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14 Prevalence of Autism Spectrum Disorder
Pages 241-266

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From page 241...
... as well as for stakeholders in the health care system and disability community, due in part to the considerable and continuous growth in the rates of disability attributed to ASD. From 2004 to 2013, the ASD and developmental disorders category grew more than any other mental disorder in the Supplemental Security Income (SSI)
From page 242...
... . The association between rising autism prevalence estimates and changes in the criteria for diagnosing autism can be seen in Figure 14-1.
From page 243...
... For purposes of this review of ASD prevalence among children in the United States, which focuses on the years 2000–2012, it is important to emphasize that no formal changes in diagnostic criteria were introduced or adopted between the years 2000 and 2012. Thus, changes in the prevalence of ASD during this period cannot be readily explained by the evolution of diagnostic criteria, though the gradual adoption and increasing application of diagnostic criteria introduced in the 1990s could have affected prevalence trends during the 2000–2012 period.
From page 244...
... . The ADDM Network ASD prevalence estimate for the year 2000 was 6.7 per 1,000.
From page 245...
... However, the ASD prevalence estimates from the ADDM Network are population based in the sense that efforts are made at each participating site to count every 8-year-old child with ASD in the defined populations rather than just counting those who receive care through a particular health care provider or who receive special education services for autism (Baio, 2014; Durkin et al., 2014)
From page 246...
... Trends Based on the Number of Children Receiving Special Educational Services for ASD In 1992, 15,556, children (ages 6 to 22 years) in the United States received special education services for ASD.
From page 247...
... This number increased from 1.7 per 1,000 in 2001 to 7.6 per 1,000 in 2012. Trends Based on the Number of Children Receiving Disability Services with an Autism Diagnosis in California The state of California provides support and services to individuals with developmental disabilities.
From page 248...
... . Trends Based on National Surveys of Parents National Health Interview Survey In each of four national surveys conducted between 1997 and 2008, the National Health Interview Survey (NHIS)
From page 249...
... TABLE 14-2  Trends from the NHIS, Parent Report, Ever Told If Child Had Autism Year (Age Range) Prevalence Estimate 1997–1999 (3–17)
From page 250...
... . POTENTIAL EXPLANATIONS FOR THE RISING PREVALENCE OF AUTISM ASD was first introduced as a category for receiving special education in the United States in 1991.
From page 251...
... Other factors that have likely contributed to the increasing numbers of children identified as having ASD include increased awareness of autism due to media attention and advocacy; increased training of clinicians and the increased availability of standard screening and diagnostic tools for identifying ASD; new policies for routine pediatric screening for ASD during well-child examinations; an increase in the assignment of co-occurring diagnoses among children with developmental disabilities, a process referred to as "diagnostic accrual" (King and Bearman, 2009) ; and the frequent requirement that a child first receive a diagnosis of ASD in order to receive needed services (Rice, 2013)
From page 252...
... As previously discussed, changes in the frequency of risk factors for ASD in the population, including changes in known or suspected risk factors, such as parental age, maternal obesity, and in vitro fertilization, may contribute to variations in trends, but they are unlikely to explain much of the observed increase. Association Between Socioeconomic Status and ASD Prevalence in the United States and Potential Under Identification of ASD Among Low-Income Children In the United States, the prevalence of ASD as identified in both the ADDM Network surveillance system and in the National Health Interview Survey increases with increasing socioeconomic status (SES)
From page 253...
... due to disparities in access to services. Figure 14-10 displays the results of an analysis of ADDM Network data showing the prevalence of ASD to be nearly twice as high in children in the highest SES tertile compared with those in the lowest SES tertile.
From page 254...
... To control for the changes in the magnitude of child poverty, allowance and recipient rates are shown as a percentage of the number of children in households under 200 percent FPL for each year. Column 4 shows the frequency of children in households under 200 percent FPL who were allowed benefits for ASD (i.e., were found to be severely impaired with TABLE 14-3  SSI Child Initial Allowances and Recipient Numbers for ASD 1 2 3 4 5 Children Under 200 Children # of % FPL Under 200% # of # of Children in Allowed FPL Who Are Child SSI Child SSI Households SSI Benefits Recipients of Allowances Recipients Under 200 for ASD SSI Benefits for Year for ASD for ASD % FPL per 1,000 ASD per 1,000 2004 9,677 43,628 28,753,000 0.3 1.5 2005 10,626 50,078 28,539,000 0.4 1.8 2006 11,613 56,976 28,757,000 0.4 2.0 2007 12,925 64,883 28,999,000 0.4 2.2 2008 15,812 73,161 30,064,000 0.5 2.4 2009 18,231 83,801 31,505,000 0.6 2.7 2010 20,317 94,606 32,254,000 0.6 2.9 2011 22,931 106,910 32,678,000 0.7 3.3 2012 24,159 121,699 32,269,000 0.7 3.8 2013 23,398 134,310 31,364,000 0.7 4.3 NOTE: The Current Population Survey table creator was used to generate numbers of children below 200 percent of the federal poverty level.
