Overview Describe what autism is 2008 AUTISM SPECTRUM DISORDERS PREVALENCE RESULTS Lisa Miller, MD MSPH Describe the Autism and Developmental Disabilities i Monitoring i (ADDM) Network and its methodology Present the 2008 results Present surveillance trends for Arapahoe County What is Autism? A group of developmental disabilities that cause significant social, communication and behavioral challenges over a lifetime. Can range from mild to severe. ASD characteristics Measured intelligence Severe-------------------------------------Gifted Social interaction Aloof----------------Passive-------------Active but odd Communication Nonverbal------------------------------------------Verbal Behaviors Intense-----------------------------------------------Mild Sensory Hyposensitve---------------------------Hypersensitive Motor Uncoordinated-----------------------------Coordinated Slide courtesy of Catherine Rice, PhD METHODS Active case-finding with broad retrospective records-based screening for ASD classifications or behaviors. Focus on children at age 8 to identify peak prevalence. Multiple health and education sources of information. Detailed behavioral, developmental, and testing information collected. Ongoing quality control within and across sites. Independent review and clinician confirmation of ASD case status based on the DSM-IV criteria. * CDC Slide Standard for setting ASD prevalence estimates in the U.S. * CDC Slide 1
COLORADO MONITORING PROJECT Goal: To determine the prevalence of autism spectrum disorders (ASD) among children who were 8 years of age in 2008. Denver Metropolitan area: Adams, Arapahoe, Boulder, Broomfield, Denver, Douglas, and Jefferson counties Complete participation : Areas with both health sources and school district participation 2002: Arapahoe and Boulder counties 2006 and 2008: Arapahoe county Permission to Access Records Health care facilities: ASD is a reportable public health condition Children < 10 years of age with confirmed or suspected ASD identified by health facilities in the Denver Metropolitan area are reportable to the Colorado Department of Public Health and Environment. Schools: Individual agreements were developed with each participating school district and/or IRB approvals. 2006 AND 2008 OLORADO ADDM COLORADO RESULTS 2008 8 year olds Lisa Miller, MD, MSPH Andria Ratchford, MSPH (Project Coordinator) Jean Menconi, RN (Abstractor) Vicki Bondurant (Abstractor) Stephanie Comienski (Abstractor) Beverly Meek (Abstractor) Kevin Hake (Data Manager) Corry Robinson, PhD, RN Judy Reaven, PhD (Expert Reviewer) Terry Hall, MA, CCC-SLP (Expert Reviewer) Andrea Hoog (Expert reviewer) Gina Quintana Yolanda Castillo, MBA (Project Coordinator) Gabriela Perez (Abstractor) 2008 COLORADO POPULATION CHARACTERISTICS Arapahoe county 6-county Denver area Population Characteristics N % N % Total 8 year-old Population in 2008 7,725725 29,336 White, Non-Hispanic 3,990 51.7 16,923 57.7 Black, Non-Hispanic 1,051 13.6 1,390 4.7 American Indian/Alaskan Native, 64 0.8 184 0.6 Non-Hispanic Asian, Non-Hispanic 387 5.0 1,179 4.0 Hispanic (regardless of race) 2,233 28.9 9,660 32.9 Source Characteristics source types School: 19% Health: 22% Both: 59% Denver metro area source types Health: 100% 2
