Analysis of prevalence trends of autism spectrum disorder in Minnesota

Background: Alarming increases in the prevalence of autism spectrum disorder have been reported recently in the United States and Europe. Objectives: To quantify and characterize prevalence trends over time in autism spectrum disorder in Minnesota. Methods: We conducted an age-period-birth cohort analysis of special educational disability data from the Minnesota Department of Children, Families & Learning from the 1981-1982 through the 2001-2002 school years. Results: Prevalence rates of autism spectrum disorder rose substantially over time within single-age groups and increased from year to year within birth cohorts. Autism spectrum disorder prevalence among children aged 6 to 11 years increased from 3 per 10000 in 1991-1992 to 52 per 10000 in 2001-2002. All other special educational disability categories also increased during this period, except for mild mental handicap, which decreased slightly from 24 per 10000 to 23 per 10000. We found that federal and state administrative changes favoring identification of autism spectrum disorders corresponded in time with the increasing rates. Conclusions: We observed dramatic increases in the prevalence of autism spectrum disorder as a primary special educational disability starting in the 1991-1992 school year, and the trends show no sign of abatement. We found no corresponding decrease in any special educational disability category to suggest diagnostic substitution as an explanation for the autism trends in Minnesota. We could not assess changes in actual disease incidence with these data, but federal and state administrative changes in policy and law favoring better identification and reporting of autism are likely contributing factors to the prevalence increases and may imply that autism spectrum disorder has been underdiagnosed in the past.