National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia.
National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia.
J Am Acad Child Adolesc Psychiatry. 2022 Jul;61(7):905-914. doi: 10.1016/j.jaac.2021.11.019. Epub 2021 Nov 24.
Early identification can improve outcomes for children with autism spectrum disorder (ASD). We sought to assess changes in early ASD identification over time and by co-occurring intellectual disability (ID) and race/ethnicity.
Using data for 2002-2016 from a biennial population-based ASD surveillance program among 8-year-old children in the United States, we defined identification as a child's earliest recorded ASD diagnosis or special education eligibility. Unidentified children had characteristics meeting the ASD surveillance case definition but no recorded identification by age 8 years. We calculated median age at identification among identified children, median age at identification including unidentified children, and cumulative incidence of identification by age 48 months.
ASD identification by age 48 months was 4 times (95% CI: 3.6-4.3) as likely in 2016 as in 2002, with the largest increases among children without ID. Median age at ASD identification among identified children decreased 3 months during this time. Children of every race/ethnicity were more likely to be identified over time. There were racial disparities stratified by ID: in 2016, Black and Hispanic children without ID were less likely to be identified with ASD than were White children (both groups risk ratio: 0.7; 95% CI: 0.5-0.8), but Black children were 1.5 times (95% CI: 1.3-1.9) as likely as White children to be identified with ASD and ID.
Substantial progress has been made to identify more children with ASD early, despite minimal decrease in median age at diagnosis. Considerable disparities remain in early ASD identification by race/ethnicity and co-occurring intellectual disability.
早期识别可以改善自闭症谱系障碍（ASD）儿童的预后。我们旨在评估随着时间的推移以及同时存在智力障碍（ID）和种族/民族的情况下，早期 ASD 识别的变化。
使用美国 8 岁儿童每两年进行一次的基于人群的 ASD 监测计划在 2002 年至 2016 年之间的数据，我们将识别定义为儿童最早记录的 ASD 诊断或特殊教育资格。未被识别的儿童具有符合 ASD 监测病例定义的特征，但在 8 岁时没有记录到任何识别。我们计算了已识别儿童的平均年龄，包括未识别儿童的平均年龄，以及在 48 个月龄时识别的累积发生率。
到 48 个月龄时，2016 年与 2002 年相比，ASD 的识别率增加了 4 倍（95%CI：3.6-4.3），而 ID 儿童的增幅最大。在此期间，已识别儿童的平均年龄减少了 3 个月。每个种族/民族的儿童随着时间的推移越来越有可能被识别。在按 ID 分层的情况下存在种族差异：在 2016 年，没有 ID 的黑人儿童和西班牙裔儿童被诊断为 ASD 的可能性比白人儿童低（两组风险比：0.7；95%CI：0.5-0.8），但黑人儿童被诊断为 ASD 和 ID 的可能性是白人儿童的 1.5 倍（95%CI：1.3-1.9）。
尽管诊断的中位数年龄几乎没有下降，但在早期识别 ASD 方面已经取得了重大进展。种族/民族和同时存在的智力障碍方面在早期 ASD 识别方面仍存在较大差异。
