The NSCH dataset for the years 2020–2021 comprised 93,669 participants, encompassing children and adolescents aged 0 to 17 years. Among these, 79,182 individuals aged 3 to 17 years were questioned about their ASD diagnosis and constituted the subjects of this study. The average age of the participants was 10.1 ± 4.6 (mean ± SD). Notably, 2,568 individuals, equivalent to 3.2%, had a confirmed current diagnosis of ASD (Table 1).
Table 1
Socio-Demographic Characteristics of the Autism Spectrum Disorder (ASD)
Socio-Demographic Characteristics | Total ( n = 79,182) | With ASD (n = 2,568) | No ASD (n = 76,614) |
Age (years) | 10.1 ± 4.6 | 10.7 ± 4.4 | 10.0 ± 4.6 |
Age Groups | Preschool: 3–5 | 18,205 (23.8%) | 453 ( 17.6%) | 18,658 (23.6%) |
School: 6–10 | 21,566 (28.1%) | 709 (27.6%) | 22,275 (28.1%) |
Adolescents: 11–17 | 36,843 (48.1%) | 1,406 ( 54.7%) | 38,249 (48.3%) |
Sex | Male | 41,076 (51.9%) | 2,022 (78.74%) | 39,054 (50.98%) |
Female | 38,106 (48.1%) | 546 (21.26%) | 37,560 (49.02%) |
Race | Hispanic | 10,717 (13.5%) | 366 (14.3%) | 10,351 (13.5%) |
White | 52,162 (65.8%) | 1,687 (65.7%) | 50,475 (65.9%) |
Black | 5,404 (6.8%) | 179 (6.9%) | 5,225 (6.8%) |
Asian | 4,495 (5.7%) | 104 (4.1%) | 4,391 (5.7%) |
American Indian/ Alaska Native | 524 (0.7%) | 15 (0.6%) | 509 (0.7%) |
Native Hawaiian/ Other Pacific Islander | 238 (0.350 | 5 (0.2%) | 233 (0.3%) |
Multi-Race | 5,642 (7.1%) | 212 (8.3%) | 5,430 (7.1%) |
Federal Poverty Level | ≥ 400% | 31,894 (40.3%) | 772 (30.1%) | 31,122 (40.6%) |
200% − 399% | 24,101 (30.4%) | 799 (31.1%) | 23,302 (30.4%) |
100% − 199% | 13,188 (16.7%) | 554 (21.6%) | 12,634 (16.5%) |
< 100% | 9,999 (12.6%) | 443 (17.3%) | 9,556 (12.5%) |
Highest education of adults in the household | Less than high school | 2,164 (2.7%) | 63 (2.5%) | 2,101 (2.7%) |
High school degree | 10,731 (13.5%) | 427 (16.6%) | 10,304 (13.5%) |
More than high school | 66,287 (83.7%) | 2,078 (80.9%) | 64,209 (83.8%) |
Multivariate analysis showed significant increases in the odds of ASD in the adolescent (11–17 year-olds) age group (odds ratio, OR: 1.5, p-value < 0.001) and multi-race ethnic group (OR: 1.2, p-value: 0.04) as well as in families with high school and higher than high school educational level (OR: 1.5, p-value: 0.005) (Table 2). Conversely, female gender (OR: 0.3, p-value < 0.001), higher household income (OR: 0.5, p-value < 0.001), and Asian race (OR: 0.7, p-value: 0.01) were associated with decreased odds of ASD among youths (Table 2).
Table 2
Socio-Demographic Predictors of Autism Spectrum Disorder (ASD)based on Univariate and Multivariate Analysis
Socio-Demographic Characteristics | Univariate Analysis OR (95% CI) | Multivariate Analysis OR (95% CI) |
Age Groups | Preschool: 3–5 | Reference | Reference |
School: 6–10 | 1.3 (1.2–1.5)*** | 1.3 (1.1–1.5)*** |
Adolescents: 11–17 | 1.5 (1.4–1.7)*** | 1.5 (1.4–1.7)*** |
Sex | Male | Reference | Reference |
Female | 0.3(0.2–0.3)*** | 0.3 (0.2–0.3)*** |
Race | Hispanic | Reference | Reference |
White | 0.9 (0.8–1.1) | 1.04(0.9–1.2) |
Black | 0.9 (0.8–1.2) | 0.9(0.7–1.1) |
Asian | 0.7(0.5–0.8)*** | 0.7 (0.6–0.9)* |
American Indian/ Alaska Native | 0.8(0.5–1.4) | 0.8(0.4–1.3) |
Native Hawaiian/ Other Pacific Islander | 0.6 (0.2–1.5) | 0.6 (0.2–1.4) |
Multi-Race | 1.1 (0.9–1.3) | 1.2 (1.0-1.4)* |
Federal Poverty Level | < 100% | Reference | Reference |
100% − 199% | 0.9 (0.8–1.1) | 0.9 (0.8-1.0) |
200% − 399% | 0.7 (0.6–0.8)*** | 0.7 (0.6–0.8)*** |
≥ 400% | 0.5 (0.5–0.6)*** | 0.5 (0.4–0.6)*** |
Highest education of adults in the household | Less than high school | Reference | Reference |
High school degree | 1.4 (1.1–1.8)* | 1.5 (1.1-2)** |
More than high school | 1.1(0.8–1.4) | 1.5 (1.1–1.9)** |
*: P value < 0.05, **: P value < 0.01, ***: P value < 0.001 |
96.4% of youth with ASD had at least one co-morbid condition. The most common neuropsychiatric co-morbid condition with ASD was developmental delay (64%), followed by behavioral and conduct problems (57.8%) and anxiety problems (45.7%); respectively (Fig. 1). While the most common medical co-morbidities were allergies (32.4%), genetic disorders (26.2%), and asthma (12.6%) (Fig. 1).
