{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,31]],"date-time":"2026-10-31T12:34:01Z","timestamp":1793450041502,"version":"4.5.0"},"reference-count":52,"publisher":"American Academy of Pediatrics (AAP)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2006,4,1]]},"abstract":"<jats:p>OBJECTIVE. Growing administrative prevalence of autism has stirred public controversy and concern. The extent to which increases in the administrative prevalence of autism have been associated with corresponding decreases in the use of other diagnostic categories is unknown. The main objective of this study was to examine the relationship between the rising administrative prevalence of autism in US special education and changes in the use of other classification categories.<\/jats:p>\n                  <jats:p>METHODS. The main outcome measure was the administrative prevalence of autism among children ages 6 to 11 in US special education. Analysis involved estimating multilevel regression models of time-series data on the prevalence of disabilities among children in US special education from 1984 to 2003.<\/jats:p>\n                  <jats:p>RESULTS. The average administrative prevalence of autism among children increased from 0.6 to 3.1 per 1000 from 1994 to 2003. By 2003, only 17 states had a special education prevalence of autism that was within the range of recent epidemiological estimates. During the same period, the prevalence of mental retardation and learning disabilities declined by 2.8 and 8.3 per 1000, respectively. Higher autism prevalence was significantly associated with corresponding declines in the prevalence of mental retardation and learning disabilities. The declining prevalence of mental retardation and learning disabilities from 1994 to 2003 represented a significant downward deflection in their preexisting trajectories of prevalence from 1984 to 1993. California was one of a handful of states that did not clearly follow this pattern.<\/jats:p>\n                  <jats:p>CONCLUSIONS. Prevalence findings from special education data do not support the claim of an autism epidemic because the administrative prevalence figures for most states are well below epidemiological estimates. The growing administrative prevalence of autism from 1994 to 2003 was associated with corresponding declines in the usage of other diagnostic categories.<\/jats:p>","DOI":"10.1542\/peds.2005-1516","type":"journal-article","created":{"date-parts":[[2006,4,3]],"date-time":"2006-04-03T17:23:11Z","timestamp":1144084991000},"page":"1028-1037","source":"Crossref","is-referenced-by-count":247,"title":["The Contribution of Diagnostic Substitution to the Growing Administrative Prevalence of Autism in US Special Education"],"prefix":"10.1542","volume":"117","author":[{"given":"Paul T.","family":"Shattuck","sequence":"first","affiliation":[{"name":"Waisman Center, University of Wisconsin, Madison, Wisconsin"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2006,4,1]]},"reference":[{"key":"2021120902164679300_R1","unstructured":"California Department of Developmental Services. Changes in the population of persons with autism and pervasive developmental disorders in California's developmental services system: 1987 through 1998. A report to the Legislature, March 1, 1999. Sacramento, CA: California Health and Human Services Agency; 1999"},{"key":"2021120902164679300_R2","unstructured":"M.I.N.D. Institute. Report to the Legislature on the Principal Findings from the Epidemiology of Autism in California. Davis, CA: University of California; 2002"},{"key":"2021120902164679300_R3","doi-asserted-by":"crossref","unstructured":"Croen LA, Grether JK, Hoogstrate J, Selvin S. The changing prevalence of autism in California. J Autism Dev Disord.\u20082002;32:207\u2013215","DOI":"10.1023\/A:1015453830880"},{"key":"2021120902164679300_R4","doi-asserted-by":"crossref","unstructured":"Gurney JG, Fritz MS, Ness KK, Sievers P, Newschaffer CJ, Shapiro EG. Analysis of prevalence trends of autism spectrum disorder in Minnesota. Arch Pediatr Adolesc Med.