Tracking the prevalence of ASD poses unique challenges because of the heterogeneity in symptom presentation, lack of biologic diagnostic markers, and changing diagnostic criteria ( 5 ). Initial signs and symptoms typically are apparent in the early developmental period; however, social deficits and behavioral patterns might not be recognized as symptoms of ASD until a child is unable to meet social, educational, occupational, or other important life stage demands ( 1 ). Features of ASD might overlap with or be difficult to distinguish from those of other psychiatric disorders, as described extensively in DSM-5 ( 1 ). Although standard diagnostic tools have been validated to inform cliniciansâ impressions of ASD symptomology, inherent complexity of measurement approaches and variation in clinical impressions and decision-making, combined with policy changes that affect eligibility for health benefits and educational programs, complicates identification of ASD as a behavioral health diagnosis or educational exceptionality. To reduce the influence of these factors on prevalence estimates, the ADDM Network has consistently tracked ASD by applying a surveillance case definition of ASD and using the same record-review methodology and behaviorally defined case inclusion criteria since 2000 ( 5 ).
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