Rates Of Autism Spectrum Disorder Research Articles

Is exposure to aluminium adjuvants associated with social impairments in mice? A pilot study

BackgroundOur group has shown that significant correlations exist between rates of Autism Spectrum Disorder (ASD) and total aluminum adjuvants given to children through vaccines in several Western countries. These correlations satisfied eight out of nine Hill criteria for causality. Experimental studies have demonstrated a range of behavioural abnormalities in young mice after postnatal exposure to aluminium. To build on our previous work, the current study will investigate the effect of aluminium adjuvants on social behaviour in mice. Anomalies in social interaction are a key characteristic of those with ASD. MethodsNeonatal CD-1 mice pups were injected with either a total of 550μg of aluminum hydroxide gel (experimental group) or saline (control) spread out during the first two weeks of postnatal life. The mice were then subjected to behavioural tests for social interest and social novelty at postnatal week 8, 17 and 29. p-Values were calculated using the Mann-Whitney and Kruskal Wallis tests. ResultsAluminum injected mice showed diminished social interest compared to controls at week 8 (p=0.016) and 17 (p=0.012). They also demonstrated abnormal social novelty from controls at week 8 (p=0.002) and week 29 (p=0.042). ConclusionThis is the first experimental study, to our knowledge, to demonstrate that aluminum adjuvants can impair social behaviour if applied in the early period of postnatal development. The study, however, is insufficient to make any assertive claims about the link between aluminium adjuvants and ASD in humans.

Critical region within 22q11.2 linked to higher rate of autism spectrum disorder

BackgroundPrevious studies have reported no clear critical region for medical comorbidities in children with deletions or duplications of 22q11.2. The purpose of this study was to evaluate whether individuals with small nested deletions or duplications of the LCR-A to B region of 22q11.2 show an elevated rate of autism spectrum disorder (ASD) compared to individuals with deletions or duplications that do not include this region.MethodsWe recruited 46 patients with nested deletions (n = 33) or duplications (n = 13) of 22q11.2, including LCR-A to B (ndel = 11), LCR-A to C (ndel = 4), LCR-B to D (ndel = 14; ndup = 8), LCR-C to D (ndel = 4; ndup = 2), and smaller nested regions (n = 3). Parent questionnaire, record review, and, for a subset, in-person evaluation were used for ASD diagnostic classification. Rates of ASD in individuals with involvement of LCR-B to LCR-D were compared with Fisher’s exact test to LCR-A to LCR-B for deletions, and to a previously published sample of LCR-A to LCR-D for duplications. The rates of medical comorbidities and psychiatric diagnoses were determined from questionnaires and chart review. We also report group mean differences on psychiatric questionnaires.ResultsIndividuals with deletions involving LCR-A to B showed a 39–44% rate of ASD compared to 0% in individuals whose deletions did not involve LCR-A to B. We observed similar rates of medical comorbidities in individuals with involvement of LCR-A to B and LCR-B to D for both duplications and deletions, consistent with prior studies.ConclusionsChildren with nested deletions of 22q11.2 may be at greater risk for autism spectrum disorder if the region includes LCR-A to LCR-B. Replication is needed.

Population-Based Assessment of Effective Contraceptive Use and Pregnancy Intentions

No prior studies have assessed change in health care provider–coded rates of Autism spectrum disorder (ASD) diagnoses over time, and few have investigated sociodemographic factors associated with having an ASD diagnosis, having behavioral conditions comorbid with ASD, or using psychotropic medications for this group.We used data from the 1994–2009 National (Hospital) Ambulatory Medical Care Surveys for children aged 2–18 years (n = 158,488).Rates of visits with coded-ASD per 100 outpatient medical visits increased from 0.04% to 0.82% from 1994 to 2009. Factors associated with an ASD diagnosis included male gender, lack of private insurance, white race, and later study period. The most frequent comorbid behavioral diagnoses were ADHD, anxiety, disruptive behavior, and mood disorders. Older age was linked to an increased likelihood of having a comorbid behavioral diagnosis and using psychotropic medications. Geographic region was also associated with having a comorbid behavioral diagnosis, and psychotropic use was linked to have a behavioral comorbidity. Comorbidities with the highest rates of psychotropic use were ADHD, mood, and anxiety disorders.Pediatric outpatient visits with an ASD diagnosis have increased dramatically from 1994 to 2009. Further study is needed to determine the reasons for the observed sociodemographic disparities in ASD diagnosis.

