{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T06:17:44Z","timestamp":1789798664293,"version":"4.0.1"},"reference-count":34,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Sage Open Medicine"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:sec>\n                    <jats:title>Background\/Objectives<\/jats:title>\n                    <jats:p>The Autism and Developmental Disabilities Monitoring (ADDM) network has observed an ongoing increase in autism spectrum disorder (ASD) among U.S. children, with highest prevalence in California. Recent county-level trends in California were analyzed to provide insight into this increase.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>ASD prevalence was estimated from the California Department of Developmental Services (DDS) ASD caseload in 2025, stratified by county, race\/ethnicity, and age across birth years 1993-2020. Denominators were estimated from the mean of public school and U.S. census data.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Diagnosed ASD prevalence increased among all race\/ethnicity groups across this period, with a strong uptick in the mid-2010s, most commonly in birth year 2016, in many low and middle income counties. The estimated values varied widely by county and by race\/ethnicity, ranging from 1.2% \u00b1 0.2% in San Mateo to 9.5 \u00b1 1.3% in Los Angeles among white and black children, respectively, born in 2019. The rate of change in diagnosed prevalence from birth year 2015-2019 was significantly correlated to county Medicaid (Medi-Cal) fraction for Hispanics and all races, although this ecological association could not distinguish individual-level risk. Comparison of diagnosed ASD prevalence in San Diego County between DDS and ADDM (for which California is represented by San Diego) suggested that DDS tends to underestimate total ASD, likely because it represents the more severely affected subset. Within DDS, diagnosed prevalence trends in San Diego captured statewide California trends relatively well but prevalence was about 20% higher in San Diego by birth year 2019.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Diagnosed ASD prevalence has risen unequally across California counties and race\/ethnicity groups since the birth years of the mid-2010s, with the steepest increases in low and middle income counties. Understanding these patterns and disentangling true increases in ASD from diagnostic changes are urgent priorities for future research.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/20503121261490679","type":"journal-article","created":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T02:25:42Z","timestamp":1789611942000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Accelerating autism prevalence in California with changepoint in the mid-2010s and divergence by county and socioeconomic indicators"],"prefix":"10.1177","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-6905-7876","authenticated-orcid":false,"given":"Cynthia","family":"Nevison","sequence":"first","affiliation":[{"name":"Pediatrics Department, Rutgers New Jersey Medical School"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Walter","family":"Zahorodny","sequence":"additional","affiliation":[{"name":"Pediatrics Department, Rutgers New Jersey Medical School"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,9,16]]},"reference":[{"key":"e_1_3_8_2_2","doi-asserted-by":"publisher","DOI":"10.1176\/appi.books.9780890425596"},{"key":"e_1_3_8_3_2","doi-asserted-by":"publisher","DOI":"10.1177\/00333549231163551"},{"key":"e_1_3_8_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ridd.2018.08.015"},{"key":"e_1_3_8_5_2","doi-asserted-by":"publisher","DOI":"10.1155\/2021\/6685204"},{"key":"e_1_3_8_6_2","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyt.2022.813304"},{"key":"e_1_3_8_7_2","doi-asserted-by":"publisher","DOI":"10.3390\/ijms24065487"},{"key":"e_1_3_8_8_2","doi-asserted-by":"publisher","DOI":"10.1001\/archgenpsychiatry.2011.76"},{"issue":"2","key":"e_1_3_8_9_2","first-page":"1","article-title":"Prevalence and early identification of autism spectrum disorder among children aged 4 and 8 years \u2013 Autism and Developmental Disabilities Monitoring Network, 16 sites, United States","volume":"74","author":"Shaw KA","year":"2025","unstructured":"Shaw KA, Williams S, Patrick ME, et al. Prevalence and early identification of autism spectrum disorder among children aged 4 and 8 years \u2013 Autism and Developmental Disabilities Monitoring Network, 16 sites, United States. Morb Mortal Wkly Rep 2025; 74(2): 1\u201322. https:\/\/doi.org\/10.15585\/mmwr.ss7402a1","journal-title":"Morb Mortal Wkly Rep"},{"issue":"01","key":"e_1_3_8_10_2","first-page":"1","article-title":"Prevalence of Autism Spectrum Disorders --- Autism and Developmental Disabilities Monitoring Network, Six sites, United States, 2000","volume":"56","author":"Centers for Disease Control and PreventionCenters for Disease Control and Prevention","year":"2007","unstructured":"Centers for Disease Control and PreventionCenters for Disease Control and Prevention. Prevalence of Autism Spectrum Disorders --- Autism and Developmental Disabilities Monitoring Network, Six sites, United States, 2000. Morb Mortal Wkly Rep 2007; 56(SS01): 1\u201311.","journal-title":"Morb Mortal Wkly Rep"},{"key":"e_1_3_8_11_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10803-020-04460-0"},{"key":"e_1_3_8_12_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10803-024-06371-w"},{"key":"e_1_3_8_13_2","unstructured":"Choate P California DDS. Personal communication 2018."},{"key":"e_1_3_8_14_2","volume-title":"Annual Estimates of the Resident Population by Age, Sex, Race, and Hispanic Origin for Counties in California: April 1, 2020 to July 1, 2025 (CC-EST2025-ALLDATA)","author":"U.S. Census Bureau, Population Division","year":"2026","unstructured":"U.S. Census Bureau, Population Division. Annual Estimates of the Resident Population by Age, Sex, Race, and Hispanic Origin for Counties in California: April 1, 2020 to July 1, 2025 (CC-EST2025-ALLDATA). U.S. Department of Commerce, 2026."},{"key":"e_1_3_8_15_2","volume-title":"National Center for Education Statistics)","author":"Elementary\/Secondary Information System","unstructured":"Elementary\/Secondary Information System. National Center for Education Statistics). NCES, Accessed Jan 10, 2026. https:\/\/nces.ed.gov\/ccd\/elsi\/"},{"key":"e_1_3_8_16_2","doi-asserted-by":"publisher","DOI":"10.1021\/es902057k"},{"key":"e_1_3_8_17_2","doi-asserted-by":"publisher","DOI":"10.1023\/A:1022964132203"},{"key":"e_1_3_8_18_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10803-018-3670-2"},{"key":"e_1_3_8_19_2","volume-title":"International Society for Autism Research (INSAR), 2019 annual meeting, Poster 31748","author":"Pearl M","year":"2019","unstructured":"Pearl M, Matias S, Poon V, et al. Trends in birth prevalence of autism spectrum disorder (ASD) in California from 1990 to 2010, by race-ethnicity and income. In: International Society for Autism Research (INSAR), 2019 annual meeting, Poster 31748. INSAR, 2019."},{"key":"e_1_3_8_20_2","volume-title":"Ranking by median household income","author":"Data Commons","year":"2024","unstructured":"Data Commons. Ranking by median household income. Data Commons by Google. All counties in California, 2024. https:\/\/datacommons.org\/explore?#q=Median%20income%20by%20county%20in%20California (Accessed Jan 25, 2026)."},{"key":"e_1_3_8_21_2","volume-title":"Medicaid coverage in California counties","author":"Georgetown University McCourt School of Public Policy","year":"2025","unstructured":"Georgetown University McCourt School of Public Policy. Medicaid coverage in California counties, 2025. https:\/\/ccf.georgetown.edu\/2025\/02\/06\/medicaid-coverage-in-california-counties-2023\/ (Accessed Jan 24, 2026)."},{"key":"e_1_3_8_22_2","volume-title":"Special education finance hearing California","author":"Educate.Advocate","year":"2018","unstructured":"Educate.Advocate. Special education finance hearing California. youtube, 2018. https:\/\/www.youtube.com\/watch?v=utVER6Jczuk (Accessed Feburary 20, 2026)."},{"key":"e_1_3_8_23_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1573-7861.2011.01238.x"},{"issue":"11","key":"e_1_3_8_24_2","first-page":"1","article-title":"Prevalence and Characteristics of Autism Spectrum Disorder Among Children Aged 8 Years - Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2018","volume":"70","author":"Maenner MJ","year":"2021","unstructured":"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. Morb Mortal Wkly Rep 2021; 70(11): 1\u201316. https:\/\/doi.org\/10.15585\/mmwr.ss7011a1","journal-title":"Morb Mortal Wkly Rep"},{"issue":"2","key":"e_1_3_8_25_2","first-page":"1","article-title":"Prevalence and characteristics of autism spectrum disorder among children aged 8 years\u2014Autism and Developmental Disabilities