had characteristics meeting the ASD surveillance case definition but no recorded identification by age 8 years. We calculated median age at identification among identified children, median age at identification including unidentified children, and cumulative incidence of identification by age 48 months.
Results: ASD identification by age 48 months was 4 times (95% CI: 3.6-4.3) as likely in 2016 as in 2002, with the largest increases among children without ID. Median age at ASD identification among identified children decreased 3 months during this time. Children of every race/ethnicity were more likely to be identified over time. There were racial disparities stratified by ID: in 2016, Black and Hispanic children without ID were less likely to be identified with ASD than were White children (both groups risk ratio: 0.7; 95% CI: 0.5-0.8), but Black children were 1.5 times (95% CI: 1.3-1.9) as likely as White children to be identified with ASD and ID.
Conclusion: Substantial progress has been made to identify more children with ASD early, despite minimal decrease in median age at diagnosis. Considerable disparities remain in early ASD identification by race/ethnicity and co-occurring intellectual disability.
Keywords: autism spectrum disorder; epidemiology; health status disparities; intellectual disability.
Published by Elsevier Inc.
Conflict of interest statement
Disclosure: Drs. Shaw, Hughes, Bakian, Lee, Pettygrove, Maenner, and Ms. McArthur have reported no biomedical financial interests or potential conflicts of interest.
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Comment in
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Editorial: Evaluating the Success of Early Detection of Autism: It's Time to Move Beyond the Median.J Am Acad Child Adolesc Psychiatry. 2022 Jul;61(7):860-861. doi: 10.1016/j.jaac.2021.12.002. Epub 2021 Dec 15. J Am Acad Child Adolesc Psychiatry. 2022. PMID: 34921909
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References
-
- American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 5th ed. (DSM-5). Arlington, VA: American Psychiatric Publishing; 2013.
-
- Autism and Developmental Disabilities Monitoring Network Surveillance Year 2000 Principal Investigators, Centers for Disease Control and Prevention. Prevalence of autism spectrum disorders–Autism and Developmental Disabilities Monitoring Network, six sites, United States, 2000. MMWR Surveill Summ. 2007;56:1–11. - PubMed