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J Autism Dev Disord. 2011 Feb;41(2):227-36. doi: 10.1007/s10803-010-1050-7.

Evaluation of a records-review surveillance system used to determine the prevalence of autism spectrum disorders.

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Developmental Disabilities Branch, Centers for Disease Control and Prevention, 1600 Clifton Road, MS E-92, Atlanta, GA 30333, USA.


We conducted the first study that estimates the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of a population-based autism spectrum disorders (ASD) surveillance system developed at the Centers for Disease Control and Prevention. The system employs a records-review methodology that yields ASD classification (case versus non-ASD case) and was compared with classification based on clinical examination. The study enrolled 177 children. Estimated specificity (0.96, [CI(.95) = 0.94, 0.99]), PPV (0.79 [CI(.95) = 0.66, 0.93]), and NPV (0.91 [CI(.95) = 0.87, 0.96]) were high. Sensitivity was lower (0.60 [CI(.95) = 0.45, 0.75]). Given diagnostic heterogeneity, and the broad array of ASD in the population, identifying children with ASD is challenging. Records-based surveillance yields a population-based estimate of ASD that is likely conservative.

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