Methods

Study Sites

The Children’s Health Act (4) authorized CDC to monitor prevalence of ASD
in multiple areas of the United States, a charge that led to the formation of
the ADDM Network in 2000. Since that time, CDC has funded grantees in
16 states (Alabama, Arizona, Arkansas, Colorado, Florida, Maryland,
Minnesota, Missouri, New Jersey, North Carolina, Pennsylvania, South
Carolina, Tennessee, Utah, West Virginia, and Wisconsin). CDC tracks ASD
in metropolitan Atlanta and represents the Georgia site collaborating with
competitively funded sites to form the ADDM Network.

The ADDM Network uses multisite, multisource, records-based

surveillance based on a model originally implemented by CDC’s
Metropolitan Atlanta Developmental Disabilities Surveillance Program
(MADDSP) (24). As feasible, the surveillance methods have remained
consistent over time. Certain minor changes have been introduced to
improve efficiency and data quality. Although a different array of
geographic areas was covered in each of the eight biennial ADDM Network
surveillance years spanning 2000–2014, these changes have been
documented to facilitate evaluation of their impact.

The core surveillance activities in all ADDM Network sites focus on

children aged 8 years because the baseline ASD prevalence study
conducted by MADDSP suggested that this is the age of peak prevalence
(3). ADDM has multiple goals: 1) to provide descriptive data on
classification and functioning of the population of children with ASD, 2) to
monitor the prevalence of ASD in different areas of the United States, and
3) to understand the impact of ASD in U.S. communities.

Funding for ADDM Network sites participating in the 2014 surveillance

year was awarded for a 4-year cycle covering 2015–2018, during which
time data were collected for children aged 8 years during 2014 and 2016.
Sites were selected through a competitive objective review process on the
basis of their ability to conduct active, records-based surveillance of ASD;
they were not selected to be a nationally representative sample. A total of
11 sites are included in the current report (Arizona, Arkansas, Colorado,
Georgia, Maryland, Minnesota, Missouri, New Jersey, North Carolina,
Tennessee, and Wisconsin). Each ADDM site participating in the 2014
surveillance year functioned as a public health authority under the Health
Insurance Portability and Accountability Act of 1996 Privacy Rule and met
applicable local Institutional Review Board and privacy and confidentiality
requirements under 45 CFR 46 (25).