Progress in the USA for autistic spectrum disorder

Abstract

The prevalence of autistic spectrum disorder is increasing in the USA, the latest figures from the Centers for Disease Control and Prevention suggest. According to the Autism and Developmental Disabilities Monitoring Network (ADDM), the prevalence of autistic spectrum disorder in children was 16·8 per 1000 in 2014—an absolute increase of 2·2% since 2012 and more than double the prevalence in 2000 when monitoring by the ADDM began. The figures are based on surveillance of health and education records of over 300 000 children aged 8 years in 11 US states. Autism was diagnosed with DSM-IV-TR (Diagnostic and Statistical Manual of Mental Disorders, Text Revision) criteria, but rates were similar when the more recent DSM-5 criteria were used. Rising autism rates are likely to be driven by better awareness and detection among minority ethnic groups. This is evidenced by a narrowing in disparities in diagnosis rates between white children and those from ethnic minorities; however, prevalence remains higher in white children (1·7%) than in black (1·6%) or Hispanic (1·4%) children. Prevalence of autism was four times greater in boys than in girls (26·6 vs 6·6 per 1000), and notably girls diagnosed with autism were more likely than boys to have intellectual disability. These findings indicate an ongoing failure to recognise autism in girls, particularly those without intellectual disability, who can camouflage their symptoms and might not come to attention until they are older—often during adolescence. Although 85% of children had developmental concerns recorded by 36 months, only 42% received a detailed evaluation by then. The median age at diagnosis was 52 months, suggesting many children experience a delay in diagnosis despite showing symptoms of autism. Continued efforts are needed to improve awareness and diagnosis, especially in minority ethnic groups, together with education of clinicians about the symptom profiles of girls with autism. Early diagnosis is crucial and wider implementation of autism services into primary care is essential to ensure that children with autism can access the care and support they need. CDC autism rate: misplaced reliance on passive sampling?We welcomed The Lancet's Editorial (May 5, p 1750)1 about the release of the seventh US Centers for Disease Control and Prevention (CDC) Autism Developmental Disabilities Monitoring Network (ADDM) report.2 This report is based on surveillance of health and education records of samples of more than 300 000 children aged 8 years from 11 US states since 2000. The latest CDC report for 2014 documents a further increase in the prevalence of autism spectrum disorder, from 14·4 per 1000 children in 2012, to 16·8 per 1000 in 2014. Full-Text PDF