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Comparative Study
. 2021 Oct 1;190(10):2198-2207.
doi: 10.1093/aje/kwab106.

Comparison of 2 Case Definitions for Ascertaining the Prevalence of Autism Spectrum Disorder Among 8-Year-Old Children

Matthew J Maenner, Sierra J Graves, Georgina Peacock, Margaret A Honein, Coleen A Boyle, Patricia M Dietz
Comparative Study

Comparison of 2 Case Definitions for Ascertaining the Prevalence of Autism Spectrum Disorder Among 8-Year-Old Children

Matthew J Maenner et al. Am J Epidemiol. .

Abstract

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.

Keywords: autism; autism spectrum disorder; developmental disabilities; surveillance.

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Conflict of interest statement

Conflict of interest: none declared.

Figures

Figure 1.
Figure 1.
Comparison of prevalence estimates (number of cases/1,000 children) based on previous and new case definitions of autism spectrum disorder, by Autism and Developmental Disabilities Monitoring (ADDM) Network site, United States, 2014 and 2016. A) Surveillance year 2014 (8 sites; unweighted Pearson’s r = 0.922); B) surveillance year 2016 (11 sites; unweighted Pearson’s r = 0.942).
See this image and copyright information in PMC

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