There are estimated to be around 52 million people living with ASD worldwide.[18]Baxter AJ, Brugha TS, Erskine HE, et al. The epidemiology and global burden of autism spectrum disorders. Psychol Med. 2015 Feb;45(3):601-13.
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The detected prevalence of ASD has increased substantially throughout the world, although since 2012, prevalence in the US may have plateaued.[7]Baird G, Simonoff E, Pickles A, et al. Prevalence of disorders of the autistic spectrum in a population cohort of children in South Thames: the Special Needs and Autism Project (SNAP). Lancet. 2006 Jul 15;368(9531):210-5.
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[19]Fombonne E. The prevalence of autism. JAMA. 2003 Jan 1;289(1):87-9.
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[20]Autism and Developmental Disabilities Monitoring Network. Prevalence of autistic spectrum disorders: autism and developmental disabilities monitoring network, 14 sites, United States, 2002. MMWR Surveill Summ. 2007 Feb 9;56(1):12-28.
http://www.cdc.gov/mmwr/preview/mmwrhtml/ss5601a2.htm
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[21]Blumberg SJ, Bramlett MD, Kogan MD, et al. Changes in prevalence of parent-reported autism spectrum disorder in school-aged U.S. children: 2007 to 2011-2012. Natl Health Stat Report. 2013 Mar 20;(65):1-11, 1 p following 11.
https://www.cdc.gov/nchs/data/nhsr/nhsr065.pdf
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[22]Elsabbagh M, Divan G, Koh YJ, et al. Global prevalence of autism and other pervasive developmental disorders. Autism Res. 2012 Jun;5(3):160-79.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3763210
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[23]Xu G, Strathearn L, Liu B, et al. Prevalence of autism spectrum disorder among US children and adolescents, 2014-2016. JAMA. 2018 Jan 2;319(1):81-2.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5919599
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[24]Baio J, Wiggins L, Christensen DL, et al. Prevalence of autism spectrum disorder among children aged 8 years - autism and developmental disabilities monitoring network, 11 Sites, United States, 2014. MMWR Surveill Summ. 2018 Apr 27;67(6):1-23.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5919599
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Data suggest that the rise in ASD diagnosis has been accompanied by a fall in the prevalence of other neurodevelopmental disorders and that more accurate clinical diagnosis underlies the increase in detected prevalence.[25]Shattuck PT. Diagnostic substitution and changing autism prevalence. Pediatrics. 2006 Apr;117(4):1438-9.
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[26]Hansen SN, Schendel DE, Parner ET. Explaining the increase in the prevalence of autism spectrum disorders: the proportion attributable to changes in reporting practices. JAMA Pediatr. 2015 Jan;169(1):56-62.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3763210
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Other data suggest that at least 1% of children have ASD; some studies report a prevalence of around 1% to 2% in the US and other industrialised countries.[22]Elsabbagh M, Divan G, Koh YJ, et al. Global prevalence of autism and other pervasive developmental disorders. Autism Res. 2012 Jun;5(3):160-79.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3763210
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[27]Kim YS, Leventhal BL, Koh YJ, et al. Prevalence of autism spectrum disorders in a total population sample. Am J Psychiatry. 2011 Sep;168(9):904-12.
http://psychiatryonline.org/doi/full/10.1176/appi.ajp.2011.10101532
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One report from the US Centers for Disease Control estimated that 1 in 44 children aged 8 years has ASD, and that ASD was 4.2 times more prevalent in boys than girls.[10]Maenner MJ, Shaw KA, Bakian AV, et al. Prevalence and characteristics of autism spectrum disorder among children aged 8 years - autism and developmental disabilities monitoring network, 11 Sites, United States, 2018. MMWR Surveill Summ. 2021 Dec 3;70(11):1-16.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8639024
http://www.ncbi.nlm.nih.gov/pubmed/34855725?tool=bestpractice.com
Within the US, there is some evidence to suggest that Hispanic and African-American children are relatively under-diagnosed compared with white, non-Hispanic children, especially those with average to above average intelligence.[28]Christensen DL, Bilder DA, Zahorodny W, et al. Prevalence and characteristics of autism spectrum disorder among 4-year-old children in the Autism and Developmental Disabilities Monitoring Network. J Dev Behav Pediatr. 2016 Jan;37(1):1-8.
