Findings released by the CDC last month based on data collected in 2020 report one in 36 8-year-olds have been identified with autism spectrum disorder, up from one in 44 estimated in 2018.
This reported increase, from 2.3 percent to 2.6 percent, does not necessarily mean that more children have autism, but that the criteria for diagnosing autism has expanded, says Ahm Mahbubul Huq, a pediatric neurologist at the Children’s Hospital of Michigan.
“In 1943, when autism was first described, that criteria was more strict,” Huq says. “A lot of the change in prevalence is a change in diagnostic criteria and the request for diagnosis.”
Huq points to a 2011 autism study that found a similar rate of 2.64 percent in 7- to 12-year-old children in South Korea.
However, an autism prevalence rate of 2.6 percent in 8-year-olds is not insignificant, says Sarah Bauer, developmental and behavioral pediatrician and site medical director of the Pediatric Developmental Center at Advocate Illinois Masonic Medical Center.
“To put this in perspective, about 20 percent of kids in the United States have been identified as having an intellectual disorder, while the combined number of cases of kids with a seizure disorder and food allergies amounts to less than that,” Bauer says. “So this is a big deal—the estimate is higher than what we’ve seen in the past.”
The research on 4-year-olds and the research on 8-year-olds is conducted by the CDC-funded Autism and Developmental Disabilities Monitoring Network at 11 sites across the United States and is considered the authority on autism spectrum disorder prevalence.
The new findings also indicate an increase in autism in girls. While autism is still four times more common in boys, for the first time the prevalence of autism among 8-year-old girls has exceeded 1 percent.
Huq says the reporting of prevalence of autism in girls is multi-factored. Girls have been found to mask autism in different ways than boys, he says, and as a result may have been historically underdiagnosed.
“Autism is diagnosed through social interaction and communication, and girls can often mask their symptoms,” he says. “Researchers now are more cognizant because it’s known that autism could be missed in girls.”
Another important finding is autism prevalence among Asian, Black and Hispanic children was at least 30 percent higher in 2020 than 2018.
Disparities among populations with co-occurring intellectual disabilities have again been reported: a higher percentage of Black children with autism were identified as also having an intellectual disability. Researchers indicate this statistic could be tied to disparities in accessing services that diagnose and support children with autism.
Bauer says that even in Chicago, there is still work to be done in providing equitable care.
“There are neighborhoods that are not equitably serviced,” Bauer, a leader of the ECHO Autism program at Advocate Children’s Hospital, says. “Services for autism have been defined by geography and financial resources for too long.”
“How do we make sure everyone has the same access to care?” she adds. “It can’t be that you have to have private insurance to access these services — we have a long way to go.”
Something Bauer stresses in her practice is the importance of early autism detection and treatment.
“Families need to seek out help, and have a proactive versus reactive stance,” she says. “It’s important to get a diagnosis early to make sure the appropriate therapeutic education and medical interventions are put in place.”
She says that if families are concerned, they should bring it up to a pediatrician or to a professional through the school system. Acting as soon as possible is especially important for kids whose regular access to care was disrupted by the COVID-19 pandemic.
“A big part of this is that we are not seeing what the pandemic has done to early identification, since this data reflects information from 2020,” Bauer says.
“Over the course of the pandemic when everything was shut down, what didn’t happen were ongoing wellness checks where screenings occur,” she adds. “Child care suffered, so ensuring that families are talking to their pediatricians about their child’s development is more important than it’s ever been.”
Bauer says having those conversations and follow-ups can create an enormous change in the trajectory of a child’s life.
CDC’s “Learn the Signs. Act Early.” program provides free resources in English, Spanish, and other languages to monitor children’s development starting at 2 months of age. CDC’s Milestone Tracker mobile app can help parents and caregivers track their child’s development and share the information with their healthcare providers. For more information visit www.cdc.gov/ActEarly.
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