Prevalence of Autism in a US Metropolitan
Area
Marshalyn
Yeargin-Allsopp, MD; Catherine Rice, PhD; Tanya Karapurkar, MPH; Nancy
Doernberg; Coleen Boyle, PhD; Catherine Murphy, MPH
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/Article Information
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.