\u20082003;157:622\u2013627","DOI":"10.1001\/archpedi.157.7.622"},{"key":"2021120902164679300_R5","doi-asserted-by":"crossref","unstructured":"Mandell DS, Palmer RF. Differences among states in the identification of autistic spectrum disorders. Arch Pediatr Adolesc Med.\u20082005;159:266\u2013269","DOI":"10.1001\/archpedi.159.3.266"},{"key":"2021120902164679300_R6","doi-asserted-by":"crossref","unstructured":"Newschaffer CJ, Falb MD, Gurney JG. National autism prevalence trends from United States special education data. Pediatrics.\u20082005;115(3). Available at: www.pediatrics.org\/cgi\/content\/full\/115\/3\/e277","DOI":"10.1542\/peds.2004-1958"},{"key":"2021120902164679300_R7","doi-asserted-by":"crossref","unstructured":"Palmer RF, Blanchard S, Carlos RJ, Mandell DS. School district resources and identification of children with autistic disorder. Am J Public Health.\u20082005;95:125\u2013130","DOI":"10.2105\/AJPH.2003.023077"},{"key":"2021120902164679300_R8","unstructured":"U.S. Department of Education. Eighteenth Annual Report to Congress on the Implementation of the Individuals with Disabilities Education Act. Washington, DC: Department of Education; 1996"},{"key":"2021120902164679300_R9","unstructured":"IDEAdata.org. Annual report tables. Available at: www.ideadata.org\/PartBdata.asp Accessed February 17, 2005"},{"key":"2021120902164679300_R10","unstructured":"Cowley G, Foote D, Tesoriero HW. Understanding autism [cover story]. Newsweek.\u20082000;136:46\u201354"},{"key":"2021120902164679300_R11","unstructured":"Goode E. More and more autism cases, yet causes are much debated. The New York Times. January 26,\u20082004:A1"},{"key":"2021120902164679300_R12","unstructured":"Nash JM, Bonesteel A. The secrets of autism [cover story]. Time.\u20082002;159:46\u201357 (cover story)."},{"key":"2021120902164679300_R13","unstructured":"Seligman K. Scientists baffled as autism cases soar in state, with no relief in sight: Treatment centers, schools inundated by kids needing help. San Francisco Chronicle. February 4, 2005:A1"},{"key":"2021120902164679300_R14","doi-asserted-by":"crossref","unstructured":"Vastag B. Congressional autism hearings continue. JAMA.\u20082001;285:2567\u20132569","DOI":"10.1001\/jama.285.20.2567"},{"key":"2021120902164679300_R15","unstructured":"United States Government Accountability Office. Special Education: Children With Autism. Washington, DC: United States Government Accountability Office; 2005."},{"key":"2021120902164679300_R16","unstructured":"Gross J. Government Mapping Out a Strategy to Fight Autism. The New York Times. November 19,\u20082003:A20"},{"key":"2021120902164679300_R17","doi-asserted-by":"crossref","unstructured":"Blaxill MF, Baskin DS, Spitzer WO. Commentary: Blaxill, Baskin, and Spitzer on Croen et al. (2002), The changing prevalence of autism in California. J Autism Dev Disord.\u20082003;33:223\u2013226","DOI":"10.1023\/A:1022912115365"},{"key":"2021120902164679300_R18","doi-asserted-by":"crossref","unstructured":"Croen LA, Grether JK. Response: a response to Blaxill, Baskin, and Spitzer on Croen et al. (2002), The changing prevalence of autism in California. J Autism Dev Disord.\u20082003;33:227\u2013229","DOI":"10.1023\/A:1022964132203"},{"key":"2021120902164679300_R19","doi-asserted-by":"crossref","unstructured":"Wing L, Potter D. The epidemiology of autistic spectrum disorders: Is the prevalence rising?Ment Retard Dev Disabil Res Rev.\u20082002;8:151\u2013161","DOI":"10.1002\/mrdd.10029"},{"key":"2021120902164679300_R20","doi-asserted-by":"crossref","unstructured":"Rutter M. Incidence of autism spectrum disorders: changes over time and their meaning. Acta Pediatr.\u20082005;94:2\u201315","DOI":"10.1080\/08035250410023124"},{"key":"2021120902164679300_R21","doi-asserted-by":"crossref","unstructured":"Gernsbacher M, Dawson M, Goldsmith HH. Three reasons not to believe in an autism epidemic. Curr Dir Psychol Sci.\u20082005;14:55\u201358","DOI":"10.1111\/j.0963-7214.2005.00334.x"},{"key":"2021120902164679300_R22","unstructured":"MacMillan DL, Speece DL. Utilitiy of current diagnostic categories for research and practice. In: Gallimore R, Bernheimer LP, MacMillan DL, Speece DL, Vaughn S, eds. Developmental Perspectives on Children with High-Incidence Disabilities. Mahwah, NJ: Erlbaum; 1999"},{"key":"2021120902164679300_R23","doi-asserted-by":"crossref","unstructured":"MacMillan DL, Gresham FM, Bocian KM. Discrepancy between definitions of learning disabilities and school practices: an empirical investigation. J Learn Disabil.