Early Identification of Autism Spectrum Disorder Among Children Aged 4 Years - Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2018.
Early Identification of Autism Spectrum Disorder Among Children Aged 4 Years - Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2018.
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DOI：
10.15585/mmwr.ss7010a1
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发表时间：
2021-12-03
期刊：
影响因子：
--
通讯作者：
Cogswell ME
中科院分区：
文献类型：
--
作者：
Shaw KA;Maenner MJ;Bakian AV;Bilder DA;Durkin MS;Furnier SM;Hughes MM;Patrick M;Pierce K;Salinas A;Shenouda J;Vehorn A;Warren Z;Zahorodny W;Constantino JN;DiRienzo M;Esler A;Fitzgerald RT;Grzybowski A;Hudson A;Spivey MH;Ali A;Andrews JG;Baroud T;Gutierrez J;Hallas L;Hall-Lande J;Hewitt A;Lee LC;Lopez M;Mancilla KC;McArthur D;Pettygrove S;Poynter JN;Schwenk YD;Washington A;Williams S;Cogswell ME
自闭症谱系障碍（ASD）。 2018 年。自闭症和发育障碍监测网络是一项主动监测计划，旨在估计 4 岁和 8 岁儿童中 ASD 患病率并监测 ASD 识别时间。本报告重点关注 2018 年 4 岁儿童，这些儿童出生于 2014 年，且父母或监护人在 2018 年任何时间居住在 11 个地点（亚利桑那州、阿肯色州、加利福尼亚州、佐治亚州、马里兰州、明尼苏达州、密苏里州、新泽西州、田纳西州、犹他州和威斯康星州）之一的监测区域。如果儿童接受过 1) ASD 诊断，则被归类为患有 ASD 评估中的声明（诊断），2) ASD 的特殊教育分类（资格），或 3) ASD 国际疾病分类 (ICD) 代码。还对 4 岁儿童中疑似自闭症谱系障碍患者进行了追踪。不符合自闭症谱系障碍病例定义的儿童，如果其记录包含合格专业人士表明怀疑患有自闭症谱系障碍的声明，则被归类为疑似自闭症谱系障碍儿童。 2018 年，自闭症谱系障碍 (ASD) 总体患病率为每 1,000 名 4 岁儿童中就有 17.0 人（每 59 人中就有 1 人）。患病率从犹他州的每 1,000 人 9.1 人到加利福尼亚州的每 1,000 人 41.6 人不等。在每个地点，男孩的患病率均高于女孩，男女总体患病率为 3.4。 4 岁儿童中，非西班牙裔白人 (White) 儿童 (每 1,000 人 12.9 人) 的 ASD 患病率低于非西班牙裔黑人 (每 1,000 人 16.6 人)、西班牙裔儿童 (每 1,000 人 21.1 人) 和亚裔/太平洋岛民 (A/PI) 儿童 (每 1,000 人 22.7 人)。在患有自闭症谱系障碍和智力信息的 4 岁儿童中，52% 符合监测病例对并发智力障碍的定义（智商≤70 或评估中记录的检查员对智力障碍的陈述）。在 4 岁患有自闭症谱系障碍 (ASD) 的儿童中，72% 在 ≤36 个月大时进行了首次评估。按人口普查区水平家庭收入中位数 (MHI) 三分位数进行分层，36 个月时，低 MHI 三分位数 (72%) 评估的患有 ASD 和智力障碍的儿童比例低于高 MHI 三分位数 (84%)。 4 岁儿童（2014 年出生的每 1,000 名儿童 13.6 例）在 48 个月大时被诊断出 ASD 的累积发生率是 8 岁儿童（2010 年出生的每 1,000 名儿童 8.9 例）的 1.5 倍。在 MHI 三分位数中，48 个月时 ASD 诊断或符合资格的累积发生率较高与较低的 MHI 相关。疑似自闭症谱系障碍患病率为每 1,000 名 4 岁儿童中有 2.6 人患有自闭症谱系障碍，这意味着每 6 名患有自闭症谱系障碍的儿童中就有 1 名儿童患有疑似自闭症谱系障碍。 ASD 和疑似 ASD 的合并患病率（每 1,000 名 4 岁儿童 19.7 例）低于 8 岁儿童的 ASD 患病率（每 1,000 名 8 岁儿童 23.0 例）。历史上 ASD 患病率较低的群体（非白人和较低 MHI）在 2018 年 4 岁儿童中 ASD 患病率和累积发病率较高，这表明这些群体的识别工作取得了进展。然而，在 36 个月大时，低 MHI 三分位数中患有自闭症谱系障碍和智力障碍的儿童接受评估的比例低于高 MHI 组，这表明及时评估存在差异。与 8 岁儿童相比，4 岁儿童在 48 个月大时的累积诊断发生率或合格率更高，这表明 ASD 的早期识别有所改善。即使包括 4 岁怀疑患有 ASD 的儿童的患病率，4 岁儿童的总体患病率仍低于 8 岁儿童。这一发现表明，许多 4 岁后发现的儿童在 48 个月大时并未记录到疑似自闭症谱系障碍 (ASD)。与 2010 年出生的儿童相比，2014 年出生的儿童在 48 个月大时被诊断出患有自闭症谱系障碍的可能性更高，这表明早期识别率有所提高。然而，4 岁儿童的自闭症谱系障碍 (ASD) 识别因地点而异，这表明有机会检查促进早期识别的发育筛查和诊断实践。 4 岁儿童也比 8 岁儿童更有可能同时出现智力障碍，这表明仍需要改进对认知障碍之外的发育问题的早期识别和评估。改善自闭症谱系障碍的早期识别可能会导致更早接受基于证据的干预措施，并可能改善发育结果。
Autism spectrum disorder (ASD). 2018. The Autism and Developmental Disabilities Monitoring Network is an active surveillance program that estimates ASD prevalence and monitors timing of ASD identification among children aged 4 and 8 years. This report focuses on children aged 4 years in 2018, who were born in 2014 and had a parent or guardian who lived in the surveillance area in one of 11 sites (Arizona, Arkansas, California, Georgia, Maryland, Minnesota, Missouri, New Jersey, Tennessee, Utah, and Wisconsin) at any time during 2018. Children were classified as having ASD if they ever received 1) an ASD diagnostic statement (diagnosis) in an evaluation, 2) a special education classification of ASD (eligibility), or 3) an ASD International Classification of Diseases (ICD) code. Suspected ASD also was tracked among children aged 4 years. Children who did not meet the case definition for ASD were classified as having suspected ASD if their records contained a qualified professional’s statement indicating a suspicion of ASD. For 2018, the overall ASD prevalence was 17.0 per 1,000 (one in 59) children aged 4 years. Prevalence varied from 9.1 per 1,000 in Utah to 41.6 per 1,000 in California. At every site, prevalence was higher among boys than girls, with an overall male-to-female prevalence ratio of 3.4. Prevalence of ASD among children aged 4 years was lower among non-Hispanic White (White) children (12.9 per 1,000) than