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The newly released Centers for Disease Control and Prevention (CDC) Autism and Developmental Disabilities Monitoring (ADDM) Network report finds that autism spectrum disorder (ASD) prevalence in the U.S. has increased to 2.8%, or 1 in 36 U.S. children born in 2012 — up from 1 in 44 from the previous report for children born in 2010.
Prevalence among 8-year-old boys was 4.3% nationwide and as high as 6.9% in California.
The policy focus of the new report is centered not around the increasing ASD rates, but rather around a social justice narrative in which disability issues take a back seat to the equity implications.
While the ADDM reports of the 2000s declared rising rates of ASD an “urgent public health concern,” the most recent reports have abandoned that messaging.
The new report’s primary public health action recommendation is to develop “enhanced infrastructure to provide equitable diagnostic, treatment, and support services for all children with ASD.”
The CDC also released the Early Identification ADDM Report, focused on 4-year-olds, which found 7.2% of boys in California (represented by San Diego) born in 2016 already were diagnosed with ASD by age 4.
The race-specific prevalence of the boys was not explicitly stated, but one can back-calculate that it was about 8% for both Blacks and Hispanics.
As the 2016 birth cohort ages and is fully diagnosed, a substantially higher prevalence can be expected, likely exceeding 10% for Black and Hispanic boys in California. (ASD rates exceeding 10% already have been reported for boys in some school districts in New Jersey.)
The new Early Identification ADDM Report emphasizes the impact of COVID-19 lockdowns on the evaluation and identification of children with ASD.
Indeed, the report’s main public health action recommendation is that communities “consider strategies to mitigate these disruptions due to public health emergencies in the future.”
By “future emergencies,” this sentence presumably refers to the next pandemic. The report does not consider ASD rates of 8% among 4-year-old Black and Hispanic boys in California to be a public health emergency.
Yet one of the most notable features of both new ADDM reports is the rapid rise in ASD prevalence among racial minorities relative to white children, who historically have had the highest prevalence.
For example, in 2004, the mean Hispanic to white ASD ratio was 0.67 nationwide for children born in 2004.
In the new reports, the mean Hispanic to white ASD ratio is 1.3 for 8-year-olds and 1.8 for 4-year-olds. The mean U.S. Black to white ASD ratio is 1.2 for 8 year-olds and 1.6 for 4-year-olds.
Figure 1 below illustrates how strikingly these racial differences in ASD prevalence have shifted over time. Meanwhile, absolute prevalence continues to climb for all racial groups, albeit more slowly for whites.
The media coverage of the ADDM reports for birth years 2006 and 2008 primarily attributed increasing overall ASD prevalence to better diagnosis among Black children.
The media went so far as to imply that the overall increased rate of ASD was hopeful news because it indicated that Blacks were “catching up” to whites and achieving diagnostic equity — the hope being that their diagnosis would afford them earlier and better access to services.
The apparent underlying assumption was that there is a natural genetic level of ASD in the population, which is reflected in white prevalence, and that all races and ethnicities will eventually stabilize at that level thanks to improved outreach and screening.
The new ADDM report recognizes that, “For the first time … the prevalence of ASD was lower among White children than among other racial and ethnic groups, reversing the direction of racial and ethnic differences in ASD prevalence observed in the past.” However, the authors neglect to acknowledge that this reversal undermines the hopeful interpretation of previous ADDM data and effectively turns the equity argument on its head.
Instead, the report adds that, “Black children with ASD were still more likely than White children with ASD to have co-occurring intellectual disability” — as though this were a reassuring line of continuity from past reports.
However, the disparity in the rate of co-occurring intellectual disability, which is nearly twice as high among Blacks compared with whites, was an overlooked and unmentioned thorn that didn’t fit with the optimistic “catching up” interpretation of the birth year 2006 and 2008 reports.
In the new birth year 2012 ADDM report, more than 60% of the 8-year-olds diagnosed with ASD nationwide have either severe (IQ < 70) or borderline (70 < IQ < 85) co-occurring intellectual disability (37.9% and 23.5%, respectively).
Among Black children, more than 75% have severe or borderline co-occurring intellectual disability (50.8% and 25.1%, respectively).
The bottom line is that many of these children are being disabled and will face significant challenges to living and working independently as adults.
Nearly 35 years have elapsed since ASD began its steep rise from ~1 in 1,000 children to the new rate of 1 in 36 (2.8%), with prevalence approaching double-digit percentages for boys in some states.
Public health experts have had a long time to figure out what is driving this increase. A pregnant woman in 2023 who asks, “What causes ASD and what can I do to reduce my child’s risk of being disabled?” deserves a well-researched answer.
As ASD prevalence among Blacks and Hispanics overtakes and surpasses white prevalence in the newest ADDM reports, the “better diagnosis/equity” argument is collapsing, clearly revealing that ASD must have a strong environmental component.
Believers in social justice who have embraced autism as an age-old part of the human condition may experience cognitive dissonance as they realize that ASD is now disproportionally hurting racial and ethnic minorities.
One wonders how high ASD prevalence will climb before public policy moves beyond its current focus on equity toward addressing the root causes of the condition.
Watch Cynthia Nevison and others discuss the CDC report on autism:
