2016 Autism and Developmental Disabilities Monitoring (ADDM) Network Surveillance Summary - PowerPoint Presentation

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2016 Autism and Developmental Disabilities Monitoring (ADDM) Network Surveillance SummarySupplemental Slides

Published March 26, 2020

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2016 ADDM Surveillance Summary Citations and Links

Maenner MJ, Shaw KA, Baio J, et al. Prevalence of autism spectrum disorder among children aged 8 years—Autism and Developmental Disability Monitoring Network, 11 sites, United States, 2016.

MMWR

Surveill

Summ

2020;69(No. SS-4)

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Shaw KA, Maenner MJ, Baio J, et al. Early identification of autism spectrum disorder among children aged 4 years—Early Autism and Developmental Disabilities Monitoring Network, six sites, United States, 2016.

MMWR

Surveill

Summ

2020;69(No. SS-3)

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2016Prevalence of Autism Spectrum Disorder Among Children Aged 8 Years

Autism and Developmental Disabilities Monitoring Network

11 Sites, United States

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Autism and Developmental Disabilities Monitoring Network, 11 sites, United States, 2016

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ADDM Case Ascertainment

Children were identified from records that included various billing codes from the

International Classification of Disease, Ninth Revision

(ICD-9) or

International Classification of Diseases, Tenth Revision

(ICD-10) or special education exceptionalities

First, abstracters reviewed records from medical, education, and service providers in the community

Second, clinicians reviewed all available records for each child and determined if the child met the ASD case definition based on

Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition

(DSM-5) criteria.

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ADDM Case Determination Using DSM-5 Criteria

A. Persistent deficits in social communication and social interaction

A1: Deficits in social emotional reciprocity

A2. Deficits in nonverbal communicative behaviors

A3. Deficits in developing, maintaining, and understanding relationships

B. Restricted, repetitive patterns of behavior, interests, or activities, currently or by history

B1: Stereotyped or repetitive motor movements, use of objects or speech

B2. Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behavior

B3. Highly restricted interests that are abnormal in intensity or focus

B4. Hyper- or hypo-reactivity to sensory input or unusual interest in sensory aspects of the environment

Historical PDD

diagnosis

Any ASD diagnosis documented in a comprehensive evaluation, including a DSM-IV diagnosis of autistic disorder, Asperger disorder, or pervasive developmental disorder–not otherwise specified (PDD-NOS)

DSM-5 case determination

All three behavioral criteria coded under part A, and at least two behavioral criteria coded under part B

OR

Any ASD diagnosis documented in a comprehensive evaluation, whether based on DSM-IV-TR or DSM-5 diagnostic criteria

Note: A child might be disqualified from meeting the DSM-5 surveillance case definition for ASD if, based on the clinical judgment of one or more reviewers, there is insufficient or conflicting information in support of ASD, sufficient information to rule out ASD, or if one or more other diagnosed conditions better account for the child’s symptoms

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ADDM Additional Data Sources and Variable Definitions

National Center for Health Statistics

population estimates

for 2016 were used as denominators. Estimates for areas smaller than county level were standardized using National Center for Education Statistics public school

enrollment counts

for 2016.

Co-occurring intellectual disability (IQ):

IQ score ≤70 on most recent test

examiner’s statement of intellectual disability in a developmental evaluation

Community-identified ASD:

a diagnostic statement from a qualified professional of autistic disorder, pervasive developmental disorder not otherwise specified, Asperger disorder, or ASD

any ASD ICD billing code at any time from birth through 2016

receipt of (or met eligibility for) special education services under the autism classification in public school

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ADDM Analytic Methods

Prevalence was calculated as the number of children with ASD per 1,000 children aged 8 years in the defined population or subgroup.

Cumulative incidence of ASD diagnoses was calculated as the total number of children with ASD diagnosed during or before a given month of age, divided by the total population of children aged 8 years in the surveillance area.

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Prevalence of autism spectrum disorder per 1,000 children aged 8 years, overall and by siteAutism and Developmental Disabilities Monitoring Network, 11 sites, United States, 2016

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Prevalence of autism spectrum disorder per 1,000 children aged 8 years, by sex and race/ethnicityAutism and Developmental Disabilities Monitoring Network, 11 sites, United States, 2016

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Prevalence of autism spectrum disorder per 1,000 children aged 8 years, by intelligence quotient score, overall and by siteAutism and Developmental Disabilities Monitoring Network, 10 sites*, United States, 2016

* Missouri is not included because it did not collect IQ information on at least 60% of children with ASD.

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Percent of children aged 8 years with autism spectrum disorder with co-occurring intellectual disability*, by sex and race/ethnicityAutism and Developmental Disabilities Monitoring Network, 10 sites†, United States, 2016

* IQ score ≤70 or examiner statement of intellectual disability in a comprehensive evaluation† Missouri is not included because it did not collect IQ information on at least 60% of children with ASD.

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Percent of children with autism spectrum disorder aged 8 years with earliest known comprehensive evaluation by age 36 months, by race/ethnicityAutism and Developmental Disabilities Monitoring Network, 11 sites, United States, 2016

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Median age at earliest documented autism spectrum disorder diagnosis,

by presence of co-occurring intellectual disability* and race/ethnicityAutism and Developmental Disabilities Monitoring Network, 11 sites, United States, 2016

* IQ score ≤70 or examiner statement of intellectual disability in a comprehensive evaluation

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Comparison of autism spectrum disorder prevalence per 1,000 children aged 8 years using Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, criteria (DSM-5)* and community-identified† autism spectrum disorder prevalence, by siteAutism and Developmental Disabilities Monitoring Network, 11 sites, United States, 2016

* clinical record review applying DSM-5 criteria† autism diagnosis stated in an evaluation, autism eligibility for special education, or autism ICD code in record. Missouri, Colorado, and Wisconsin had limited access to information from educational records

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Cumulative incidence of autism spectrum disorder diagnoses per 1,000 children aged 8 years, by age and siteAutism and Developmental Disabilities Monitoring Network, 11 sites, United States, 2016

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Prevalence of autism spectrum disorder per 1,000 children aged 8 years, by surveillance yearAutism and Developmental Disabilities Monitoring Network

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2016Early Identification of Autism Spectrum Disorder Among Children Aged 4 Years

Early Autism and Developmental Disabilities Monitoring Network

6 Sites, United States

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Early Autism and Developmental Disabilities Monitoring Network, 6 sites, United States, 2016

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Early ADDM Case Ascertainment

Children were identified from records that included various billing codes from the

International Classification of Disease, Ninth Revision

(ICD-9) or

International Classification of Diseases, Tenth Revision

(ICD-10) or special education exceptionalities

First, abstracters reviewed records from medical, education, and service providers in the community

Second, clinicians reviewed all available records for each child and determined if the child met the ASD case definition based on

Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition

(DSM-5) criteria.

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Early ADDM Case Determination Using DSM-5 Criteria

A. Persistent deficits in social communication and social interaction

A1: Deficits in social emotional reciprocity

A2. Deficits in nonverbal communicative behaviors

A3. Deficits in developing, maintaining, and understanding relationships

B. Restricted, repetitive patterns of behavior, interests, or activities, currently or by history

B1: Stereotyped or repetitive motor movements, use of objects or speech

B2. Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behavior

B3. Highly restricted interests that are abnormal in intensity or focus

B4. Hyper- or hypo-reactivity to sensory input or unusual interest in sensory aspects of the environment

Historical PDD

diagnosis

Any ASD diagnosis documented in a comprehensive evaluation, including a DSM-IV diagnosis of autistic disorder, Asperger disorder, or pervasive developmental disorder–not otherwise specified (PDD-NOS)

DSM-5 case determination

All three behavioral criteria coded under part A, and at least two behavioral criteria coded under part B

OR

Any ASD diagnosis documented in a comprehensive evaluation, whether based on DSM-IV-TR or DSM-5 diagnostic criteria

Note: A child might be disqualified from meeting the DSM-5 surveillance case definition for ASD if, based on the clinical judgment of one or more reviewers, there is insufficient or conflicting information in support of ASD, sufficient information to rule out ASD, or if one or more other diagnosed conditions better account for the child’s symptoms

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Early ADDM Additional Data Sources and Variable Definitions

National Center for Health Statistics

population estimates

for 2016 were used as denominators. Estimates for areas smaller than county level were standardized using National Center for Education Statistics public school

enrollment counts

for 2016.

Co-occurring intellectual disability (IQ):

IQ score ≤70 on most recent test

examiner’s statement of intellectual disability in a developmental evaluation

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Early ADDM Analytic Methods

Prevalence was calculated as the number of children with ASD per 1,000 children aged 4 years in the defined population or subgroup.

Cumulative incidence for children aged 4 years was compared with the subset of children aged 8 years from the overall ADDM Network who lived in the Early ADDM Network surveillance areas. Cumulative incidence of ASD diagnosis was calculated by dividing the total number of children with diagnoses at each month of age by the 2016 population denominator for each age group.

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Percent of children aged 4 years with autism spectrum disorder with earliest known evaluation by age 36 months, by site and surveillance yearEarly Autism and Developmental Disabilities Monitoring Network, 6 sites, United States, 2014 & 2016

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Cumulative incidence of autism spectrum disorder diagnoses per 1,000 children aged 4 or 8 yearsEarly Autism and Developmental Disabilities Monitoring Network, 6 sites, United States, 2016

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Cumulative incidence of autism spectrum disorder diagnoses per 1,000 children aged 4 or 8 years by siteEarly Autism and Developmental Disabilities Monitoring Network, 6 sites, United States, 2016

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Cumulative incidence of autism spectrum disorder diagnoses per 1,000 children aged 4 or 8 years by sexEarly Autism and Developmental Disabilities Monitoring Network, 6 sites, United States, 2016

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