Autism spectrum disorders and their treatment with psychotropic medications in a nationally representative outpatient sample: 1994–2009

PurposeNo prior studies have assessed change in health care provider–coded rates of Autism spectrum disorder (ASD) diagnoses over time, and few have investigated sociodemographic factors associated with having an ASD diagnosis, having behavioral conditions comorbid with ASD, or using psychotropic medications for this group. MethodsWe used data from the 1994–2009 National (Hospital) Ambulatory Medical Care Surveys for children aged 2–18 years (n = 158,488). ResultsRates of visits with coded-ASD per 100 outpatient medical visits increased from 0.04% to 0.82% from 1994 to 2009. Factors associated with an ASD diagnosis included male gender, lack of private insurance, white race, and later study period. The most frequent comorbid behavioral diagnoses were ADHD, anxiety, disruptive behavior, and mood disorders. Older age was linked to an increased likelihood of having a comorbid behavioral diagnosis and using psychotropic medications. Geographic region was also associated with having a comorbid behavioral diagnosis, and psychotropic use was linked to have a behavioral comorbidity. Comorbidities with the highest rates of psychotropic use were ADHD, mood, and anxiety disorders. ConclusionsPediatric outpatient visits with an ASD diagnosis have increased dramatically from 1994 to 2009. Further study is needed to determine the reasons for the observed sociodemographic disparities in ASD diagnosis.

The development of offspring from mothers with systemic lupus erythematosus. A systematic review.

To analyze published data on the influence of maternal systemic lupus erythematosus (SLE) on different aspects of child development. A systematic review was conducted using PubMed and Embase searches for SLE or SLE-related antibodies and physical, neurocognitive, psychiatric or motor development outcomes in children. In total 24 cohort and 4 case-control studies were included after initial screening of 1853 hits. Learning disorders (LD) were reported in 21.4-26% of SLE offspring, exceeding the prevalence in the general population. Four studies reported that dyslexia and reading problems were present in 14.3-21.6% of lupus offspring with a clear male predominance. Furthermore, a twofold increased rate of autism spectrum disorders (ASD) (n=1 study) and a two- to threefold increased risk for speech disorders (n=3 studies) were reported in lupus offspring compared to controls, although the latter was not statistically significant. More divergent results were found for attention deficit (n=5 studies) and behavior disorders (n=3 studies). In two large controlled studies attention disorders were more prevalent and a trend towards more behavior disorders was reported in 2 of 3 studies analyzing this subject. Finally, IQ and motor skills were not affected in respectively 7 and 5 studies. Cardiopulmonary functioning and mood disorders were scarcely investigated (both n=1). Maternal anti-SSA antibodies were associated with LD in offspring in one study. Other SLE-related antibodies were rarely studied. This systematic review suggests that maternal SLE is associated with LD (specifically dyslexia), ASD, attention deficit and probably speech problems in offspring. However, over half of the studies were assigned a low or moderate evidence level. Therefore, further research is necessary to substantiate the found evidence and expand the scope to lesser researched areas such as cardiopulmonary functioning.

Rates of autism and potential risk factors in children with congenital heart defects.