The odds of co-morbid vision problems (OR: 2.3, p-value < 0.001), cerebral palsy (OR: 2.2, p-value: 0.042), frequent/ severe headaches (OR:1.7, p-value: 0.002), epilepsy (OR: 1.7, p-value: 0.014), depression (OR: 1.6, p-value < 0.001), and intellectual disability (OR:1.5, p-value: 0.001) were significantly greater in females than males, whereas ADHD (OR: 0.8, p-value: 0.007) and anxiety problems (OR: 0.35, p-value < 0.001) were significantly lower among female individuals with ASD (Table 3).
Regarding the severity of ASD, we found that co-morbid occurrence of intellectual disability (OR: 5.8, p-value < 0.001), developmental delay (OR: 5, p-value < 0.001), epilepsy (OR: 3.4, p-value < 0.001), Down syndrome (OR: 3, p-value: 0.01),, vision problems (OR: 2.5, p-value < 0.001), behavioral and conduct problems (OR: 2.4, p-value < 0.001), genetic disorders (OR: 2.3, p-value < 0.001), hearing problems (OR: 1.6, p-value: 0.03), and anxiety problems (OR: 1.3, p-value < 0.001) may contribute to a more severe manifestation of ASD (Table 3).
Table 3
Psychiatric and Medical Co-morbidities in Autism Spectrum Disorder (ASD), Abbreviation: M: Male, F: Female, 1: Mild ASD, 2: Moderate to severe ASD
Disorders | ASD (n = 2,568) | Sex OR (95% CI) | ASD Severity OR (95% CI) |
Attention-Deficit Hyperactivity Disorder (ADHD) | 1,136 (44.3%)*** | M: Reference F: 0.8 (0.6–0.9)** | 1: Reference 2: 1.03 (0.9–1.2) |
Tourette Syndrome | 43 (1.7%)*** | M: Reference F: 0.6 (0.2–1.4) | 1: Reference 2: 1.8 (0.9–3.5) |
Depression | 425(16.7%)*** | M: Reference F: 1.6 (1.3-2.0)*** | 1: Reference 2: 0.9 (0.2–1.2) |
Anxiety Problems | 1,151(45.7%)*** | M: Reference F: 0.35 ( 0.3–0.4)*** | 1: Reference 2: 1.3 (1.3–1.8)*** |
Heart Disorders | 89 (3.5%) *** | M: Reference F: 1.3 (0.8–2.1) | 1: Reference 2: 0.9 (0.6–1.5) |
Developmental Delay | 1,628(64.0%)*** | M: Reference F: 1.02 (0.8–1.2) | 1: Reference 2: 5.0 (4.1–5.9)*** |
Intellectual Disability | 411 (16.1%) *** | M: Reference F: 1.5 (1.2–1.9) ** | 1: Reference 2: 5.8 (4.4–7.7)*** |
Behavioral and Conduct Problems | 1,470 (57.8%)*** | M: Reference F: 0.9 ( 0.7-1.0) | 1: Reference 2: 2.4 (2.0-2.8)*** |
Asthma | 320 (12.6%)*** | M: Reference F: 1.06 (0.8–1.4) | 1: Reference 2: 1.1 (0.9–1.4) |
Allergies | 832 (32.4%)*** | M: Reference F: 0.8 (0.7–1.03) | 1: Reference 2: 1.3 (1.06–1.5) |
Arthritis | 14 (0.5%)** | M: Reference F: 0.6 (0.1–2.7) | 1: Reference 2: 1.6 (0.5–4.8) |
Cerebral Palsy | 30 (1.2%)*** | M: Reference F: 2.2 (1.02–4.6)* | 1: Reference 2: 3 (1.3-7.0)** |
Diabetes | 25( 0.9%)*** | M: Reference F: 1.2 (0.5–2.9) | 1: Reference 2: 0.9( 0.4–2.1) |
Down Syndrome | 25 (0.9% )*** | M: Reference F: 2.1 (0.9–4.7) | 1: Reference 2: 4.5 (1.5–13.4)** |
Epilepsy | 107 (4.2%)*** | M: Reference F: 1.7 (1.1–2.6)** | 1: Reference 2: 3.4 (2.1–5.5)*** |
Frequent/Severe Headaches | 159 (6.2%) *** | M: Reference F: 1.7 (1.2–2.4)** | 1: Reference 2: 1.06 (0.7–1.5) |
Hearing Problems | 87 (3.4%)*** | M: Reference F:1.2 (0.7–1.9) | 1: Reference 2: 1.6 (1.03–2.5)* |
Genetic Disorder | 669 (26.2%)*** | M: Reference F: 1.2 ( 0.9–1.5) | 1: Reference 2: 2.3 (1.9–2.8)*** |
Vision Problems | 117 (4.6%)*** | M: Reference F: 2.3 (1.6–3.5)*** | 1: Reference 2: 2.5 (1.6–3.8)*** |
*: P value < 0.05, **: P value < 0.01, ***: P value < 0.001 |