Updated CDC Report on Autism

Recently the Centers for Disease Control and Prevention (CDC), announced that the prevalence of children with autism spectrum disorder (ASD) has grown to one in 36 eight-year-olds (2.8%). The CDC spokesperson commented that the increase is most likely due to greater awareness and more children being identified.

The rates of autism have been increasing since the CDC began monitoring autism prevalence in 1996. In 2000, it was 1 in 150 children. Then in 2008, it was 1 in 88 children and as recently in 2018, it was 1 in 44.

Autism is a neurobiological difference that is characterized by social and communication challenges along with repetitive behaviors, sensory differences, and strong interests. Autism is believed to occur on a spectrum because autistic children can have very different characteristics, abilities, and areas of need.

CDC data source

The CDC’s findings are based on 2020 data from its Autism and Developmental Disabilities Monitoring Network, which spans 11 states. The CDC cautions that reports from the network may not be nationally representative.

In 2020 autism rates were lowest for white children (2.4%), followed by 2.9% for black children, 3.2% for Hispanic children, and 3.3% for Asian /Pacific Islander children. According to the report 38% of children with autism had intellectual disability. ASD prevalence continues to be higher for boys than girls.

Explanations for increase in ASD

Possible explanations for an increase in the prevalence of autism include:

• Greater awareness of autism has led to more children being identified with ASD. Parents may desire to seek services for their child.
• Diagnostic criteria for autism have changed over the years, becoming broader and including more mild presentations of autism.
• Increased survival of more extremely premature infants (born before 28 weeks gestation) has resulted from advances in NICU care. Premature and low birthweight babies have higher rates of autism. In addition, the rate of prematurity rose by 4% in the U.S. during 2021 and is now higher than it has been since 2007.
• Increased parental age (both maternal and paternal age) has been associated with an increased likelihood of autism.

There is no single cause of autism. For most individuals, autism is caused by a combination of genetic and environmental factors. Researchers estimate that autism is highly genetic (81%). Currently, over 100 genes have been identified as being associated with autism.

Autism is NOT related to vaccinations

Many large scale and well-controlled trials have consistently found absolutely no link between childhood vaccinations and autism. Despite news headlines, there is no evidence that screen time in early childhood increases the risk for autism.

Some early signs of autism to be aware of

Children on the autism spectrum tend to show developmental differences during their infant and toddler years, especially in social and language skills. There may be some delays in spoken language or differences in how they interact with peers. However, children on the autism spectrum develop motor skills – sitting, crawling, and walking – on time.

One of the most important differences between children with ASD and children without ASD is a delay in, or lack of, joint attention. In fact, delays in joint attention skills are found in most children with ASD.

Joint attention is looking back and forth between an object or event and another person and connecting with that person. It is a building block for later social and communication skills. Engaging in many back-and-forth social interactions, such as emotional expressions, sounds and gestures, is called reciprocal social interaction.

Children on the autism spectrum usually show delayed or absent social communication skills at every developmental stage:

At 12 months of age, children on the autism spectrum may appear to ignore the parent. This can cause parents to worry about their child’s hearing.

At 15 months of age, instead of pointing to an object, a child with autism may instead take a parent’s hand and lead the parent to the object without making much, if any, eye contact.

At 18 months of age, children with ASD will often point to an object because they want a parent to get it for them, not because they want the parent to enjoy looking at the object with them.

Almost all children on the autism disorder spectrum show delays in nonverbal communication and spoken language. A child on the autism spectrum may have words they use to label things, for example, but not to ask for things. They may use words for objects before using words for people or family members.

Children with ASD may repeat what they hear for a longer period. They also may repeat dialogue from movies or conversations. This is called parroting or echoing.

Other early signs of ASD include:

• Avoidance of eye contact or limited eye contact (normally this occurs about 6 months)
• Limited “social smiles” (normally this occurs around 2 to 3 months)
• Limited facial expressions (meaning it is hard to tell when they are happy, sad, angry, etc. by looking at their face)
• Consistently preferring to be alone
• Loss of skills they once had (such as no longer saying words they used to say)
• Difficulty understanding the emotions of others
• Resisting or having difficulty with minor changes in their routine or environment (this is normal for toddlers but more intense for children with ASD)
• Repetitive behaviors (such as flapping their arms, rocking, or spinning)
• Having very strong interests that may not be typical for their age (such as ceiling fans or vacuums)
• Lining up toys or playing with toys in the same way every time
• Intense responses to sounds, smells, tastes, textures, lights, or colors

Routine developmental screening of children is necessary

The American Academy of Pediatrics (AAP) recommends routine developmental screening at 9, 18 and 30 months and, in addition, specific screening for autism at ages 18 and 24 months.

Parents who are concerned about their child should talk to their pediatrician. Your child’s doctor will then make a referral for speech and language evaluation.  If the doctor is not concerned but the parents still are, then parents should trust their instincts and get a second opinion. They can have their child evaluated by a speech-language pathologist.

Research shows that early intervention helps autistic children make gains in communication and emotional regulation, so any “wait and see” approach may not be the best choice for your child.

Helpful sources for parents

The CDC’s “Learn the Signs. Act Early” program provides parents and childcare professionals with free resources, in English and Spanish, for monitoring a child’s development. The program offers parent-friendly, research-based milestone checklists for children as young as 2 months of age.

The Milestone Tracker mobile app can help parents track their child’s development and share the information with their pediatricians.

The AAP has published an award-winning book, entitled “Autism Spectrum Disorder: What Every Parent Needs to Know.”

When grandparents, friends, or neighbors are worried about a child’s speech and language development, they may hesitate to bring it up for fear of upsetting or offending a parent. While raising any concern to parents about their child is difficult, it is in a child’s best interest to have any speech and language issues identified and treated as early as possible.

Please see the free information “How to Raise Concerns about a Child’s Speech and Language Development: Do’s and Don’ts” at Healthy Children.org

HealthyChildren.org is a treasure trove of valuable medical information for parents

The AAP has a parent-facing Web site, HealthyChildren.org, which offers numerous articles in English and Spanish related to ASD.

One article of particular relevance is “What Are the Early Signs of Autism?”