Monitoring Network, 11 sites, United States, 2020","volume":"72","author":"Maenner MJ","year":"2023","unstructured":"Maenner MJ, Warren Z, Williams AR, et al. Prevalence and characteristics of autism spectrum disorder among children aged 8 years\u2014Autism and Developmental Disabilities Monitoring Network, 11 sites, United States, 2020. Morb Mortal Wkly Rep 2023; 72(2): 1\u201314. https:\/\/doi.org\/10.15585\/mmwr.ss7202a1","journal-title":"Morb Mortal Wkly Rep"},{"key":"e_1_3_8_26_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10803-019-04188-6"},{"issue":"6","key":"e_1_3_8_27_2","first-page":"1","article-title":"Prevalence and Characteristics of Autism Spectrum Disorder Among Children Aged 8 Years \u2014 Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2014","volume":"67","author":"Baio J","year":"2018","unstructured":"Baio J, Wiggins L, Christensen DL, et al. Prevalence and Characteristics of Autism Spectrum Disorder Among Children Aged 8 Years \u2014 Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2014. Morb Mortal Wkly Rep 2018; 67(6): 1\u201323. https:\/\/doi.org\/10.15585\/mmwr.ss6706a1","journal-title":"Morb Mortal Wkly Rep"},{"key":"e_1_3_8_28_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amepre.2024.02.015"},{"key":"e_1_3_8_29_2","unstructured":"US Department of Education (USDE). Educational Services for Immigrant Children and Those Recently Arrived to the United States. https:\/\/www.ed.gov\/sites\/ed\/files\/policy\/rights\/guid\/unaccompanied-children.pdf (2019 Accessed March 10 2026)."},{"key":"e_1_3_8_30_2","unstructured":"Department of Health Care Services (DHCS). SB 75 \u2013 Full scope Medi-Cal for all children. https:\/\/www.dhcs.ca.gov\/services\/medi-cal\/eligibility\/Pages\/SB-75.aspx (2016 accessed March 11 2026)."},{"key":"e_1_3_8_31_2","volume-title":"Changes in the Population of Persons with Autism and Pervasive Developmental Disorders in California\u2019s Developmental Services System: 1987 through 1998","author":"California Department of Developmental Services","year":"1999","unstructured":"California Department of Developmental Services. Changes in the Population of Persons with Autism and Pervasive Developmental Disorders in California\u2019s Developmental Services System: 1987 through 1998. California DDS, 1999."},{"key":"e_1_3_8_32_2","volume-title":"Changes in California Caseload. An Update: 1999 through 2002","author":"California Department of Developmental Services. Autistic spectrum disorders","year":"2003","unstructured":"California Department of Developmental Services. Autistic spectrum disorders. Changes in California Caseload. An Update: 1999 through 2002. California DDS, 2003."},{"issue":"2","key":"e_1_3_8_33_2","first-page":"1","article-title":"Prevalence of autism spectrum disorder among children aged 8 years - autism and developmental disabilities monitoring network, 11 sites, United States, 2010","volume":"63","author":"Centers for Disease Control and Prevention Centers for Disease Control and Prevention CDC","year":"2014","unstructured":"Centers for Disease Control and Prevention Centers for Disease Control and Prevention CDC. Prevalence of autism spectrum disorder among children aged 8 years - autism and developmental disabilities monitoring network, 11 sites, United States, 2010. Morb Mortal Wkly Rep 2014; 63 (2): 1\u201321, Suppl 2.","journal-title":"Morb Mortal Wkly Rep"},{"key":"e_1_3_8_34_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0151970"},{"key":"e_1_3_8_35_2","volume-title":"California DDS","author":"Di Biasi E","year":"2026","unstructured":"Di Biasi E. California DDS. Personal communication, 2026."}],"container-title":["Sage Open Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/20503121261490679","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/20503121261490679","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/20503121261490679","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T05:46:20Z","timestamp":1789796780000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/20503121261490679"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9]]},"references-count":34,"alternative-id":["10.1177\/20503121261490679"],"URL":"https:\/\/doi.org\/10.1177\/20503121261490679","relation":{},"ISSN":["2050-3121","2050-3121"],"issn-type":[{"value":"2050-3121","type":"print"},{"value":"2050-3121","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9]]},"article-number":"20503121261490679"}}