Atypical development, behavioral difficulties, and academic underachievement are common morbidities in children with a history of congenital heart defects and impact quality of life. Language and social-cognitive deficits have been described, which are associated with autism spectrum disorders. The current study aimed to assess the rates of autism spectrum disorders in a large sample of children with a history of congenital heart defects and to assess medical, behavioral, and individual factors that may be associated with the risk of autism spectrum disorders. Participants included 195 children with a history of congenital heart defects, who are followed in a large-scale longitudinal study. Measures included behavioral data from 4-year-old neurodevelopmental evaluations and parent-report data from a later annual follow-up. Using established cutoffs on an autism spectrum disorder screener, children with congenital heart defects showed higher rates of "possible" autism spectrum disorders than national rates, (Chi-square Test of Equal Proportions), all Ps < .05. A stepwise variable selection method was used to create a "best prediction model" and multivariable logistic regression was used to identify variables predicting diagnostic status. Factors associated with diagnostic risk included medical (delayed sternal closure, prematurity, positive genetic findings), behavioral (cognitive, language, attention issues), and individual (socioeconomic, cultural/racial) variables. ROC analyses identified a cutoff of 7 to maximize sensitivity/specificity based on parent-reported diagnosis. Risk of autism spectrum disorder screening status in children with congenital heart defects was higher than expected from population rates. Findings highlight the need for referral to a specialist to assess the presence and severity of social-communication issues and congenital heart defects population-specific screening thresholds for children with concern for autism spectrum disorders.

The “Western disease”: Autism and Somali parents' embodied health movements

There is some statistical evidence indicating that Somali refugees and immigrants have high rates of autism spectrum disorder (ASD). Somalis in North America call autism the “Western disease” because there is no word for autism in the Somali language and because many believe it does not exist in Somalia. In Toronto, Somali parents have forged an “epistemic community,” united around a coherent theory of the development of autism, its defining features, and most successful therapies. They work together with researchers to support the theory that gut bacteria is a causal factor for the development of autism. They argue that it is the diet and medical environment in North America (including the use of preservatives, genetically-modified processing, and antibiotics in both health care and food production) that explains the high rates of autism within the Somali diaspora. The paper argues that race and nationality have been underexplored in theories of embodied health movements. I argue that Somali parents' organizing pushes theories of health social movements in new directions, by suggesting that experiences of forced migration and racial exclusion, as well as non-Western cultural ontologies of health, are important for understanding embodied experiences of illness and the forging of “politicized collective illness identities” that challenge mainstream scientific understandings of autism. As such, Somalis' race and nationality play key roles in their pathways to group construction, in their embodied experiences of illness, and in their resources for mobilization.

Autism Spectrum Disorder Prevalence Rates in the United States: Methodologies, Challenges, and Implications for Individual States

Many different studies have been conducted to determine the prevalence rates of Autism Spectrum Disorder (ASD) in the United States. The methodologies of these studies have varied, resulting in a multitude of publications with differing prevalence rates. Because there is such a wide range in the results of prevalence studies, it may be difficult for individual states to determine their rates. Accurate prevalence rates are important to obtain for many different reasons including increasing advocacy and awareness, increasing funding, and proper allocation of services for individuals with ASD and their families. Additionally, prevalence studies can be used to assess which groups are more at risk for ASD based off location and environmental factors. This paper describes different methodologies that can be utilized to determine ASD prevalence rates, the strengths and weaknesses of each method, and the challenges to determining accurate rates. This paper also includes the results from a study conducted in Nebraska to determine prevalence rates of ASD in the state. Implications for future prevalence studies are addressed and recommendations are provided.

