California Autism Prevalence by County and Race/Ethnicity: Declining Trends Among Wealthy Whites
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ORIGINAL PAPER
California Autism Prevalence by County and Race/Ethnicity: Declining Trends Among Wealthy Whites Cynthia Nevison1 · William Parker2
© The Author(s) 2020
Abstract County-level ASD prevalence was estimated using an age-resolved snapshot from the California Department of Developmental Services (DDS) for birth years 1993–2013. ASD prevalence increased among all children across birth years 1993–2000 but plateaued or declined thereafter among whites from wealthy counties. In contrast, ASD rates increased continuously across 1993–2013 among whites from lower income counties and Hispanics from all counties. Both white ASD prevalence and rate of change in prevalence were inversely correlated to county income from birth year 2000–2013 but not 1993–2000. These disparate trends within the dataset suggest that wealthy white parents, starting around 2000, may have begun opting out of DDS in favor of private care and/or making changes that effectively lowered their children’s risk of ASD. Keywords Autism spectrum disorder · Prevalence · Time trends · California · County · Silicon Valley · Income · Race/ ethnicity · Black · White · Hispanic · Asian
Introduction Autism spectrum disorder (ASD) is a diagnosis that encompasses a range of severity and can present with co-occurring medical and developmental disorders, including anxiety, epilepsy, attention deficit hyperactivity disorder (ADHD) and intellectual disability (ID) (Rubenstein et al. 2018). ASD is associated with biomarkers that are linked to oxidative stress and inflammation (Goldani et al. 2014; Yang et al. 2015), and is a behavioral condition characterized by impairments in social interaction, communication and restricted or stereotyped behaviors (APA 2013). The most recent survey of the Autism and Developmental Disabilities Monitoring (ADDM) Network found a mean ASD prevalence of 1 in 59, or nearly 2% of 8 year-olds born Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10803-020-04460-0) contains supplementary material, which is available to authorized users. * Cynthia Nevison [email protected] 1
Institute for Alpine and Arctic Research, University of Colorado, Campus Box 450, Boulder 80309‑0450, USA
Department of Surgery, Duke University Medical Center, Durham, NC, USA
2
in 2006 in selected counties in 11 states (CDC 2018). The 2006 result represented an increase from 1 in 68 in the two previous ADDM surveys in birth years 2002 and 2004 (CDC 2014, 2016). The 2016 National Health Interview Survey (NHIS) estimated a somewhat higher overall prevalence of ASD among American children age 3–17 of 1 in 36, or nearly 3% (Zablotsky et al. 2017). This was up from 1 in 45 in the 2014 NHIS, although the increase was not considered statistically significant (Zablotsky et al. 2017). ADDM is a biannual surveillance system conducted in selected regions of the United States that focuses on 8 yearold children. ASD cases are determined by systematic review and abstraction of information from existing
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