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In the US, earlier diagnosis is typically seen in children of higher socioeconomic status and with better access to services.[29]Hyman SL, Levy SE, Myers SM, et al. Identification, evaluation, and management of children with autism spectrum disorder. Pediatrics. 2020 Jan;145(1):e20193447.
https://pediatrics.aappublications.org/content/145/1/e20193447.long
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Lower rates of ASD are reported in resource-limited settings, which is likely, in part, to reflect difficulties in collecting epidemiological data.[30]Tomlinson M, Yasamy MT, Emerson E, et al. Setting global research priorities for developmental disabilities, including intellectual disabilities and autism. J Intellect Disabil Res. 2014 Dec;58(12):1121-30.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4556421
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It is estimated that between 40% to 80% of children with ASD have an intellectual disability. Specific learning disorders or disabilities, such as dyslexia or dyscalculia, may also occur in ASD.[6]Levy SE, Mandell DS, Schultz RT. Autism. Lancet. 2009 Nov 7;374(9701):1627-38.
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[10]Maenner MJ, Shaw KA, Bakian AV, et al. Prevalence and characteristics of autism spectrum disorder among children aged 8 years - autism and developmental disabilities monitoring network, 11 Sites, United States, 2018. MMWR Surveill Summ. 2021 Dec 3;70(11):1-16.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8639024
http://www.ncbi.nlm.nih.gov/pubmed/34855725?tool=bestpractice.com
People with ASD may also have other neurodevelopmental disorders; co-occurring ADHD is common.[31]Ghirardi L, Brikell I, Kuja-Halkola R, et al. The familial co-aggregation of ASD and ADHD: a register-based cohort study. Mol Psychiatry. 2017 Feb;23(2):257-62.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5794881
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[15]Lee DO, Ousley OY. Attention-deficit hyperactivity disorder symptoms in a clinic sample of children and adolescents with pervasive developmental disorders. J Child Adolesc Psychopharmacol. 2006 Dec;16(6):737-46.
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[16]Goldstein S, Schwebach AJ. The comorbidity of pervasive developmental disorder and attention deficit hyperactivity disorder: results of a retrospective chart review. J Autism Dev Disord. 2004 Jun;34(3):329-39.
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[17]Gadow KD, DeVincent CJ, Pomeroy J. ADHD symptom subtypes in children with pervasive developmental disorder. J Autism Dev Disord. 2006 Feb;36(2):271-83.
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Coexisting mental health problems, such as depression, anxiety, and sleeping difficulties, are also more common in people with ASD than in their age-matched peers; anxiety disorders are experienced by around 50% of children and adults, depression by around 10% of children and 25% to 50% of adults, and sleeping difficulties by around 50% to 80% of children.[32]Mayes SD, Calhoun SL, Murray MJ, et al. Anxiety, depression, and irritability in children with autism relative to other neuropsychiatric disorders and typical development. Res Autism Spectr Disord. 2010 Jul;5:474–85.[33]de Bruin EI, Ferdinand RF, Meester S, et al. High rates of psychiatric co-morbidity in PDD-NOS. J Autism Dev Disord. 2007 May;37(5):877-86.
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[34]Simonoff E, Pickles A, Charman T, et al. Psychiatric disorders in children with autism spectrum disorders: prevalence, comorbidity, and associated factors in a population-derived sample. J Am Acad Child Adolesc Psychiatry. 2008 Aug;47(8):921-9.
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[35]Richdale AL, Schreck KA. Sleep problems in autism spectrum disorders: prevalence, nature, & possible biopsychosocial aetiologies. Sleep Med Rev. 2009 Dec;13(6):403-11.
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[36]Croen LA, Zerbo O, Qian Y, et al. The health status of adults on the autism spectrum. Autism. 2015 Oct;19(7):814-23.
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[37]Lever AG, Geurts HM. Psychiatric co-occurring symptoms and disorders in young, middle-aged, and older adults with autism spectrum disorder. J Autism Dev Disord. 2016 Jun;46(6):1916-30.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4860203
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[38]Joshi G, Wozniak J, Petty C, et al. Psychiatric comorbidity and functioning in a clinically referred population of adults with autism spectrum disorders: a comparative study. J Autism Dev Disord. 2013 Jun;43(6):1314-25.
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[39]Hofvander B, Delorme R, Chaste P, et al. Psychiatric and psychosocial problems in adults with normal-intelligence autism spectrum disorders. BMC Psychiatry. 2009 Jun 10;9:35.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2705351
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There is some evidence to suggest that older adults with ASD experience a reduction in their risk of psychiatric comorbidities compared with in their youth, and in particular in their risk of social phobia.[37]Lever AG, Geurts HM. Psychiatric co-occurring symptoms and disorders in young, middle-aged, and older adults with autism spectrum disorder. J Autism Dev Disord. 2016 Jun;46(6):1916-30.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4860203
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