Categorical Versus Dimensional Approaches to Autism-Associated Intermediate Phenotypes in 22q11.2 Microdeletion Syndrome

22q11.2 Microdeletion syndrome (22q11DS) is associated with elevated rates of autism spectrum disorders (ASDs), although the diagnosis is controversial. In order to determine whether there is a biological substrate of ASD in 22q11DS, we examined neurocognitive and structural neuroanatomic differences between those with 22q11DS and an ASD diagnosis (22q11DS-ASD+) and those with 22q11DS without ASD (22q11DS-ASD-); we then determined whether these differences were better characterized within a categorical or dimensional framework. We collected multiple neurocognitive measures and high-resolution T1-weighted scans on 116 individuals (29 22q11DS-ASD+, 32 22q11DS-ASD-, 55 typically developing controls) between 6 and 26 years of age. Measures of subcortical volume, cortical thickness (CT), and surface area were extracted using the FreeSurfer image analysis suite. Group differences in neurocognitive and neuroanatomic measures were assessed; regression analyses were then performed to determine whether a categorical or dimensional measure of ASD was a better predictor of neurocognitive impairment and/or neuroanatomic abnormalities observed in 22q11DS-ASD+. In comparison to 22q11DS-ASD-, 22q11DS-ASD+ participants exhibited decreased bilateral hippocampal CT and decreased right amygdala volumes. Those with 22q11DS-ASD+ also showed slowed processing speed and impairments in visuospatial and facial memory. Neurocognitive impairments fit a dimensional model of ASD, whereas reductions in parahippocampal CT were best explained by a categorical measure of ASD. A combination of categorical and dimensional measures of ASD may provide the most comprehensive understanding of ASDs in 22q11DS.

22q11.2 duplication syndrome: elevated rate of autism spectrum disorder and need for medical screening.

BackgroundWidespread use of microarray technology has led to increasing identification of 22q11.2 duplication syndrome (22q11.2DupS), the reciprocal syndrome of the well-characterized 22q11.2 deletion syndrome (22q11.2DS). Individuals with 22q11.2DS have elevated rates of community diagnoses of autism spectrum disorder (ASD), schizophrenia, and a range of medical problems and birth defects that necessitate extensive medical screening. Case reports of 22q11.2DupS include patients with ASD, fewer medical problems, and no schizophrenia; however, no prospective cohort study has been reported. The goals of the study were to (1) characterize the neuropsychiatric functioning of a cohort of individuals with 22q11.2DupS in comparison to large samples of typically developing controls (TDCs), ASD and 22q11.2DS; (2) estimate the prevalence of ASD in 22q11.2DupS; (3) determine whether the indications that prompted the genetic testing in 22q11.2DupS differ from 22q11.2DS and (4) determine whether comprehensive medical screening should be recommended for those diagnosed with 22q11.2DupS.MethodsMedical characterization was done by parental questionnaire and medical chart review of individuals with 22q11.2DupS (n = 37) and 22q11.2DS (n = 101). Neuropsychiatric characterization of children with 22.11.2DupS, 22q11.2DS, TDCs, and ASD was done by parent-report questionnaires; in addition, the ASD and 22q11.2DupS groups received the Autism Diagnostic Interview-Revised and Autism Diagnostic Observation Schedule.ResultsIndividuals with 22q11.2DupS, 22q11.2DS, and ASD had significantly impaired social interaction and adaptive behavior skills compared to TDCs. Overall, 38 % of children aged 2–18 with 22q11.2DupS had community diagnoses of ASD, but fewer (14–25 %) met on the basis of best clinical judgment that included ADI-R and ADOS data. Indications for genetic testing were significantly different for 22q11.2DupS and 22q11.2DS, with the deletions more commonly tested because of birth defects or medical problems, and the duplications because of developmental delay. However, when the screening protocol for 22q11.2DS was applied to the 22q11.2DupS sample, several medical problems were identified that would pose significant risk if left undetected.Conclusions22q11.2DupS has a high rate of ASD at 14–25 %, among the highest of any genetic disorder. Prospective medical screening should be done for all patients with 22q11.2DupS, including those diagnosed due to developmental delays and ASD alone.Electronic supplementary materialThe online version of this article (doi:10.1186/s13229-016-0090-z) contains supplementary material, which is available to authorized users.

Inclusion of Children with Autism Spectrum Disorders: Listening and Hearing to Voices from the Grassroots.