among non-Hispanic Black (Black) children (16.6 per 1,000), Hispanic children (21.1 per 1,000), and Asian/Pacific Islander (A/PI) children (22.7 per 1,000). Among children aged 4 years with ASD and information on intellectual ability, 52% met the surveillance case definition of co-occurring intellectual disability (intelligence quotient ≤70 or an examiner’s statement of intellectual disability documented in an evaluation). Of children aged 4 years with ASD, 72% had a first evaluation at age ≤36 months. Stratified by census-tract–level median household income (MHI) tertile, a lower percentage of children with ASD and intellectual disability was evaluated by age 36 months in the low MHI tertile (72%) than in the high MHI tertile (84%). Cumulative incidence of ASD diagnosis or eligibility received by age 48 months was 1.5 times as high among children aged 4 years (13.6 per 1,000 children born in 2014) as among those aged 8 years (8.9 per 1,000 children born in 2010). Across MHI tertiles, higher cumulative incidence of ASD diagnosis or eligibility received by age 48 months was associated with lower MHI. Suspected ASD prevalence was 2.6 per 1,000 children aged 4 years, meaning for every six children with ASD, one child had suspected ASD. The combined prevalence of ASD and suspected ASD (19.7 per 1,000 children aged 4 years) was lower than ASD prevalence among children aged 8 years (23.0 per 1,000 children aged 8 years). Groups with historically lower prevalence of ASD (non-White and lower MHI) had higher prevalence and cumulative incidence of ASD among children aged 4 years in 2018, suggesting progress in identification among these groups. However, a lower percentage of children with ASD and intellectual disability in the low MHI tertile were evaluated by age 36 months than in the high MHI group, indicating disparity in timely evaluation. Children aged 4 years had a higher cumulative incidence of diagnosis or eligibility by age 48 months compared with children aged 8 years, indicating improvement in early identification of ASD. The overall prevalence for children aged 4 years was less than children aged 8 years, even when prevalence of children suspected of having ASD by age 4 years is included. This finding suggests that many children identified after age 4 years do not have suspected ASD documented by age 48 months. Children born in 2014 were more likely to be identified with ASD by age 48 months than children born in 2010, indicating increased early identification. However, ASD identification among children aged 4 years varied by site, suggesting opportunities to examine developmental screening and diagnostic practices that promote earlier identification. Children aged 4 years also were more likely to have co-occurring intellectual disability than children aged 8 years, suggesting that improvement in the early identification and evaluation of developmental concerns outside of cognitive impairments is still needed. Improving early identification of ASD could lead to earlier receipt of evidence-based interventions and potentially improve developmental outcomes.
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影响因子：
3.8
作者：
Durkin MS;Maenner MJ;Benedict RE;Van Naarden Braun K;Christensen D;Kirby RS;Wingate M;Yeargin-Allsopp M
通讯作者：
Yeargin-Allsopp M
DOI：
10.15585/mmwr.ss6706a1
发表时间：
2018-04-27
期刊：
Morbidity and mortality weekly report. Surveillance summaries (Washington, D.C. : 2002)
影响因子：
--
作者：
Baio J;Wiggins L;Christensen DL;Maenner MJ;Daniels J;Warren Z;Kurzius-Spencer M;Zahorodny W;Robinson Rosenberg C;White T;Durkin MS;Imm P;Nikolaou L;Yeargin-Allsopp M;Lee LC;Harrington R;Lopez M;Fitzgerald RT;Hewitt A;Pettygrove S;Constantino JN;Vehorn A;Shenouda J;Hall-Lande J;Van Naarden Braun K;Dowling NF
通讯作者：
Dowling NF
影响因子：
8
作者：
Lappé M;Lau L;Dudovitz RN;Nelson BB;Karp EA;Kuo AA
通讯作者：
Kuo AA
影响因子：
7.6
作者：
Pickles, Andrew;McCauley, James B.;Lord, Catherine
通讯作者：
Lord, Catherine
影响因子：
12.7
作者：
Durkin, Maureen S.;Maenner, Matthew J.;Yeargin-Allsopp, Marshalyn
通讯作者：
Yeargin-Allsopp, Marshalyn