From page 255...
... Column 5 shows the frequency of children in households under 200 percent FPL who were recipients of SSI payments for ASD in December of each year, per 1,000 children. These numbers can be interpreted as the prevalence each year of children under 200 percent FPL receiving SSI benefits for ASD per 1,000 children.
From page 256...
... Column 2 shows the prevalence of ASD diagnoses per 1,000 among the smaller subpopulation of Medicaid enrollees who were eligible to be enrolled in Medicaid as an SSI beneficiary.2 As shown in Figure 14-12, the rate of ASD diagnoses among all child Medicaid enrollees and among child SSI-eligible Medicaid enrollees increased more than threefold between 2001 and 2010. The frequency of ASD diagnoses among all Medicaid enrollees increased from 2 per 1,000 in 2001 to 7 per 1,000 in 2010.
From page 257...
... For the years in which the Medicaid data and the SSI administrative data overlapped, 2004–2010, the rate of ASD diagnoses among all Medicaid-enrolled children increased by 133 percent; the rate of ASD diagnoses among the SSI-eligible Medicaid-enrolled children increased by 123 percent, and the rate of SSI recipients for ASD among children in households under 200 percent FPL increased by 93 percent. These findings confirm that recipients of SSI benefits on the basis of an ASD diagnosis have not grown faster than comparison populations.
From page 258...
... The data presented here do not provide additional evidence to support a conclusion that diagnostic substitution is, in fact, a cause of the observed trends, but the trends observed in the SSI program are consistent with the possibility that there are children with developmental/cognitive/social impairments who were previously eligible for services or benefits on the basis of a diagnosis of ID or MR but who are more recently deemed eligible on the basis of a diagnosis of ASD. 30,000 25,000 Number of Allowances 20,000 AuƟsm SSI allowances 15,000 ID SSI allowances 10,000 5,000 0 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 Year FIGURE 14-13  Autism and intellectual disability initial allowances for SSI.
From page 259...
... Therefore, the expected number of children with severe or moderate autism living in families below 200 percent FPL would be 258,152. By comparison, in 2012 there were 121,699 child recipients of the SSI benefits for autism, fewer than half the number expected based on the NSCH estimate.
From page 260...
... Parameters used to generate the numbers include get count of: persons in poverty universe (everyone except unrelated individuals under 15) ; years: 2004 to 2013; Census 2010 weights; row variable: age; column variable: income-to-poverty ratio; and customized formatting: income-to-poverty ratio percent cutoff of 200 percent.
From page 261...
... • The trend in ASD diagnoses among Medicaid-enrolled children was similar to general population trends between 2001 and 2010. The yearly prevalence estimates of ASD diagnoses among children enrolled in Medicaid were similar to estimates based on special education child counts, but lower than ASD prevalence estimates from surveillance and survey data for the general population.
From page 262...
... Parameters used to generate the numbers include get count of: persons in poverty universe (everyone except unrelated individuals under 15) ; years: 2004 to 2013; Census 2010 weights; row variable: age; column variable: income-to-poverty ratio; and customized formatting: income-to-poverty ratio percent cutoff of 200 percent.
From page 263...
... 2014. Prevalence of autism spectrum disorder among children aged 8 years: Autism and developmental disabilities monitoring network, 11 sites, United States, 2010.
From page 264...
... 2007. Prevalence of autism spectrum disorders -- Autism and developmental disabilities monitoring network, six sites, United States, 2000; Prevalence of autism spectrum disorders -- Autism and developmental dis abilities monitoring network, 14 sites, United States, 2002; and Evaluation of a meth odology for a collaborative multiple source surveillance network for autism spectrum disorders -- Autism and Developmental Disabilities Monitoring Network, 14 sites, United States, 2002.
From page 265...
... 2002. The epidemiology of autistic spectrum disorders: Is the prevalence rising?


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