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2008 A UTISM S PECTRUM D ISORDERS P REVALENCE R ESULTS

2008 A UTISM S PECTRUM D ISORDERS P REVALENCE R ESULTS. Overview. Describe what autism is Describe the Autism and Developmental Disabilities Monitoring (ADDM) Network and its methodology Present the 2008 results Present surveillance trends for Arapahoe County. What is Autism?.

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2008 A UTISM S PECTRUM D ISORDERS P REVALENCE R ESULTS

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  1. 2008 AUTISM SPECTRUM DISORDERS PREVALENCE RESULTS

  2. Overview • Describe what autism is • Describe the Autism and Developmental Disabilities Monitoring (ADDM) Network and its methodology • Present the 2008 results • Present surveillance trends for Arapahoe County

  3. What is Autism? • A group of developmental disabilities that cause significant social, communication and behavioral challenges over a lifetime. • Can range from mild to severe.

  4. * CDC Slide

  5. ADDM NETWORK METHODS • Active case-finding with broad retrospective records-based screening for ASD classifications or behaviors. • Focus on children at age 8 to identify peak prevalence. • Multiple health and education sources of information. • Detailed behavioral, developmental, and testing information collected. • Ongoing quality control within and across sites. • Independent review and clinician confirmation of ASD case status based on the DSM-IV criteria. • Standard for setting ASD prevalence estimates in the U.S. * CDC Slide

  6. COLORADO MONITORING PROJECT • Goal: Determine the prevalence of autism spectrum disorders (ASD) among children who were 8 years of age in 2008. • Denver Metropolitan area: Adams, Arapahoe, Boulder, Broomfield, Denver, Douglas, and Jefferson counties • “Complete participation”: Areas with both health sources and school district participation • 2002: Arapahoe and Boulder counties • 2006 and 2008: Arapahoe county • “Incomplete participation”: - 2008: Adams, Boulder, Broomfield, Denver, Douglas, and Jefferson counties

  7. Permission to Access Records • Health care facilities: • ASD is a reportable public health condition • Children < 10 years of age with confirmed or suspected ASD identified by health facilities in the Denver Metropolitan area are reportable to the Colorado Department of Public Health and Environment. • Schools: • Individual agreements were developed with each participating school district and/or IRB approvals.

  8. 2006 AND 2008 COLORADO ADDM • Lisa Miller, MD, MSPH • Andria Ratchford, MSPH (Project Coordinator) • Jean Menconi, RN (Abstractor) • Vicki Bondurant (Abstractor) • Stephanie Comienski (Abstractor) • Beverly Meek (Abstractor) • Kevin Hake (Data Manager) • Corry Robinson, PhD, RN • Judy Reaven, PhD (Expert Reviewer) • Terry Hall, MA, CCC-SLP (Expert Reviewer) • Andrea Hoog • (Expert reviewer) • Gina Quintana • Yolanda Castillo, MBA (Project Coordinator) • Gabriela Perez (Abstractor)

  9. RESULTS2008 8 year olds

  10. 2008 Colorado Population CHARACTERISTICS

  11. Source Characteristics • Arapahoe County source types • School: 19% • Health: 22% • Both: 59% • Denver metro area source types • Health: 100%

  12. ADDM NETWORK 2008 ASD estimated prevalence per 1,000 persons among 8-year-old children

  13. ADDM NETWORK OVERALL ASD Estimated Prevalence, 2000-2008 * modified CDC Slide

  14. ADDM NETWORK 2008 Estimated Prevalence by Sex

  15. ADDM NETWORK 2008 Estimated Prevalence per 1,000 by Race /Ethnicity

  16. Associated Features of ASD Cases, Arapahoe County, 2008

  17. Estimated prevalence of ASDs by IQ,ADDM Network, 2008 MMWR / March 30, 2012 / Vol. 61 / No. 3

  18. Proportion estimated incidence by IQ scores, Arapahoe County, 2008 • 36% of all cases in Arapahoe County had an unknown IQ score

