Prevalence and Characteristics of Autism Spectrum Disorder Among Children Aged 8 Years - Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2012.
Prevalence and Characteristics of Autism Spectrum Disorder Among Children Aged 8 Years - Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2012.
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DOI：
10.15585/mmwr.ss6513a1
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发表时间：
2018-11-16
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通讯作者：
Yeargin-Allsopp M
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作者：
Christensen DL;Braun KVN;Baio J;Bilder D;Charles J;Constantino JN;Daniels J;Durkin MS;Fitzgerald RT;Kurzius-Spencer M;Lee LC;Pettygrove S;Robinson C;Schulz E;Wells C;Wingate MS;Zahorodny W;Yeargin-Allsopp M
自闭症谱系障碍（ASD）。 2012 年。自闭症和发育障碍监测 (ADDM) 网络是一个主动监测系统，提供对父母或监护人居住在美国 11 个 ADDM 网络站点（阿肯色州、亚利桑那州、科罗拉多州、佐治亚州、马里兰州、密苏里州、新泽西州、北卡罗来纳州、南卡罗来纳州、犹他州和威斯康星州）的 8 岁儿童 ASD 患病率和特征的估计。确定 ASD 病例状况的监测分两个阶段进行。第一阶段由社区专业服务机构进行综合评价筛选和提炼。确定用于记录审查的数据源分为 1) 教育源类型，包括确定特殊教育服务资格的发展评估，或 2) 医疗保健源类型，包括诊断和发展评估。第二阶段包括由训练有素的临床医生审查所有抽象评估，以确定 ASD 监测病例状态。如果由合格的专业人员完成的对儿童的一项或多项综合评估所描述的行为符合精神障碍诊断和统计手册第四版文本修订版诊断标准，则该儿童符合自闭症谱系障碍（ASD）监测病例定义：自闭症、广泛性发育障碍（未另有说明）（包括非典型自闭症）或阿斯伯格障碍。本报告提供了 2012 年居住在 ADDM 网络站点覆盖范围内的 8 岁儿童的 ASD 患病率估计值，按性别、种族/族裔以及源记录类型（教育和健康记录与仅健康记录）进行总体分层。此外，本报告还描述了在标准化智力测试中得分与智力障碍一致的自闭症谱系障碍儿童的比例、最早进行已知综合评估的年龄、既往患有自闭症谱系障碍诊断的儿童的比例、自闭症谱系障碍诊断的具体类型以及任何特殊教育资格分类。 2012 年，11 个 ADDM 网络站点中自闭症谱系障碍 (ASD) 的综合患病率估计为每 1,000 名 8 岁儿童（每 69 名儿童中就有 1 名）14.5 例。估计 8 岁男孩的患病率（每 1,000 人 23.4 人）显着高于 8 岁女孩（每 1,000 人 5.2 人）。与非西班牙裔黑人儿童（每 1000 人 13.1 人）和 8 岁西班牙裔儿童（每 1000 人 10.2 人）相比，8 岁非西班牙裔白人儿童（每 1000 人 15.3 人）的 ASD 患病率估计明显更高。 11 个 ADDM 网络站点之间的估计患病率差异很大，从每 1,000 名 8 岁儿童中的 8.2 例（在仅审查医疗保健记录的马里兰州站点区域）到每 1,000 名 8 岁儿童中的 24.6 例（在新泽西州，审查了教育和医疗保健记录）。与仅审查健康记录的监测点相比，审查教育记录和健康记录的监测点的估计患病率较高（分别为每 1,000 名 8 岁儿童 17.1 名和每 1,000 名 10.4 名 8 岁儿童）。在 ADDM 网络确定患有 ASD 的儿童中，82% 之前有过 ASD 诊断或教育分类；这并不因性别或非西班牙裔白人和非西班牙裔黑人儿童而异。与非西班牙裔白人儿童 (82%) 和非西班牙裔黑人儿童 (84%) 相比，西班牙裔儿童 (78%) 之前有过 ASD 诊断或分类的比例较低。已知最早综合评估的中位年龄为 40 个月，43% 的儿童在 36 个月大时接受了已知最早综合评估。男孩和女孩在 36 个月大时进行已知最早综合评估的比例相似，但非西班牙裔白人儿童 (45%) 高于非西班牙裔黑人儿童 (40%) 和西班牙裔儿童 (39%)。 2012 年，ADDM 网络站点中自闭症谱系障碍总体估计患病率为每 1,000 名 8 岁儿童 14.5 例。审查教育和健康记录的站点中估计患病率较高，这表明特殊教育系统在为发育障碍儿童提供全面评估和服务方面发挥着重要作用。估计自闭症谱系障碍患病率（尤其是西班牙裔儿童）因种族/族裔而存在差异，以及最早进行综合评估的年龄和先前自闭症谱系障碍诊断或分类的年龄差异，表明某些儿童可能缺乏或延迟获得治疗和服务。 ADDM 网络将继续监测居住在美国选定地点的 8 岁儿童中 ASD 的患病率和特征。 ADDM 网络的建议包括加强战略：1) 根据“健康人民 2020”目标，降低社区提供者首次评估 ASD 的年龄，即患有 ASD 的儿童在 36 个月大时接受评估，并在 48 个月大时开始接受基于社区的支持和服务； 2) 减少种族/族裔在已确定的 ASD 患病率、首次综合评估的年龄以及先前 ASD 诊断或分类方面的差异； 3) 评估《精神疾病诊断与统计手册》第五版中发布的修订版 ASD 诊断标准对 ASD 患病率的影响。
Autism spectrum disorder (ASD). 2012. The Autism and Developmental Disabilities Monitoring (ADDM) Network is an active surveillance system that provides estimates of the prevalence and characteristics of ASD among children aged 8 years whose parents or guardians reside in 11 ADDM Network sites in the United States (Arkansas, Arizona, Colorado, Georgia, Maryland, Missouri, New Jersey, North Carolina, South Carolina, Utah, and Wisconsin). Surveillance to determine ASD case status is conducted in two phases. The first phase consists of screening and abstracting comprehensive evaluations performed by professional service providers in the community. Data sources identified for record review are categorized as either 1) education source type, including developmental evaluations to determine eligibility for special education services or 2) health care source type, including diagnostic and developmental evaluations. The second phase involves the review of all abstracted evaluations by trained clinicians to determine ASD surveillance case status. A child meets the surveillance case definition for ASD if one or more comprehensive evaluations of that child completed by a qualified professional describes behaviors that are consistent with the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision diagnostic criteria for any of the following conditions: autistic disorder, pervasive developmental disorder–not otherwise specified (including