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In the United States, about 1.5 million children had an Autism Spectrum Disorder (ASD) in 2016, according to a nationally representative survey of parents on the health and well-being of their children . Boys were more than three times as likely as girls to be diagnosed.
Yet, many children are subcontracted. Parents of children with ASD were 44% more likely to say they had difficulty obtaining mental health treatment and 46% were more likely to say they did not receive the required mental health care , compared to children with other emotional, behavioral or developmental disorders. Parents of children with ASD were twice as likely to say that they were generally or always frustrated with getting services.
Although children with ASD have more mental health and medical needs, they were 23% less likely to live in a medical center and 24% less likely to benefit from coordination care.
Michael D. Kogan, PhD, of the Administration of Resources and Health Services, Office of Maternal and Child Health, Rockville, Maryland, and colleagues reported their findings online on November 26 pediatrics.
Researchers analyzed data from 43,283 children aged 3 to 17 from the 2016 National Child Health Survey (NSCH), a nationally representative survey of health and safety. the well-being of children from 0 to 17 years old.
Parents of one in 40 American children (2.50 per 100 children) reported that their child had ASD; 27% of these children were taking medication to treat ASD symptoms and 64% had been on behavioral therapy in the previous year.
This is the fourth time NSCH has asked questions about ASD, but the authors caution against comparing surveys of different years because the methods and questions of investigation have changed. That said, the prevalence rate of 2.50% is close to that found in the national survey of health interviews conducted in 2016, at 2.47%.
The authors note that they found fewer variations in prevalence rates with respect to age, race / ethnicity, and socioeconomic groups than those found in previous surveys. Policy changes such as the 2007 AAP [American Academy of Pediatrics] The universal screening recommendations of 18 to 24 months may have helped to increase the diagnosis of ASD in young children, thus reducing the age-related prevalence gap, they write. The type of recommendations could also have had a wider impact by raising awareness among providers and parents. In general, ASDs can contribute to increasing the number of diagnoses in traditionally underserved racial and ethnic groups.
Heterogeneity between states
Sarabeth Broder-Fingert, MD, MPH, of the Boston Medical Center and the Massachusetts Medical School, and their colleagues write in an editorial. Previous studies have shown great heterogeneity among states. For example, between 2000 and 2012, the prevalence of ASD in Alabama increased at an average annual rate of 12% (relative rate: 1.12); in comparison, in North Carolina, prevalence increased at an average annual rate of 28% (relative rate: 1.28).
"One prevalence rate for the entire United States fails to capture this variance," write Broder-Fingert and colleagues. "Therefore, we recommend publishing heterogeneity metrics alongside national estimates of ASD prevalence," editorialists say.
Such an approach would increase awareness of the wide variance in ASD prevalence in the United States and would warrant careful consideration of its causes, Broder-Fingert and his colleagues added.
They hope that an increased awareness of heterogeneity will advance the debate on what national prevalence estimates mean, "especially on the way in which they conceal an underlying heterogeneity that may reflect the prevalence of heterogeneity." significant differences between local policies, educational and medical practices and / or causal environmental exposures ". They continue.
The editorialists urge researchers to carefully explore why the prevalence of ASD increases faster in some states than in others. "This requires paying attention to local conditions and variations – for example, if the rate at which clinicians offer and accept ASD diagnoses depends on service availability, local politics, or community factors, then we should expect to find differences in the prevalence of ASD between states that differ in these ways, "they add.
"[G]Given the strong evidence of heterogeneity at the state level that may reflect important differences in policies, educational and medical practices and / or causal environmental exposures, we question the meaning of any national estimate of the prevalence of ASD. A more detailed report on the heterogeneity of the prevalence of ASD is an important first step, "editorialists conclude.
The survey was funded by the National Institutes of Health. Authors and editorialists have not revealed any relevant financial relationship.
pediatrics. Posted online November 26, 2018. Abstract, Editorial
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