Autism spectrum disorder (ASD) is a developmental impairment involving challenges in repetitive behaviors, social interaction, and communication with symptoms ranging in severity. Early screening at ages 18 and 24 months is recommended to support timely intervention. The Autism and Developmental Disabilities Monitoring (ADDM) network has tracked ASD in U.S. children since 2000, showing increased prevalence from 1 in 150 children in 2000 to 1 in 36 in 2020.
A recent report published in the Morbidity and Mortality Weekly Report (MMWR) showed higher prevalence among historically underserved groups. These ADDM network data guide communities in improving early, equitable identification of ASD and planning effective support services.
In 2022, the ADDM network expanded to 16 U.S. community sites, including California, Indiana, Arizona, Maryland, Missouri, Pennsylvania, Tennessee, Wisconsin, Georgia, New Jersey, Texas (Austin and Laredo), Minnesota, Utah, Arkansas, and Puerto Rico. These sites monitored ASD among children aged 4 (born in 2018) and 8 years (born in 2014). All sites are operated under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and local regulations. This ensures compliance with confidentiality and privacy laws for ASD surveillance.
Information related to demographic characteristics, individualized education programs (IEPs), comprehensive developmental assessments, intelligence quotient (IQ) scores, and availability of ASD diagnostic evaluations, as well as evaluation instruments for ASD, were gathered from the children’s medical records. The Wilson score analysis technique estimated a 95% confidence interval (CI) for prevalence, prevalence ratios, differences, risk ratios, and cumulative incidence.
The overall prevalence of ASD was observed in 32.2/1000 (one in 31) among 8-year-old children, and incidence varied from 9.7 in Texas to 53.1 in California. In the Bayesian hierarchical modeling method, the overall prevalence was 32.2 with 95% Bayesian credible intervals of 25.4–39.3. In the random-effects restricted maximum likelihood technique, it was 30.9 with a 95% CI of 25.8–36.0. Prevalence was higher in 2022 across 11 sites compared to 2020 across nine sites (from 14% to 36.7% higher) and overall (22.2% higher).
The overall prevalence of the male-to-female ratio was found to be 3.4, with 49.2/1000 occurrence in males and 14.3/1000 in females. Overall, 68.4% of children with ASD had a documented ASD diagnostic statement across 15 sites that completed record abstraction, ranging from 41.2% in Austin to 95% in Puerto Rico. A documented ICD code for ASD was present in 68.9% of children, with rates ranging from 40.9% in Maryland to 88.7% in Pennsylvania.
The top 5 eligibility categories were autism (77.7% of children), developmental delay (6.9%), speech/language impairment (24.7%), intellectual disability (3.6%) and physical, health or other disability (7.9%) among children with ≥1 IEP in health records (63.7% of 8-years old children).
Among 5,292, approximately 39.6% of children with ASD were diagnosed with intellectual disability. This was observed in 52.8% of Black, 38.8% of Hispanic, 31.2% of multiracial, and 32.7% of White ASD children. The overall cumulative incidence of ASD diagnosis in children born in 2018 was found to be 1.7 times higher compared to those born in 2014.
Overall, 66.5% of 8-years old children with ASD had documentation of an autism assessment with varied among sites from 24.7% in New Jersey to 93.5% in Puerto Rico. The widely used autism tests among 4 years old children were Autism Diagnostic Observation Schedule (31.7%), Gilliam Autism Rating Scale (6.2%), Social Responsiveness Scale (8.1%), Autism Spectrum Rating Scales (21.1%) and Childhood Autism Rating Scale (38%).
This report’s limitations include non-nationally representative data, limited data sources, site changes over time, variable record quality, and differences between clinical diagnosis and surveillance.
In conclusion, ASD prevalence rose from 2020 to 2022 with significant site variation. Racial, socioeconomic, and community vulnerability disparities remained. Early identification improved, highlighting the increasing demand for equitable services and access.
Reference: Shaw KA, Williams S, Patrick ME, et al. Prevalence and Early Identification of Autism Spectrum Disorder Among Children Aged 4 and 8 Years — Autism and Developmental Disabilities Monitoring Network, 16 Sites, United States, 2022. MMWR Surveill Summ. 2025;74(SS-2):1–22. doi:10.15585/mmwr.ss7402a1