atypical autism), or Asperger disorder. This report provides ASD prevalence estimates for children aged 8 years living in catchment areas of the ADDM Network sites in 2012, overall and stratified by sex, race/ethnicity, and the type of source records (education and health records versus health records only). In addition, this report describes the proportion of children with ASD with a score consistent with intellectual disability on a standardized intellectual ability test, the age at which the earliest known comprehensive evaluation was performed, the proportion of children with a previous ASD diagnosis, the specific type of ASD diagnosis, and any special education eligibility classification. For 2012, the combined estimated prevalence of ASD among the 11 ADDM Network sites was 14.5 per 1,000 (one in 69) children aged 8 years. Estimated prevalence was significantly higher among boys aged 8 years (23.4 per 1,000) than among girls aged 8 years (5.2 per 1,000). Estimated ASD prevalence was significantly higher among non-Hispanic white children aged 8 years (15.3 per 1,000) compared with non-Hispanic black children (13.1 per 1,000), and Hispanic (10.2 per 1,000) children aged 8 years. Estimated prevalence varied widely among the 11 ADDM Network sites, ranging from 8.2 per 1,000 children aged 8 years (in the area of the Maryland site where only health care records were reviewed) to 24.6 per 1,000 children aged 8 years (in New Jersey, where both education and health care records were reviewed). Estimated prevalence was higher in surveillance sites where education records and health records were reviewed compared with sites where health records only were reviewed (17.1 per 1,000 and 10.4 per 1,000 children aged 8 years, respectively; p<0.05). Among children identified with ASD by the ADDM Network, 82% had a previous ASD diagnosis or educational classification; this did not vary by sex or between non-Hispanic white and non-Hispanic black children. A lower percentage of Hispanic children (78%) had a previous ASD diagnosis or classification compared with non-Hispanic white children (82%) and with non-Hispanic black children (84%). The median age at earliest known comprehensive evaluation was 40 months, and 43% of children had received an earliest known comprehensive evaluation by age 36 months. The percentage of children with an earliest known comprehensive evaluation by age 36 months was similar for boys and girls, but was higher for non-Hispanic white children (45%) compared with non-Hispanic black children (40%) and Hispanic children (39%). Overall estimated ASD prevalence was 14.5 per 1,000 children aged 8 years in the ADDM Network sites in 2012. The higher estimated prevalence among sites that reviewed both education and health records suggests the role of special education systems in providing comprehensive evaluations and services to children with developmental disabilities. Disparities by race/ethnicity in estimated ASD prevalence, particularly for Hispanic children, as well as disparities in the age of earliest comprehensive evaluation and presence of a previous ASD diagnosis or classification, suggest that access to treatment and services might be lacking or delayed for some children. The ADDM Network will continue to monitor the prevalence and characteristics of ASD among children aged 8 years living in selected sites across the United States. Recommendations from the ADDM Network include enhancing strategies to 1) lower the age of first evaluation of ASD by community providers in accordance with the Healthy People 2020 goal that children with ASD are evaluated by age 36 months and begin receiving community-based support and services by age 48 months; 2) reduce disparities by race/ethnicity in identified ASD prevalence, the age of first comprehensive evaluation, and presence of a previous ASD diagnosis or classification; and 3) assess the effect on ASD prevalence of the revised ASD diagnostic criteria published in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition.