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Prevalence of Autism Spectrum Disorder in China: A Nationwide Multi-Centre Population-Based Study Among Children Aged 6 to 12 Years

33 Pages Posted: 7 Sep 2018

See all articles by Hao Zhou

Hao Zhou

Fudan University - Department of Neurology

Xiu Xu

Fudan University

Weili Yan

Fudan University

Xiaobing Zou

Sun Yat-Sen University (SYSU)

Lijie Wu

Harbin Medical University

Xuerong Luo

Central South University - Department of Psychiatry

Tingyu Li

Chongqing Medical University

Yi Huang

Sichuan University

Hongyan Guan

Sun Yat-Sen University (SYSU)

Xiang Chen

Wenzhou Medical University

Meng Mao

Chengdu Women and Children’s Hospital

Kun Xia

Central South University

Lan Zhang

Chengdu Women and Children’s Hospital

Erzhen Li

Capital Institute of Paediatrics

Xiaoling Ge

Fudan University

Lili Zhang

Fudan University

Chunpei Li

Fudan University - Department of Neurology

Xudong Zhang

Fudan University - Children’s Hospital

Yuanfeng Zhou

Fudan University - Department of Neurology

Ding Ding

Fudan University - Huashan Hospital

Andy Shih

Autism Speaks

Eric Fombonne

Oregon Health and Science University

Yi Zheng

Capital Medical University - Beijing Chest Hospital

Jisheng Han

Peking University

Zhongsheng Sun

Chinese Academy of Sciences (CAS)

Yong-hui Jiang

Duke University - Department of Pediatrics

Yi Wang

Fudan University - Department of Neurology

LATENT-NHC Study

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Abstract

Background: Autism has emerged as a major public health issue in children that imposes a significant socioeconomic burden in the United State and other developed countries. China has the world's largest population and has witnessed the same growing concern over the last decade. However, a reliable national prevalence estimate for autism spectrum disorder (ASD) is lacking. This study aimed to obtain the first national prevalence estimate for ASD in Chinese children.

Methods: We targeted the population of 6 to 12-year-old Chinese children in eight selected representative cities for this prevalence study (Shanghai, Guangzhou, Changsha, Harbin, Beijing, Chongqing, Chengdu, and Wenzhou). The study sample was selected by multistage convenient cluster sampling of eligible children residing within the targeted areas. The parent and teacher Modified Chinese Autism Spectrum Rating Scale (MC-ASRS) was employed for the screening process. DSM-5 was used primarily for the case determination and followed by evaluation with the Autism Diagnostic Observation Schedule (ADOS) and the Autism Diagnostic Interview-Revised (ADI-R) in a subset of cases.

Findings: Of the target population of 142,086 6 to 12-year-old children in eight sites, 88.5% (N=125,806; 53.0% male and 47.0% female) subjects with a mean age of 9.0±2.0 years, participated in this study. A total of 363 children (male to female ratio of 4.3 to 1) were confirmed as having ASD using either DSM-5 alone or together with ADOS or ADI-R. The estimated overall prevalence was 0.7% (95% CI: 0.64%-0.74%), with a prevalence of 0.95% (95% CI: 0.87%-1.02%) in boys and 0.30% (95% CI: 0.26%-0.34%) in girls. Of the 363 confirmed ASD cases, 43.3% were newly diagnosed, and most of those (90.4%) were attending regular schools. The newly diagnosed ASD cases were milder and had significantly higher IQ than previously diagnosed ASD cases.

Interpretation: This first population-based and largest study reports a reliable estimate of 0.7% (1 in 143) ASD prevalence among 6 to 12-year-old children in cities in China. Importantly, almost half of the ASD cases were new and attending regular schools. Our findings provide information critical for the development of early screening, early intervention, and better care for children affected by ASD in China.

Clinical Trial Number: Clinical Trials (NCT02200679).

Funding Statement: This project was supported by the National Health Commission of the People’s Republic of China (201302002), and the Shanghai International Cooperation Ministry of Science Projects (14430712200).

Declaration of Interests: The authors declare that they have no competing interests.

Ethics Approval Statement: The study was approved by the institute ethics committee at the Children’s Hospital of Fudan University. Written informed consent was obtained from parents of participants.

