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Context  Concern has been raised about possible increases in the prevalence of autism. However, few population-based studies have been conducted in the United States.

Objectives  To determine the prevalence of autism among children in a major US metropolitan area and to describe characteristics of the study population.

Design, Setting, and Population  Study of the prevalence of autism among children aged 3 to 10 years in the 5 counties of metropolitan Atlanta, Ga, in 1996. Cases were identified through screening and abstracting records at multiple medical and educational sources, with case status determined by expert review.

Main Outcome Measures  Autism prevalence by demographic factors, levels of cognitive functioning, previous autism diagnoses, special education eligibility categories, and sources of identification.

Results  A total of 987 children displayed behaviors consistent with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria for autistic disorder, pervasive developmental disorder–not otherwise specified, or Asperger disorder. The prevalence for autism was 3.4 per 1000 (95% confidence interval [CI], 3.2-3.6) (male-female ratio, 4:1). Overall, the prevalence was comparable for black and white children (black, 3.4 per 1000 [95% CI, 3.0-3.7] and white, 3.4 per 1000 [95% CI, 3.2-3.7]). Sixty-eight percent of children with IQ or developmental test results (N = 880) had cognitive impairment. As severity of cognitive impairment increased from mild to profound, the male-female ratio decreased from 4.4 to 1.3. Forty percent of children with autism were identified only at educational sources. Schools were the most important source for information on black children, children of younger mothers, and children of mothers with less than 12 years of education.

Conclusion  The rate of autism found in this study was higher than the rates from studies conducted in the United States during the 1980s and early 1990s, but it was consistent with those of more recent studies.

JAMA. 2003;289:49-55

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Author Affiliations: National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention (Drs Yeargin-Allsopp, Rice, and Boyle, and Mss Doernberg and Murphy) and Battelle Memorial Institute, Centers for Public Health Research and Evaluation (Ms Karapurkar), Atlanta, Ga.
 
Corresponding Author and Reprints: Marshalyn Yeargin-Allsopp, MD, Centers for Disease Control and Prevention (F-15), 4770 Buford Hwy NE, Atlanta, GA 30341 (e-mail: mxy1@cdc.gov).

Author Contributions: Study concept and design: Yeargin-Allsopp, Rice, Doernberg, Boyle, Murphy.

Acquisition of data: Yeargin-Allsopp, Rice, Doernberg, Murphy.

Analysis and interpretation of data: Yeargin-Allsopp, Rice, Karapurkar, Doernberg, Boyle.

Drafting of the manuscript: Yeargin-Allsopp, Rice, Karapurkar, Doernberg, Boyle.

Critical revision of the manuscript for important intellectual content: Yeargin-Allsopp, Rice, Karapurkar, Doernberg, Murphy.

Statistical expertise: Karapurkar, Doernberg, Boyle, Murphy.

Administrative, technical, or material support: Yeargin-Allsopp, Rice, Doernberg, Murphy.

Study supervision: Yeargin-Allsopp, Murphy.

Acknowledgment: We thank Gail McGee and Michael Morrier, Emory Autism Center, and Jacqueline Bertrand, CDC, Atlanta, Ga, for their participation as expert reviewers to determine case status; Catherine Lord, University of Michigan, Ann Arbor, for her expertise related to the case definition and clinical features of autism; and the numerous education and medical service providers in metropolitan Atlanta who participated in the study. Also, Courtney Alison, CDC; and Fiona Steele, Kim McKee, Pamela Bradford, Melissa Talley, Teri Hirschfield, Shryl Epps, Claudia Bryant, and Lori Chandler, Battelle Memorial Institute, Atlanta, Ga, abstracted education and medical records; Camille Smith, CDC, participated in pilot study efforts; Susan Williams, Battelle Memorial Institute, provided computer and data management support; William Thompson, CDC, provided epidemiologic and biostatistical advice; and Eric Fombonne, McGill University, Montreal, Quebec; Christopher Gillberg, University of Göteborg, Göteborg, Sweden; Catherine Lord; Cindy Mervis, Battelle Memorial Institute; Diana Schendel, CDC; Kim VanNaarden Braun, Oak Ridge Institute for Science and Education, Atlanta, Ga; and Maggie Kelly, TRW Systems, Atlanta, Ga, reviewed the manuscript, provided epidemiologic advice, and/or editorial assistance.