The current significantly high prevalence rates of autism spectrum disorder (ASD) coupled with the paradigm shift from exclusive to inclusive education warrants research on inclusion of children with ASD in mainstream classrooms in Zimbabwe. A qualitative methodology was used to interview 21 regular primary school teachers regarding social barriers and enablers of inclusion of 6-12year old children with ASD in mainstream classrooms in Harare educational province of Zimbabwe. Data analysis comprised pattern coding and cross-case analysis. Social rejection, communication impairments and behavioural challenges of children with ASD interfered with inclusion in mainstream classrooms. Regular teachers' training, stakeholder collaboration and institutionalization of social support services and programmes would facilitate the inclusion of children with ASD in mainstream classrooms.

Evaluation of Asperger Syndrome in Youth Presenting to a Gender Dysphoria Clinic.

There is evolving evidence that children and adolescents with gender dysphoria have higher-than-expected rates of autism spectrum disorder (ASD), yet clinical data on ASD among youth with gender dysphoria remain limited, particularly in North America. This report aims to fill this gap. We conducted a retrospective review of patient chart data from 39 consecutive youth ages 8 to 20 years (mean age 15.8 years, natal male: n = 22, natal female: n = 17) presenting for evaluation at a multidisciplinary gender clinic in a large U.S. pediatric hospital from 2007 to 2011 to evaluate the prevalence of ASD in this patient population. Overall, 23.1% of patients (9/39) presenting with gender dysphoria had possible, likely, or very likely Asperger syndrome as measured by the Asperger Syndrome Diagnostic Scale (ASDS). These findings are consistent with growing evidence supporting increased prevalence of ASD in gender dysphoric children. To guide provision of optimal clinical care and therapeutic intervention, routine assessment of ASD is recommended in youth presenting for gender dysphoria.

Multidisciplinary Aspects of 104 Patients With Pierre Robin Sequence.

To describe Pierre Robin sequence patients with a cleft palate from a multidisciplinary perspective. A total of 104 individuals with Pierre Robin sequence and cleft palate, born between 1980 and 2010. Data were collected retrospectively and compared with large control groups. Of 104 patients, 19 (18.3%) were treated with a nasopharyngeal or oropharyngeal tube, continuous positive airway pressure, and/or a tracheotomy. The mean weight percentile for newborns with Pierre Robin sequence was 30.9. It decreased to 29.9 at the time of cleft palate repair (mean age, 13.7 months) (P = .78). Of 87 patients, 30 (34.5%) developed normal speech after cleft palate repair. Of 93 nonsyndromic Pierre Robin sequence patients, 31 (33.3%) had or are having surgery for velopharyngeal insufficiency, a rate that is significantly higher when compared with a control group of cleft palate-only patients (19.4%; P = .004). Of 31 patients, 25 (80.6%) developed normal resonance after surgery for velopharyngeal insufficiency. There was no significant difference in the rate of syndromes between the Pierre Robin sequence patients and a control group of cleft palate patients without Pierre Robin sequence (P = .25). Seven of 39 boys (17.9%) with Pierre Robin sequence had a diagnosis of autism spectrum disorder. Even though the mean weight percentile for newborns with Pierre Robin sequence was low, the patients did not show a growth spurt during the first year of life. The high rate of velopharyngeal insufficiency after cleft palate repair in patients with Pierre Robin sequence needs further investigation. Also, the high rate of autism spectrum disorder among boys with Pierre Robin sequence prompts further investigation.

Research sheds light on gene expression differences in 22q11.2 deletion syndrome.

Research sheds light on gene expression differences in 22q11.2 deletion syndrome.

Impact of aerobic exercise on sleep and motor skills in children with autism spectrum disorders - a pilot study.

BackgroundPrevalence rates of autism spectrum disorder (ASD) have increased dramatically in the last two decades. In addition to the core symptoms such as impaired communication, difficulties in social interaction, and restricted and stereotypical patterns of behavior and interests, poor sleep and motor skill (MS) deficits have also been observed in children with ASD. On the other hand, there is evidence that aerobic exercise training (AET) has a positive impact on sleep, and that specific training improves MSs. Accordingly, the aim of the present pilot study was to investigate to what extent a combination of AET and MS training (MST) would improve sleep and physical performance in a small sample of children with ASD.MethodsTen children with ASD (mean age: 10 years) took part in the study. After a thorough medical examination and psychiatric assessment, children participated in thrice-weekly 60-minute sessions of AET and MST lasting for 3 consecutive weeks. Sleep was assessed both objectively (sleep-encephalography [sleep-EEG]) and subjectively (parents’ questionnaire). MSs were assessed via standardized test batteries. Parents completed sleep and mood logs, and ratings of mood.ResultsMild-to-moderate insomnia was reported in 70% of children. Compared to nights without previous AET and MS, on nights following AET and MS, sleep efficiency increased (d=1.07), sleep onset latency shortened (d=0.38), and wake time after sleep onset decreased for 63% of the sample (d=1.09), as assessed via sleep-EEG. Mood in the morning, as rated by parents, improved after three weeks (d=0.90), as did MSs (ball playing, balance exercise: ds>0.6).ConclusionThe pattern of results of this pilot study suggests that regular AET and MST impact positively on sleep, MSs, and mood among children with ASD.

Incidence and cohort prevalence for autism spectrum disorders in the Avalon Peninsula, Newfoundland and Labrador.

Recent studies have reported increased prevalence for autism spectrum disorders in a number of geographical locations. Our objective was to determine the incidence and 1-year cohort prevalence for autism spectrum disorders in children less than 15 years of age and living in the Avalon Peninsula at the time of diagnosis. Retrospective and prospective data were obtained from the Janeway Children's Health and Rehabilitation Centre (St. John's), including the identification and specific diagnosis for all children assessed for autism spectrum disorder from 2006 to 2010. Additional clinic data were reviewed to update the data until the end of 2013. From 2006 to 2010, 272 children had a diagnosis of autism spectrum disorder, averaging 54 new cases per year. The incidence of new cases increased from 10.1 to 16.7 cases per 10 000 per year from 2006 to 2010. At the end of 2013, the prevalence among children born in 2006 was 1 case of autism spectrum disorder per 46 children or 215.77 per 10 000. We found higher rates of autism spectrum disorder than previously reported for this population. The prevalence in this region is also high when compared with other global populations. The high rate of diagnosis supports the need for a provincial autism spectrum disorder registry and further research on autism spectrum disorder within this population.

Autism is Not Caused by Terbutaline

Objective: To identify the rate of Autism Spectrum Disorder (ASD) in children exposed to terbutaline in utero compared to patients untreated with this beta agonist. Methods: Members of three lay organizations collected data regarding significant childhood development problems following their pregnancy using a web-based survey. Results: Over a 90 day period, 11,717 surveys were sent electronically to members of the high risk pregnancy organizations. Of these, 2217 members (18.9%) responded and results showed that 965(43.5%) had received terbutaline during their pregnancies. Overall 523(23.6%) reported having at least one child with some form of chronic disability and of these 128 had a child with ASD. Of fetuses with no exposure to terabutaline 79/1252 (6.3%) had a diagnosis of ASD compared to 49/965 (5.1%) who reported a history of terbutaline exposure (p=0.233). In contrast, prematurity was strongly associated with ASD as 102/128 (80%) were delivered at 36 weeks. ASD was not associated with terabutaline exposure in pregnancy; however ASD was associated with preterm delivery.

Explaining the Unexplained Growth in Autism Prevalence

Rates of autism spectrum disorder (ASD) have been increasing for reasons that are not fully understood. To examine this increase, investigators used

Vaccine myths and misconceptions.