2008 ASD estimated prevalence per 1,000 persons among 8-year-old children Surveillance Year OVERALL ASD Estimated Prevalence, 2000-20082008 Birth Year # sites 8-year-old Population 8-year-olds with an ASD 2000 1992 6 187,761 1,252 2002 1994 14 407,578 2,685 2004 1996 8 172,335 1,376 2006 1998 11 308,038 2,759 2008 2000 14 337,093 3,820 Ave Prev/1000 Range 6.7 4.5-9.9 6.6 3.3-10.6 8.0 4.6-9.8 9.0 4.2-12.1 11.3 4.8 21.2 * modified CDC Slide 2008 Estimated Prevalence by Sex 2008 Estimated Prevalence per 1,000 by Race /Ethnicity ADDM network Males 18.4 per 1,000 (1 in 54) 20.1 per 1,000 (1 in 50) Females 4.0 per 1,000 (1 in 250) 2.9 per 1,000 (1 in 345) Male to female ratio almost 5 boys to every 1 girl 7 boys to every 1 girl ADDM Network Average rate Range Rate 95% CI White, non-hispanic i 12.0 (4.6 to 40.0) 0) 14.8 11.5 19.11 Black, non-hispanic 10.2 (3.0 to 25.9) 10.5 5.8 18.9 Hispanic 7.9 (1.4 to 20.0) 6.7 4.1 11.1 Associated Features of ASD Cases,, 2008 ASSOCIATED FEATURE N Percent Abnormality in eating/drinking 53 58.2 Abnormality in sleeping 35 38.5 Abnormality in mood/affect 77 84.6 Abnormality in cognitive skills 37 40.7 Aggression 50 54.9 Argumentative, defiant, oppositional 75 82.4 Delayed motor functioning 74 81.3 Hyperactivity, attention problems 87 95.6 Lack of fear or excessive fear 46 50.5 Odd response to sensory stimuli 73 80.2 Self injurious behavior 30 33.0 Staring spells/seizure like activity 22 24.2 Temper tantrums 46 50.5 Earliest Known ASD Diagnosis Median Age and Proportion by Diagnostic Subtype ADDM Network and, 2008 Subtype of Earliest Diagnosis: Distribution of subtypes, ADDM Network: Median age of earliest diagnosis, ADDM Network: Distribution of subtypes, Median age of earliest diagnosis, Autistic Disorder ASD/PDD Asperger Disorder 44% 47% 9% 48 months 53 months 75 months 46% 40% 14% 52 months 54 months 79 months 3
Percent of cases in special education and with an ASD classification, ADDM Network, 2008 Percent of Children with ASD by Primary Education Eligibility Category, 2008 Primary Exceptionality Percent Autism 39.0 Emotional disturbance 2.6 Speech/Language Disability 19.5 Other Physical Disability 27.3 Multiple Disabilities with Cognitive Impairment 7.8 Intellectual disability 3.9 84.6% of all children were receiving Special Education services Estimated prevalence of ASDs by IQ, ADDM Network, 2008 Proportion estimated incidence by IQ scores,, 2008 36% of all cases in had an unknown IQ score MMWR / March 30, 2012 / Vol. 61 / No. 3 2002, 2006 and 2008 COMPARISON persons Prevalence per 1,000 p Change in Estimated ASD Prevalence by Sex,, 2008 Study year 4
Change in Estimated ASD Prevalence by Race/Ethnicity,, 2008 Change in ASD Prevalence from 2002 to 2008 and 2006 to 2008 by Cognitive Functioning Level, ADDM Network persons Prevalence per 1,000 p Overall percent change, 2002 to 2008 Cognitive Average to impairment Borderline above average (IQ 70) (IQ = 71-85) (IQ > 85) 45 117 93 ARAPAHOE COUNTY: EARLIEST DOCUMENTED DIAGNOSIS Earliest ASD Diagnosis in an Evaluation 2002 2006 2008 Median Age 62 months 60 months 54 months ADDM Network Summary of Findings, 2008 Estimated prevalence of ASDs continues to rise in most ADDM Network communities, including Arapahoe County Average prevalence of ASDs > 1% of 8-year-olds Average = 1 in 88 eight-year-old (1 in 85 in ) 23% increase, 2006-2008 78% increase, 2002-2008 Estimated prevalence of ASDs varies widely Across sites By sex By race/ethnicity *Modified CDC Slide ADDM Network Implications of Findings ASDs continue to be an important public health concern ~1 million children with ASDs in the United States Better identification among certain subgroups More children than ever are being recognized as having an ASD Many may not be recognized as early as they can be * Modified CDC Slide WHY IS THE IDENTIFIED PREVALENCE OF ASD RISING? *CDC Slide Changes in diagnostic criteria over time Increased awareness in the community Changes in availability of services Development of specialty services Training of professionals Recognition that ASDs can occur with severe ID, higher intellectual functioning, and other disorders True increase in symptoms in the population Increased risk due to environmental and/or genetic factors 5