Prevalence of autism spectrum disorder among children aged 8 Years-Autism and developmental disabilities monitoring network, 11 Sites, United States, 2016

Matthew J. Maenner, Kelly A. Shaw, Jon Baio, Anita Washington, Mary Patrick, Monica DiRienzo, Deborah L. Christensen, Lisa D. Wiggins, Sydney Pettygrove, Jennifer G. Andrews, Maya Lopez, Allison Hudson, Thaer Baroud, Yvette Schwenk, Tiffany White, Cordelia Robinson Rosenberg, Li Ching Lee, Rebecca A. Harrington, Margaret Huston, Amy HewittAmy Esler, Jennifer Hall-Lande, Jenny N. Poynter, Libby Hallas-Muchow, John N. Constantino, Robert T. Fitzgerald, Walter Zahorodny, Josephine Shenouda, Julie L. Daniels, Zachary Warren, Alison Vehorn, Angelica Salinas, Maureen S. Durkin, Patricia M. Dietz

Research output: Contribution to journalArticlepeer-review

1593 Scopus citations


PROBLEM/CONDITION: Autism spectrum disorder (ASD).


DESCRIPTION OF SYSTEM: The Autism and Developmental Disabilities Monitoring (ADDM) Network is an active surveillance program that provides estimates of the prevalence of ASD among children aged 8 years whose parents or guardians live in 11 ADDM Network sites in the United States (Arizona, Arkansas, Colorado, Georgia, Maryland, Minnesota, Missouri, New Jersey, North Carolina, Tennessee, and Wisconsin). Surveillance is conducted in two phases. The first phase involves review and abstraction of comprehensive evaluations that were completed by medical and educational service providers in the community. In the second phase, experienced clinicians who systematically review all abstracted information determine ASD case status. The case definition is based on ASD criteria described in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition.

RESULTS: For 2016, across all 11 sites, ASD prevalence was 18.5 per 1,000 (one in 54) children aged 8 years, and ASD was 4.3 times as prevalent among boys as among girls. ASD prevalence varied by site, ranging from 13.1 (Colorado) to 31.4 (New Jersey). Prevalence estimates were approximately identical for non-Hispanic white (white), non-Hispanic black (black), and Asian/Pacific Islander children (18.5, 18.3, and 17.9, respectively) but lower for Hispanic children (15.4). Among children with ASD for whom data on intellectual or cognitive functioning were available, 33% were classified as having intellectual disability (intelligence quotient [IQ] ≤70); this percentage was higher among girls than boys (39% versus 32%) and among black and Hispanic than white children (47%, 36%, and 27%, respectively) [corrected]. Black children with ASD were less likely to have a first evaluation by age 36 months than were white children with ASD (40% versus 45%). The overall median age at earliest known ASD diagnosis (51 months) was similar by sex and racial and ethnic groups; however, black children with IQ ≤70 had a later median age at ASD diagnosis than white children with IQ ≤70 (48 months versus 42 months).

INTERPRETATION: The prevalence of ASD varied considerably across sites and was higher than previous estimates since 2014. Although no overall difference in ASD prevalence between black and white children aged 8 years was observed, the disparities for black children persisted in early evaluation and diagnosis of ASD. Hispanic children also continue to be identified as having ASD less frequently than white or black children.

PUBLIC HEALTH ACTION: These findings highlight the variability in the evaluation and detection of ASD across communities and between sociodemographic groups. Continued efforts are needed for early and equitable identification of ASD and timely enrollment in services.

Original languageEnglish (US)
Pages (from-to)1-12
Number of pages12
JournalMMWR Surveillance Summaries
Issue number4
StatePublished - 2020

Bibliographical note

Funding Information:
Project management, data collection, and abstraction: Kristen Clancy Mancilla, Arizona; Michelle Cantrell Kelley and Sandra Walker, Arkansas; MJ Erickson-Eger, Leanne Glenn, Julia Group, Leovi Madera, Jean Menconi, and Cynthia Vogel, Colorado; Kate Sidwell, Cindy Cruz Alvarez, Michael Verile, and Yuriy Levin, New Jersey; Julie Rusyniak, North Carolina; Madeline Santulli, Tennessee; Lynn Peterson, Lynn Boelter, Robert Rettammel, and Madison Carey, Wisconsin. Data management and programming support: Susan Williams, CDC; Julie Nick, Arkansas; Bill Vertees, Colorado; Adam Ryer, Maryland; Paul Zumoff, New Jersey; Carrie Arneson, Wisconsin. Clinician review activities: Stefanie Jernigan, Arkansas; Terry Hall, Patricia LaVesser, Judy Reaven, and Nuri Reyes, Colorado; Rebecca Born, Cassondra Gayman, Michael Morrier, Catherine Rice, and Daniel Wright, Georgia; Rebecca Born and Mary Schlaak, Maryland; Catherine Burrows, Minnesota; Carolyn Skowyra, Rebecca Born, and Michael Bunis, Missouri; Audrey Mars, Mildred Waale, Arline Fusco, Tara Gleeson, and Gail Burack, New Jersey; Jessica Rivers, Julie Rusyniak, and Tamara Watson, North Carolina; Evon Batey Lee, Amy Swanson, and Amy S. Weitlauf, Tennessee; Madison Carey, Mary Schlaak, and Maia Piccagli, Wisconsin. Project staff including data abstractors, epidemiologists, and others. Ongoing ADDM Network support: Bruce Heath, CDC.

Funding Information:
All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. Zachary Warren reports personal fees from Hoffman La Roche, grants and personal fees from Adaptive Technology Consulting, grants from Autism Speaks, grants from Cognoa, and grants from Simons Foundation; all fees and grants received are outside the submitted work. John Constantino reports a grant from Western Psychological Services outside the submitted work.

Publisher Copyright:
© 2020 Centers for Disease Control and Prevention (CDC).

PubMed: MeSH publication types

  • Journal Article


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