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. 2019 Feb 28:10:7.
doi: 10.1186/s13229-018-0246-0. eCollection 2019.

Autism prevalence in China is comparable to Western prevalence

Xiang Sun  1   2   3 , Carrie Allison  2 , Liping Wei  4   5 , Fiona E Matthews  6 , Bonnie Auyeung  2   7 , Yu Yu Wu  8 , Sian Griffiths  9 , Jie Zhang  4 , Simon Baron-Cohen #  2 , Carol Brayne #  1
Affiliations

Autism prevalence in China is comparable to Western prevalence

Xiang Sun et al. Mol Autism. .

Abstract

Background: Autism prevalence in the West is approximately 1% of school age children. Autism prevalence in China has been reported to be lower than in the West. This is likely due to at least two reasons: (1) most studies in China only included the special school population, overlooking the mainstream school population; and (2) most studies in China have not used contemporary screening and diagnostic methods. To address this, we tested total autism prevalence (mainstream and special schools) in Jilin City, and mainstream school autism prevalence in Jiamusi and Shenzhen cities.

Methods: The study included a three-step process: (1) screening; (2) clinical assessment of 'screen positives' plus controls; and (3) research diagnostic assessment of those meeting clinical threshold for concerns at step 2. Prevalence estimates per 10,000 children aged 6-10 years old were weighted for study design using diagnostic criteria applied at the research assessment stage.

Results: In Jilin City, 77 cases of autism were identified from a total population of 7258, equating to a prevalence of 108 per 10,000 (95% confidence interval (CI) 89, 130). In Shenzhen City: 21,420 children were screened and 35 cases of autism were identified, resulting in a mainstream prevalence of 42 per 10,000 (95% CI 20-89). In Jiamusi City, 16,358 children were screened, with 10 autism cases being identified, with a mainstream prevalence of 19 per 10,000 (95% CI 10-38).

Conclusions: Results from Jilin City, where both mainstream and special school data were available, revealed a similar prevalence of autism in China to the West, at around 1%. Results from Shenzhen and Jiamusi cities, where only mainstream data were available, prevalence is also in line with Western estimates. In all three cities, new cases of autism were identified by the study in mainstream schools, reflecting current under-diagnosis. Non-significant variation across different cities is seen indicating the need to explore potential variation of autism across diverse Chinese regions with large sample sizes to achieve a fully robust national picture.

Keywords: Autism; Children; China; Diagnosis; Prevalence; Screening.

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Conflict of interest statement

This study was approved by the Research Ethics Committee at the Chinese University of Hong Kong and the Peking University Institutional Review Board. Consent was provided to participants via the screening package before participating. Participants were asked to indicate whether they continued to consent at the end of the study.Not applicable.The authors declare that they have no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Location of three cities in China studied in phase I of the China SCORE study
Fig. 2
Fig. 2
Flowchart of Jilin City
Fig. 3
Fig. 3
Mainstream-school screening in Shenzhen City
Fig. 4
Fig. 4
Flowchart of Jiamusi City
Fig. 5
Fig. 5
Prevalence of autism in China vs. USA
See this image and copyright information in PMC

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