Data Confirm Trend of Sharp Rise in ASD Cases

In a reflection of national trends, a recent study of children in Massachusetts reports that diagnoses of autism spectrum disorders (ASDs) are increasing, particularly among boys. The study was published online May 16 in Pediatrics.

By linking Massachusetts birth certificate and early-intervention program data, Susan Manning, M.D., M.P.H., an epidemiology field officer with the Maine Center for Disease Control and Prevention, and her colleagues were able to identify infants born from 2001 to 2005 who were enrolled in early-intervention programs providing autism-related services before age 36 months (through December 31, 2008).

They discovered that 1 of every 129 children born in Massachusetts in that five-year period was enrolled in an early intervention for an ASD by age 36 months. Early ASD diagnoses increased linearly from 1 in 178 for the 2001 birth cohort to 1 in 108 for the 2005 birth cohort, an increase of 66 percent.

The increase, although apparent in both girls and boys, was more dramatic in boys, whose enrollment increased 72 percent (from 88 per 10,000 to 151 per 10,000 over the four-year study) compared with an increase of 39 percent among girls (23 per 10,000 to 32 per 10,000).

"This study was conducted on behalf of the Massachusetts Department of Public Health (MDPH) Early Intervention (EI) program in order to examine trends in ASD diagnoses among children in the Massachusetts EI program and to identify characteristics associated with early ASD diagnoses," Manning told Psychiatric News. "Massachusetts was able to conduct this population-based analysis by using linked birth-certificate and EI-program data from the Massachusetts Pregnancy to Early Life Longitudinal (PELL) Data System, a unique linked data system created through a public-private partnership between MDPH, the Boston University School of Public Health, and the Centers for Disease Control and Prevention."

But do these very young children represent only the tip of a very large iceberg? Not necessarily, said Manning. "From other studies, we know that the average age of diagnosis of ASDs is 41 to 60 months; therefore, we would expect additional children to be diagnosed after age 3 years, particularly those who are high functioning and those with Asperger syndrome."

She noted as well that "Massachusetts has the advantages of high percentages of children with medical insurance, reasonable efforts on the part of pediatric practices to routinely screen children for developmental disabilities, and a cadre of diagnosticians associated with medical centers and in private practice that provide reasonable access to diagnostic appointments. These factors combined with increases in autism awareness and advocacy efforts have improved early identification of ASDs in Massachusetts."

A rise in the number of ASD cases is not necessarily good news, but Manning characterized the general reaction to these findings as favorable: "It's an indication that national and local efforts to promote early identification and diagnosis of ASDs have been successful. This is important since it has been found that children with ASD who are identified early and enrolled in early intervention programs show significant improvements in their language, cognitive, social, and motor skills, as well as in future educational attainment," she said.

Tracy Osbahr, M.A., one of the study's coauthors and the director of the Office of Specialty Services at the Massachusetts Department of Public Health, agreed: "Our partners in the medical field and among autism advocates [indicate] that this is an important addition to the literature because it may spur policymakers in other states to scrutinize their data for screening and identification of young children and prompt them to work to improve their results."

"These data can be used by communities and service systems to identify trends in early ASD diagnoses," she added, "and can provide a basis for planning to address disparities" in getting early help for ASDs among many children who would benefit from such intervention.

An abstract of "Early Diagnoses of Autism Spectrum Disorders in Massachusetts Birth Cohorts, 2001-2005" is posted at <http://pediatrics.aappublications.org/content/127/6/1043>.