Keywords: Autism; Prevalence; DSM-5; Children; China

Suggested Citation

Zhou, Hao and Xu, Xiu and Yan, Weili and Zou, Xiaobing and Wu, Lijie and Luo, Xuerong and Li, Tingyu and Huang, Yi and Guan, Hongyan and Chen, Xiang and Mao, Meng and Xia, Kun and Zhang, Lan and Li, Erzhen and Ge, Xiaoling and Zhang, Lili and Li, Chunpei and Zhang, Xudong and Zhou, Yuanfeng and Ding, Ding and Shih, Andy and Fombonne, Eric and Zheng, Yi and Han, Jisheng and Sun, Zhongsheng and Jiang, Yong-hui and Wang, Yi and Study, LATENT-NHC, Prevalence of Autism Spectrum Disorder in China: A Nationwide Multi-Centre Population-Based Study Among Children Aged 6 to 12 Years (July 18, 2018). Available at SSRN: https://ssrn.com/abstract=3216225 or http://dx.doi.org/10.2139/ssrn.3216225

Hao Zhou (Contact Author)

Fudan University - Department of Neurology

Beijing West District Baiyun Load 10th
Shanghai, 100045
China

Xiu Xu

Fudan University

Beijing West District Baiyun Load 10th
Shanghai, 100045
China

Weili Yan

Fudan University

Beijing West District Baiyun Load 10th
Shanghai, 100045
China

Xiaobing Zou

Sun Yat-Sen University (SYSU)

135, Xingang Xi Road
Guangzhou, Guangdong 510275
China

Lijie Wu

Harbin Medical University

157 Baojian Rd
Nangang Qu
Haerbin Shi, Heilongjiang Sheng
China

Xuerong Luo

Central South University - Department of Psychiatry

Changsha, Hunan 410011
China

Tingyu Li

Chongqing Medical University

China

Yi Huang

Sichuan University

No. 24 South Section1, Yihuan Road,
Chengdu, Sichuan 610064
China

Hongyan Guan

Sun Yat-Sen University (SYSU)

135, Xingang Xi Road
Guangzhou, Guangdong 510275
China

Xiang Chen

Wenzhou Medical University

Zhejiang Province
China

Meng Mao

Chengdu Women and Children’s Hospital

Chengdu 610091
China

Kun Xia

Central South University

Changsha, Hunan 410083
China

Lan Zhang

Chengdu Women and Children’s Hospital

Chengdu 610091
China

Erzhen Li

Capital Institute of Paediatrics

Beijing, 100020
China

Xiaoling Ge

Fudan University

Beijing West District Baiyun Load 10th
Shanghai, 100045
China

Lili Zhang

Fudan University

Beijing West District Baiyun Load 10th
Shanghai, 100045
China

Chunpei Li

Fudan University - Department of Neurology

Beijing West District Baiyun Load 10th
Shanghai, 100045
China

Xudong Zhang

Fudan University - Children’s Hospital

Beijing West District Baiyun Load 10th
Shanghai, 100045
China

Yuanfeng Zhou

Fudan University - Department of Neurology

Beijing West District Baiyun Load 10th
Shanghai, 100045
China

Ding Ding

Fudan University - Huashan Hospital

Beijing West District Baiyun Load 10th
Shanghai, 100045
China

Andy Shih

Autism Speaks

1 East 33rd Street
New York, NY 10016
United States

Eric Fombonne

Oregon Health and Science University

3181 S.W. Sam Jackson Park Rd.
Portland, OR 97201
United States

Yi Zheng

Capital Medical University - Beijing Chest Hospital

Fengtai
China

Jisheng Han

Peking University

No. 38 Xueyuan Road
Haidian District
Beijing, Beijing 100871
China

Zhongsheng Sun

Chinese Academy of Sciences (CAS)

52 Sanlihe Rd.
Datun Road, Anwai
Beijing, Xicheng District 100864
China

Yong-hui Jiang

Duke University - Department of Pediatrics

2301 Erwin Road
Durham, NC 27705
United States

Yi Wang

Fudan University - Department of Neurology ( email )

Beijing West District Baiyun Load 10th
Shanghai, 100045
China

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