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
Autism spectrum disorder.......
Introduction
The largest U.S. surveillance system that monitors the prevalence of autism spectrum disorder (ASD) among children is the Autism and Developmental Disabilities Monitoring (ADDM) Network, which receives funding from the Centers for Disease Control and Prevention (CDC). The 2022 report provides insights into diagnostic trends, disparities, and the impact of COVID-19 on early identification by providing updated estimates for 8-year-olds and preliminary data on 4-year-olds from 16 U.S. sites. What We Know About ASD's Prevalence 1. Rising Prevalence in 8-Year-Olds
The overall ASD prevalence was 1 in 36 children (2.8%), a significant increase from 1 in 44 (2.3%) in 2018.
Gender Disparity:
Boys: 4.3% (1 in 23)
Girls: 1.1% (1 in 88)
Geographic Variability:
California (2.9%), New Jersey (3.8%), and Minnesota (3.6%) have the highest prevalence. Lowest Prevalence: Arkansas (2.1%), Utah (2.2%)
Different screening policies, inaccessibility to healthcare, and community awareness could be the reasons. 2. Trends Among Children Under 4 Early data suggest a similar upward trend, but COVID-19 disruptions likely delayed evaluations.
Median age of first ASD diagnosis: ~4 years (still later than the recommended screening age of 18–24 months).
Early Identification: Progress and Persistent Gaps
1. Improvements in Early Diagnosis
By age 4, more children are being evaluated, indicating improved awareness and screening. a rise in pediatric practices' use of developmental questionnaires like M-CHAT. 2. Racial and Ethnic Disparities
White children: 51% received developmental evaluations by 36 months.
Black children: 45%
Hispanic children: 40%
Black and Hispanic children were 30% less likely to receive an early ASD diagnosis than White peers.
3. Gender Differences in Diagnosis
Girls are diagnosed later than boys, often due to:
Social masking (camouflaging symptoms).
Clinician bias toward male ASD presentations.
4. Impact of COVID-19 on Diagnoses
Decline in evaluations during 2020–2021, particularly among 4-year-olds.
Increased use of telehealth assessments, but disparities emerged for:
Low-income families with limited internet access.
Non-English-speaking households.
Co-Occurring Conditions and Clinical Characteristics
1. Intellectual Disability (ID) and Cognitive Abilities
35% of children with ASD had co-occurring ID (IQ ≤ 70).
48% had average or above-average intelligence (IQ > 85).
2. Common Comorbidities
ADHD: 44%
Anxiety disorders: 40%
Speech delays: 60%
Self-injurious behaviors: 25%
Public Health Implications
1. Need for Equitable Access to Early Screening
Universal screening at 18 and 24 months (per AAP guidelines) is still inconsistently applied.
Barriers in underserved communities:
Lack of pediatric specialists.
Cultural stigma around developmental disorders.
2. Eliminating Disparities in Diagnostics Community outreach programs to improve ASD awareness in minority populations.
Culturally sensitive screening tools for non-English-speaking families.
3. Assistance for Girls with ASD training for clinicians to recognize ASD in girls. Research on female-specific ASD phenotypes.
4. Addressing Pandemic-Related Delays
telehealth expansion with insurance coverage for remote evaluations. School-based screening programs to catch missed cases.
Conclusion
The 2022 ADDM report confirms that ASD prevalence continues to rise (now 1 in 36 children), driven by improved detection and broader diagnostic criteria. However, persistent disparities in early identification—particularly among racial minorities, girls, and low-income families—highlight the need for targeted interventions. The COVID-19 pandemic further disrupted screenings, underscoring the importance of resilient healthcare systems to ensure timely diagnoses.
Recommendations for Future Action
Mandate universal early screening in all pediatric practices.
Increase funding for ASD services in underserved areas.
Enhance provider training on recognizing ASD in diverse populations.
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Binte Mistry
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