Autism rates have increased slightly to 1 in 59 school-aged children (1.7%), according to a new report on 11 communities.
Experts say the uptick from 1 in 68 children (1.5%) is not a cause for concern and likely is due to several factors, including improved screening among black and Hispanic children.
“I think pediatricians should continue to stay the course and diligently work to implement developmental and behavioral surveillance, asking at every well-child visit ‘Do you have any concerns about your child’s behavior or development,’” said Susan E. Levy, M.D., M.P.H., FAAP, chair of the AAP Council on Children with Disabilities Autism Subcommittee.
The Academy also recommends screening all children at 18 and 24 months.
The estimates released today are based on 2014 data from the Centers for Disease Control and Prevention’s (CDC’s) Autism and Developmental Disabilities Monitoring Network and are published in the CDC’s Morbidity and Mortality Weekly Report. Researchers looked at medical and educational records for more than 300,000 8-year-olds from 11 communities around the country, although they are not intended to be a nationally representative sample.
Community estimates ranged from a low of 1 in 77 (1.3%) in areas of Arkansas to a high of 1 in 34 (3%) in areas of New Jersey. While rates remained highest for white children compared to black and Hispanic, the gaps are narrowing. White children are about 1.1 times more likely to be identified with autism than black children and 1.2 times more likely than Hispanic children.
“The higher number of black and Hispanic children now being identified with autism could be due to more effective outreach in minority communities and increased efforts to have all children screened for autism so they can get the services they need,” Stuart Shapira, M.D., Ph.D., associate director for science at the CDC’s National Center on Birth Defects and Developmental Disabilities said in a news release.
Large gender gaps remain, with boys four times more likely to be diagnosed with autism than girls. Dr. Levy said girls may be more likely to have symptoms, such as social impairment, that are harder to detect than behavioral issues.
While screening efforts appear to be improving, more work needs to be done, experts said. By age 3, about 85% of children with autism had concerns noted in their health record, but only 42% had received a developmental evaluation, according to the report. Part of the difficulty is that not all communities have a specialist available to perform these evaluations.
“There’s still a challenge once you identify a child with a delay or at risk for a diagnosis of autism. Where do you send them and are there enough people that can do the evaluation, and will families of children who need the evaluation … be able to afford (it),” Dr. Levy said.
She emphasized the importance of identifying children with autism at an early age. “The children that have been identified early and gotten into treatment early have the best outcomes,” Dr. Levy said. “So they do better developmentally, the families have less stress, the families feel supported.
”Pediatricians should ask parents about any concerns and use a standardized screening tool. Likewise, parents should share any concerns they have about how their child plays, learns, speaks or acts.
“If they observe or see anything and have concerns about how their child is developing or what their child is doing, bring it up to their pediatrician and be persistent,” Dr. Levy said. “Don’t overreact but be persistent.”
Melissa Jenco, News Content Editor, American Academy of Pediatrics http://www.aappublications.org/news/2018/04/26/autism042618