  19. 2002, 2006 and 2008 COMPARISON

  20. Change in Estimated ASD Prevalence by Race/Ethnicity, Arapahoe County, 2008 Prevalence per 1,000 persons

  21. Change in ASD Prevalence from 2002 to 2006 and 2006 to 2008 by Cognitive Functioning Level, ADDM Network • * From MMWR December 18, 2009 / 58(SS10);1-20 • ** From MMWR / March 30, 2012 / Vol. 61 / No. 3

  22. Arapahoe County: EARLIEST DOCUMENTED DIAGNOSIS

  23. ADDM Network Summary of Findings, 2008 • Estimated prevalence of ASDs continues to rise in most ADDM Network communities, including Arapahoe County • Average prevalence of ASDs > 1% of 8-year-olds • Average = 1 in 88 eight-year-old (1 in 85 in Arapahoe County) • 23% increase, 2006-2008 • 78% increase, 2002-2008 • Estimated prevalence of ASDs varies widely • Across sites • By sex • By race/ethnicity *Modified CDC Slide

  24. GENERAL ISSUES: WHYISTHEIDENTIFIEDPREVALENCEOF ASD RISING? • Changes in diagnostic criteria over time • Increased awareness in the community • Changes in availability of services • Parents as advocates • Development of specialty services • Training of professionals • Recognition that ASDs can occur with severe ID, higher intellectual functioning, and other medical and psychiatric disorders • True increase in symptoms in the population • Increased risk due to environmental and/or genetic factors *CDC Slide

  25. Extra Slides

  26. ASD characteristics • Measured intelligence Severe-------------------------------------Gifted • Social interaction Aloof----------------Passive-------------Active but odd • Communication Nonverbal------------------------------------------Verbal • Behaviors Intense-----------------------------------------------Mild • Sensory Hyposensitve---------------------------Hypersensitive • Motor Uncoordinated-----------------------------Coordinated Slide courtesy of Catherine Rice, PhD

  27. Percent of cases in special education and with an ASD classification, ADDM Network, 2008

  28. Earliest Known ASD DiagnosisMedian Age and Proportion by Diagnostic SubtypeADDM Network and Arapahoe County, 2008

  29. Percent of Children with ASD by Primary Education Eligibility Category, Arapahoe County 2008 • 84.6% of all children were receiving Special Education services

  30. Change in Estimated ASD Prevalence by Sex, Arapahoe County, 2008 Prevalence per 1,000 persons Study year

  31. ADDM NetworkImplications of Findings • ASDs continue to be an important public health concern • ~1 million children with ASDs in the United States • Better identification among certain subgroups • More children than ever are being recognized as having an ASD • Many may not be recognized as early as they can be * Modified CDC Slide

  32. Estimated ASD prevalence among 8-year-olds, by access to education records and population size covered, ADDM Network, 2008 MMWR / March 30, 2012 / Vol. 61 / No. 3

  33. Proportion of children identified with ASDs by previous ASD classification as of age 8 years, by state and year, ADDM Network, 2008 MMWR / March 30, 2012 / Vol. 61 / No. 3

  34. Change in Estimated ASD Prevalence per 1,000 Children by Cognitive Functioning Level – ADDM Network, 7 SITES, 2002 to 2008 *CDC Slide

  35. Previous diagnosis, ADDM Network, 2008 • 79% of cases had a previously documented ASD classification • Range: 67% (Arapahoe County)–87% (Pennsylvania and Wisconsin). • In Arapahoe County, • 67% had an previous ASD diagnosis • 11% had a suspicion of ASD noted • 22% had no mention of ASD noted

  36. Number of Records Screened • Denver Metro Area Records Reviewed ~ 3,019 • Number of records abstracted = 546 • Arapahoe County Records Reviewed ~1,282 • Number of records abstracted = 177 • 5 of 5 districts participated

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