Communicable diseases are on the rise worldwide. Some of the increase in prevalence of these nearly eradicated diseases is due to a decrease in vaccination rates. This decrease is primarily due to parental concerns over vaccine safety and the increasing rates of autism spectrum disorders. Medical providers must address the growing antivaccine movement and misconceptions about immunizations. Physician assistants are in a unique position to offer evidence-based medical advice and encourage immunizations in order to prevent disease outbreaks.

Prevalence Rate of Autism Continues Steady Rise

Back to table of contents Previous article Next article Clinical and Research NewsFull AccessPrevalence Rate of Autism Continues Steady RiseJoan Arehart-TreichelJoan Arehart-TreichelSearch for more papers by this authorPublished Online:25 Apr 2014https://doi.org/10.1176/appi.pn.2014.5a9AbstractRegardless of whether the increasing prevalence rate of autism spectrum disorder is due to better diagnosis or an actual increase in cases, more youngsters will need services.On March 28, the Centers for Disease Control and Prevention (CDC) published in its Morbidity and Mortality Weekly Report that 1 in 68 American children has autism spectrum disorder (ASD). That translates to 14.7 per 1,000 8-year-olds.This rate is about 30 percent higher than the prevalence of ASD that the CDC reported in 2012, which was 1 in 88 children—that is, 11.3 per 1,000 8-year-olds.The new finding is based on 2010 data from 11 sites participating in the CDC’s long-running Autism and Developmental Disabilities Monitoring (ADDM) network. A total of 363,749 8-year-old children were evaluated for the report, representing 9 percent of the U.S. population of 8-year-olds in 2010. (The 2012 report reflected data gathered in 2008.)Other new findings indicate that ASD is almost five times more common among boys than girls and that white children are more likely to be identified with the disorder than black or Hispanic children are. Although the level of intellectual ability varies greatly among children with ASD, ranging from severe intellectual challenges to average or above-average intellectual ability, the new findings likewise show that almost half the children identified with ASD have average or above-average intellectual ability.“The CDC report was based on a review of records rather than actual clinical assessments,” David Fassler, M.D., a clinical professor of psychiatry at the University of Vermont, a child and adolescent psychiatrist, and APA treasurer, noted in an interview with Psychiatric News. “As a result, it tells us more about how often autism is being diagnosed as opposed to changes in the underlying incidence. The data were also derived from relatively few states. However, even in this limited sample, the geographic variations are quite striking and clearly warrant further investigation. From a clinical perspective, increased awareness is leading to earlier recognition and more accurate diagnoses. The real challenge is to make sure that all these kids have access to the comprehensive services they need and deserve.”“Is this increase [in ASD] a mark of better care, with more cases identified and treated, or is this a reflection of a continually growing public health care emergency due to more children affected?” Thomas Insel, M.D., director of the National Institute of Mental Health, asked in his March 27 blog. “ADDM cannot answer these questions, but it does point to the need for a population-wide study, as currently planned by the CDC and Autism Speaks in South Carolina…. Whatever the meaning of the new ADDM report, there is little doubt that more children and more adults on the autism spectrum will require more services.”Ever since the ADDM was launched in 2000, ADDM staff members have determined cases of ASD in two phases. The first phase involves screening and abstracting records from multiple sources in the community. In the second phase, clinicians review the collected data and determine whether putative ASD cases are truly ASD according to DSM criteria. ASD case definitions for both 2010 and 2012, as well as for the earlier years, were based on DSM-IV-TR. However, beginning this year, ASD case definitions will be based on DSM-5 criteria.Since its first study of autism prevalence, the ADDM has found that the number of children diagnosed with the disorder has been on a steady upward trajectory. Indeed, “The global prevalence of autism has increased 20-fold to 30-fold since the earliest epidemiologic studies were conducted in the late 1960s and early 1970s,” the new report noted. ■“Prevalence of Autism Spectrum Disorder Among Children Aged Eight Years—Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2010” can be accessed here. ISSUES NewArchived