Prevalence of Autism in a US Metropolitan Area

TLDR

Concern has been raised about possible increases in autism prevalence, yet few population‑based studies have been conducted in the United States. The study aimed to determine autism prevalence among children aged 3–10 in metropolitan Atlanta in 1996 and describe the study population’s characteristics. Researchers identified cases by screening and abstracting records from multiple medical and educational sources, with expert review determining case status, and analyzed prevalence across demographic factors, cognitive levels, prior diagnoses, special education categories, and identification sources. Autism prevalence was 3.4 per 1,000 (95% CI 3.2–3.6) with a 4:1 male‑female ratio; rates were similar for black and white children, 68% had cognitive impairment, the male‑female ratio fell with increasing severity, 40% were identified only through schools, and the overall rate was higher than earlier U.S.

Abstract

Concern has been raised about possible increases in the prevalence of autism. However, few population-based studies have been conducted in the United States.To determine the prevalence of autism among children in a major US metropolitan area and to describe characteristics of the study population.Study of the prevalence of autism among children aged 3 to 10 years in the 5 counties of metropolitan Atlanta, Ga, in 1996. Cases were identified through screening and abstracting records at multiple medical and educational sources, with case status determined by expert review.Autism prevalence by demographic factors, levels of cognitive functioning, previous autism diagnoses, special education eligibility categories, and sources of identification.A total of 987 children displayed behaviors consistent with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria for autistic disorder, pervasive developmental disorder-not otherwise specified, or Asperger disorder. The prevalence for autism was 3.4 per 1000 (95% confidence interval [CI], 3.2-3.6) (male-female ratio, 4:1). Overall, the prevalence was comparable for black and white children (black, 3.4 per 1000 [95% CI, 3.0-3.7] and white, 3.4 per 1000 [95% CI, 3.2-3.7]). Sixty-eight percent of children with IQ or developmental test results (N = 880) had cognitive impairment. As severity of cognitive impairment increased from mild to profound, the male-female ratio decreased from 4.4 to 1.3. Forty percent of children with autism were identified only at educational sources. Schools were the most important source for information on black children, children of younger mothers, and children of mothers with less than 12 years of education.The rate of autism found in this study was higher than the rates from studies conducted in the United States during the 1980s and early 1990s, but it was consistent with those of more recent studies.