\u20081998;31:314\u2013326","DOI":"10.1177\/002221949803100401"},{"key":"2021120902164679300_R24","doi-asserted-by":"crossref","unstructured":"MacMillan DL, Siperstein GN, Gresham FM. Mild mental retardation: A challenge to its viability as a diagnostic category. Except Child.\u20081996;62:356\u2013371","DOI":"10.1177\/001440299606200405"},{"key":"2021120902164679300_R25","unstructured":"MacMillan DL, Gresham FM, Siperstein GN, Bocian KM. The labyrinth of IDEA: school decisions on referred students with subaverage general intelligence. Am J Ment Retard.\u20081996;101:161\u2013174"},{"key":"2021120902164679300_R26","doi-asserted-by":"crossref","unstructured":"MacMillan DL, Gresham FM, Bocian KM, Siperstein GN. The role of assessment in qualifying students as eligible for special education: what is and what's supposed to be?Focus Except Child.\u20081997;30:1\u201318","DOI":"10.17161\/foec.v30i2.6757"},{"key":"2021120902164679300_R27","doi-asserted-by":"crossref","unstructured":"Barbaresi WJ, Katusic SK, Colligan RC, Weaver AL, Jacobsen SJ. The incidence of autism in Olmstead County, Minnesota, 1976\u20131997. Arch Pediatr Adolesc Med.\u20082005;159:37\u201344","DOI":"10.1001\/archpedi.159.1.37"},{"key":"2021120902164679300_R28","unstructured":"Education of the Handicapped Act Amendments of 1990. Pub L. 101-476. Vol Pub L. 101-476; 1990"},{"key":"2021120902164679300_R29","unstructured":"Muller E, Linehan P. Federal Disability Terms: A Review of State Use. Project Forum: National Association of State Directors of Special Education; 2001. Available at: www.nasdse.org\/publications\/fed_disability_terms.pdf. Accessed February 16, 2006"},{"key":"2021120902164679300_R30","unstructured":"IDEAdata.org. Data notes for IDEA, part B. Available at: www.ideadata.org\/docs\/bdatanotes2002.pdf Accessed February 16, 2006"},{"key":"2021120902164679300_R31","unstructured":"US Department of Education. Twenty-Fourth Annual Report to Congress on the Implementation of the Individuals With Disabilities Education Act. Washington, DC: US Department of Education; 2002"},{"key":"2021120902164679300_R32","doi-asserted-by":"crossref","unstructured":"Bertrand J, Boyle C, Yeargin-Allsopp M, Decoufle P, Mars A, Bove F. Prevalence of autism in a United States population: the Brick Township, New Jersey, investigation. Pediatrics.\u20082001;108:1155\u20131162","DOI":"10.1542\/peds.108.5.1155"},{"key":"2021120902164679300_R33","doi-asserted-by":"crossref","unstructured":"Yeargin-Allsopp M, Rice C, Karapurkar T, Doernberg N, Boyle C, Murphy C. Prevalence of autism in a US metropolitan area. JAMA.\u20082003;289:49\u201355","DOI":"10.1001\/jama.289.1.49"},{"key":"2021120902164679300_R34","doi-asserted-by":"crossref","unstructured":"Laidler JR. US Department of Education data on \u201cautism\u201d are not reliable for tracking autism prevalence. Pediatrics.\u20082005;116(1). Available at: www.pediatrics.org\/cgi\/content\/full\/116\/1\/e120","DOI":"10.1542\/peds.2004-2341"},{"key":"2021120902164679300_R35","doi-asserted-by":"crossref","unstructured":"Singer JD, Willett JB. Applied Longitudinal Data Analysis: Modeling Change and Event Occurrence. New York, NY: Oxford Press; 2003","DOI":"10.1093\/acprof:oso\/9780195152968.001.0001"},{"key":"2021120902164679300_R36","unstructured":"Scientific Software International. HLM 6.0: Hierarchical Linear and Nonlinear Modeling [computer program]. Chicago, IL: Scientific Software International; 2004"},{"key":"2021120902164679300_R37","unstructured":"Long J. Regression Models for Categorical and Limited Dependent Variables. Vol 7. Thousand Oaks, CA: Sage; 1997"},{"key":"2021120902164679300_R38","doi-asserted-by":"crossref","unstructured":"Chakrabarti S, Fombonne E. Pervasive developmental disorders in preschool children. JAMA.