Am J Epidemiol. 2021 Oct 1;190(10):2198-2207. doi: 10.1093/aje/kwab106.
The Autism and Developmental Disabilities Monitoring (ADDM) Network conducts population-based surveillance of autism spectrum disorder (ASD) among 8-year-old children in multiple US communities. From 2000 to 2016, investigators at ADDM Network sites classified ASD from collected text descriptions of behaviors from medical and educational evaluations which were reviewed and coded by ADDM Network clinicians. It took at least 4 years to publish data from a given surveillance year. In 2018, we developed an alternative case definition utilizing ASD diagnoses or classifications made by community professionals. Using data from surveillance years 2014 and 2016, we compared the new and previous ASD case definitions. Compared with the prevalence based on the previous case definition, the prevalence based on the new case definition was similar for 2014 and slightly lower for 2016. Sex and race/ethnicity prevalence ratios were nearly unchanged. Compared with the previous case definition, the new case definition's sensitivity was 86% and its positive predictive value was 89%. The new case definition does not require clinical review and collects about half as much data, yielding more timely reporting. It also more directly measures community identification of ASD, thus allowing for more valid comparisons among communities, and reduces resource requirements while retaining measurement properties similar to those of the previous definition.
自闭症和发育障碍监测（ADDM）网络在多个美国社区对 8 岁儿童进行自闭症谱系障碍（ASD）的基于人群的监测。从 2000 年到 2016 年，ADDM 网络站点的研究人员根据从医疗和教育评估中收集的行为文字描述对 ASD 进行分类，这些描述由 ADDM 网络临床医生进行审查和编码。发表特定监测年度的数据需要至少 4 年的时间。2018 年，我们开发了一种替代的病例定义，利用社区专业人员做出的 ASD 诊断或分类。我们使用 2014 年和 2016 年的监测数据，比较了新的和以前的 ASD 病例定义。与以前的病例定义相比，新病例定义的患病率在 2014 年相似，而在 2016 年略低。性别和种族/族裔患病率比值几乎没有变化。与以前的病例定义相比，新病例定义的敏感性为 86%，阳性预测值为 89%。新病例定义不需要临床审查，并且收集的数据量约为一半，从而可以更及时地报告。它还更直接地衡量社区对 ASD 的识别，从而可以在社区之间进行更有效的比较，并减少资源需求，同时保留与以前定义相似的测量特性。
