Prevalence of autism spectrum disorder among children aged 8 years - autism and developmental disabilities monitoring network, 11 sites, United States, 2010.
Prevalence of autism spectrum disorder among children aged 8 years - autism and developmental disabilities monitoring network, 11 sites, United States, 2010.
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2014-03
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通讯作者：
J. Baio
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作者：
J. Baio
自闭症谱系障碍（ASD）。2010年期间。系统描述自闭症和发育障碍监测（ADDM）网络是美国的一个主动监测系统，提供父母或监护人居住在美国11个ADDM站点的8岁儿童的ASD患病率和其他特征的估计。ADDM监测分两个阶段进行。第一阶段包括筛选和提取由社区专业提供者进行的综合评价。这些评估的多个数据来源包括普通儿科健康诊所和发育障碍儿童的专门计划。此外，大多数ADDM网络网站还审查和提取在公立学校接受特殊教育服务的儿童的记录。第二阶段涉及由经过培训的临床医生审查所有抽象评价，以确定ASD监测病例状态。如果由合格的专业人员完成的儿童综合评估描述的行为符合精神疾病诊断和统计手册第四版文本修订版（DSM-IV-TR）对以下任何情况的诊断标准，则儿童符合ASD的监测病例定义：自闭症，广泛性发育障碍-未另行说明（包括非典型自闭症）或自闭症。本报告提供了自2010年监测年度以来ASD的最新患病率估计。除了患病率估计，自闭症儿童的人口特征进行了描述。结果：2010年，ADDM站点中ASD的总体患病率为14.7/1000（1/68）8岁儿童。各研究中心的ASD患病率估计值从每1,000名8岁儿童5.7至21.9不等。ASD患病率估计值也因性别和种族/民族而异。在ADDM网络社区中，大约每42个男孩中就有一个，每189个女孩中就有一个被确定为患有ASD。非西班牙裔白色儿童比非西班牙裔黑人儿童更有可能被识别为ASD，并且比西班牙裔儿童更有可能被识别为ASD。在7个有足够智力数据的研究中心中，31%的ASD儿童的智商得分在智力残疾范围内（智商≤70），23%在边缘范围内（智商= 71-85），46%在智力能力的平均或高于平均范围（智商>85）。被归类为智力残疾的儿童比例因种族/族裔而异。大约48%的非西班牙裔黑人ASD儿童被归类为智力残疾，而西班牙裔儿童为38%，非西班牙裔白色儿童为25%。已知最早ASD诊断的中位年龄为53个月，性别或种族/民族之间没有显著差异。这些来自CDC ADDM网络的发现基于2010年11个站点报告的数据，提供了美国多个社区ASD患病率的最新基于人群的估计。由于ADDM网络站点没有提供整个美国的代表性样本，因此本报告中提供的合并患病率估计值不能推广到美国人口中所有8岁儿童。与ADDM网络以前的报告一致，2010年监测年的结果显示，ASD患病率在地理区域、性别、种族/民族和智力水平方面存在显著差异。这种差异在多大程度上可能归因于诊断实践，某些种族/民族对ASD症状的认识不足，获得服务的社会经济差异以及可能影响本报告结果的临床或学校实践的区域差异尚不清楚。公共卫生行动ADDM网络研究人员将继续监测选定社区的ASD患病率，重点探索这些社区内可能影响观察到的ASD患病率和患有ASD的儿童的基于人群的特征的变化。虽然ASD有时在2岁时被诊断出来，但在ADDM网络社区中，首次ASD诊断的中位年龄仍然大于4岁。ADDM网络的建议包括加强战略，以满足以下需求：1）标准化，广泛采用的措施，以记录ASD严重程度和与ASD诊断相关的功能限制; 2）改善对ASD症状的识别和记录，特别是男孩和女孩，无智力残疾的儿童以及所有种族/民族的儿童; 3）降低儿童首次接受ASD评估和诊断并加入社区支持系统的年龄。
PROBLEM/CONDITION Autism spectrum disorder (ASD). PERIOD COVERED 2010. DESCRIPTION OF SYSTEM The Autism and Developmental Disabilities Monitoring (ADDM) Network is an active surveillance system in the United States that provides estimates of the prevalence of ASD and other characteristics among children aged 8 years whose parents or guardians live in 11 ADDM sites in the United States. ADDM surveillance is conducted in two phases. The first phase consists of screening and abstracting comprehensive evaluations performed by professional providers in the community. Multiple data sources for these evaluations include general pediatric health clinics and specialized programs for children with developmental disabilities. In addition, most ADDM Network sites also review and abstract records of children receiving special education services in public schools. The second phase involves review of all abstracted evaluations by trained clinicians to determine ASD surveillance case status. A child meets the surveillance case definition for ASD if a comprehensive evaluation of that child completed by a qualified professional describes behaviors consistent with the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) 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 updated prevalence estimates for ASD from the 2010 surveillance year. In addition to prevalence estimates, characteristics of the population of children with ASD are described. RESULTS For 2010, the overall prevalence of ASD among the ADDM sites was 14.7 per 1,000 (one in 68) children aged 8 years. Overall ASD prevalence estimates varied among sites from 5.7 to 21.9 per 1,000 children aged 8 years. ASD prevalence estimates also varied by sex and racial/ethnic group. Approximately one in 42 boys and one in 189 girls living in the ADDM Network communities were identified as having ASD. Non-Hispanic white children were approximately 30% more likely to be identified with ASD than non-Hispanic black children and were almost 50% more likely to be identified with ASD than Hispanic children. Among the seven sites with sufficient data on intellectual ability, 31% of children with ASD were classified as having IQ scores in the range of intellectual disability (IQ ≤70), 23% in the borderline range (IQ = 71-85), and 46% in the average or above average range of intellectual ability (IQ >85). The proportion of children classified in the range of intellectual disability differed by race/ethnicity. Approximately 48% of non-Hispanic black children with ASD were classified in the range of intellectual disability compared with 38% of Hispanic children and 25% of non-Hispanic white children. The median age of earliest known ASD diagnosis was 53 months and did not differ significantly by sex or race/ethnicity. INTERPRETATION These findings from CDC's ADDM Network, which are based on 2010 data reported from 11 sites, provide updated population-based estimates of the prevalence of ASD in multiple communities in the United States. Because the ADDM Network sites do not provide a representative sample of the entire United States, the combined prevalence estimates presented in this report cannot be generalized to all children aged 8 years in the United States population. Consistent with previous reports from the ADDM Network, findings from the 2010 surveillance year were marked by significant variations in ASD prevalence by geographic area, sex, race/ethnicity, and level of intellectual ability. The extent to which this variation might be attributable to diagnostic practices, underrecognition of ASD symptoms in some racial/ethnic groups, socioeconomic disparities in access to services, and regional differences in clinical or school-based practices that might influence the findings in this report is unclear. PUBLIC HEALTH ACTION ADDM Network investigators will continue to monitor the prevalence of ASD in select communities, with a focus on exploring changes within these communities that might affect both the observed prevalence of ASD and population-based characteristics of children identified with ASD. Although ASD is sometimes diagnosed by 2 years of age, the median age of the first ASD diagnosis remains older than age 4 years in the ADDM Network communities. Recommendations from the ADDM Network include enhancing strategies to address the need for 1) standardized, widely adopted measures to document ASD severity and functional limitations associated with ASD diagnosis; 2) improved recognition and documentation of symptoms of ASD, particularly among both boys and girls, children without intellectual disability, and children in all racial/ethnic groups; and 3) decreasing the age when children receive their first evaluation for and a diagnosis of ASD and are enrolled in community-based support systems.