\u20082001;285:3093\u20133100","DOI":"10.1001\/jama.285.24.3093"},{"key":"2021120902164679300_R39","doi-asserted-by":"crossref","unstructured":"Baird G, Charman T, Baron-Cohen S, et al. A screening instrument for autism at 18 months of age: A 6-year follow-up study. J Am Acad Child Adolesc Psychiatry.\u20082000;39:694\u2013702","DOI":"10.1097\/00004583-200006000-00007"},{"key":"2021120902164679300_R40","unstructured":"Gordis L. Epidemiology. 2nd ed. Philadelphia, PA: WB Saunders; 2000"},{"key":"2021120902164679300_R41","unstructured":"Individuals with Disabilities Education Act. United States Code. Vol US Code 20; 1997"},{"key":"2021120902164679300_R42","unstructured":"Office of Special Education Programs, US Department of Education. Children with ADD\/ADHD: topic brief. Available at: www.ed.gov\/policy\/speced\/leg\/idea\/brief6.html Accessed March 18, 1995"},{"key":"2021120902164679300_R43","unstructured":"Snijders T, Bosker R. Multilevel Analysis: An Introduction to Basic and Advanced Multilevel Modeling. Thousand Oaks, CA: Sage; 1999"},{"key":"2021120902164679300_R44","doi-asserted-by":"crossref","unstructured":"Madsen KM, Hviid A, Vestergaard M, et al. A population-based study of measles, mumps, and rubella vaccination and autism. N Eng J Med.\u20082002;347:1477\u20131482","DOI":"10.1056\/NEJMoa021134"},{"key":"2021120902164679300_R45","doi-asserted-by":"crossref","unstructured":"Wilson K, Mills E, Ross C, McGowan J, Jadad A. Association of autistic spectrum disorder and the measles, mumps, and rubella vaccine. Arch Pediatr Adolesc Med.\u20082003;157:628\u2013634","DOI":"10.1001\/archpedi.157.7.628"},{"key":"2021120902164679300_R46","doi-asserted-by":"crossref","unstructured":"Hviid A, Stellfield M, Wohlfahrt J, Melbye M. Association between thimerosal-containing vaccine and autism. JAMA.\u20082003;290:1763\u20131766","DOI":"10.1001\/jama.290.13.1763"},{"key":"2021120902164679300_R47","doi-asserted-by":"crossref","unstructured":"Honda H, Shimizu Y, Rutter M. No effect of MMR withdrawal on the incidence of autism: a total population study. J Child Psychol Psychiatry.\u20082005;46:572\u2013579","DOI":"10.1111\/j.1469-7610.2005.01425.x"},{"key":"2021120902164679300_R48","doi-asserted-by":"crossref","unstructured":"Ip P, Ho M. Mercury exposure in children with autistic spectrum disorder: case-control study. J Child Neurol.\u20082004;19:431\u2013434","DOI":"10.1177\/088307380401900606"},{"key":"2021120902164679300_R49","doi-asserted-by":"crossref","unstructured":"Fombonne E. Is there an epidemic of autism?Pediatrics.\u20082001:411\u2013413","DOI":"10.1542\/peds.107.2.411"},{"key":"2021120902164679300_R50","unstructured":"Szklo M, Nieto FJ. Epidemiology: Beyond the Basics. Gaithersburg, MD: Aspen; 2000"},{"key":"2021120902164679300_R51","unstructured":"Centers for Disease Control and Prevention. Learn the signs. Act early. Early identification of children with autism or other developmental disorders awareness campaign. Available at: www.cdc.gov\/ncbddd\/autism\/actearly Accessed March 2, 2005"},{"key":"2021120902164679300_R52","unstructured":"American Academy of Pediatrics, National Center of Medical Home Initiatives for Children with Special Needs. National medical home autism initiative. Available at: www.medicalhomeinfo.org\/grant\/mchb.html Accessed March 2, 2005"}],"container-title":["Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/117\/4\/1028\/1072716\/zpe00406001028.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/117\/4\/1028\/1072716\/zpe00406001028.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,12,9]],"date-time":"2021-12-09T05:40:21Z","timestamp":1639028421000},"score":1,"resource":{"primary":{"URL":"https:\/\/publications.aap.org\/pediatrics\/article\/117\/4\/1028\/70958\/The-Contribution-of-Diagnostic-Substitution-to-the"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2006,4,1]]},"references-count":52,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2006,4,1]]},"published-print":{"date-parts":[[2006,4,1]]}},"URL":"https:\/\/doi.org\/10.1542\/peds.2005-1516","relation":{},"ISSN":["0031-4005","1098-4275"],"issn-type":[{"value":"0031-4005","type":"print"},{"value":"1098-4275","type":"electronic"}],"subject":[],"published":{"date-parts":[[2006,4,1]]}}}