Summary: New analysis of school records shows that about one in 57 children in England (1.76%) is on the autism spectrum—higher than earlier estimates. The study also found differences in diagnosis rates across ethnic groups and that autistic children are more likely to experience social disadvantage.
Source: University of Cambridge
A comprehensive study of more than 7 million pupils in England finds autism prevalence in children is higher than previously reported. Researchers from the University of Cambridge’s Department of Psychiatry, working with colleagues at Newcastle University and Maastricht University, report that 1.76% of children in state-funded schools have a recorded diagnosis of autism spectrum disorder (ASD).
The study found variation by ethnicity: Black pupils and Chinese pupils showed 26% and 38% higher recorded rates of autism respectively compared with the overall average. It also found autistic pupils were substantially more likely to face social disadvantage. The findings are published in JAMA Pediatrics.
The research team used the Spring School Census from the National Pupil Database, which covers children aged 2–21 in state-funded schools across England. Out of 7,047,238 pupils included in the dataset, 119,821 had an autism diagnosis recorded in school records; 21,660 of those (18.1%) also had recorded learning difficulties. The recorded prevalence was 2.8% for boys and 0.65% for girls, yielding a boy-to-girl ratio of 4.3:1.
By ethnic group, standardized prevalence was highest among Black pupils (2.11%) and lowest among Roma/Irish Traveller pupils (0.85%); these are among the first published estimates for some groups. Pupils with autism were about 60% more likely to be classified as socially disadvantaged, and 36% less likely to have English as their first language recorded. The results reveal substantial differences in recorded autism prevalence across ethnic groups and geographic areas.
Dr Andres Roman-Urrestarazu, lead author and researcher at the Autism Research Centre (ARC) and Cambridge Public Health, said: “We can now see that autism is much more common than previously thought. We also found significant variations in autism diagnosis in different ethnic minorities, though the reason why this should be the case isn’t clear and warrants further research.”
Earlier work by the same Cambridge group, which used a school-based survey, estimated autism prevalence at one in 64 children (1.57%). Because school records generally underestimate the number of children who meet diagnostic criteria, the new records-based estimate—1.76%—represents a notable increase. The researchers suggest the rise likely reflects improved recognition of autism by parents, schools, and services in recent years.
Professor Carol Brayne, Co-chair of Cambridge Public Health and Professor of Public Health Medicine, commented: “This study shows how large administrative datasets can be used rigorously to improve our understanding of autism.”
Professor Fiona Matthews of Newcastle University added: “This study highlights the need for greater attention to the unrecognised and differing needs of autistic children from disadvantaged and diverse backgrounds.”
Professor Simon Baron-Cohen, Director of the ARC, said: “We can now see a snapshot of how many autistic children there are, and can drill down into local and ethnic variation, and reveal links with vulnerability. It is important that we safeguard the rights of children to access diagnostic services and education, tailored to their needs.”
Funding: This research was supported by a donation for a Global Public Health Leadership programme (a Dennis and Mireille Gillings Fellowship awarded to Dr Andres Roman-Urrestarazu), and received additional support from the Autism Research Trust, the Wellcome Trust, the Innovative Medicines Initiative 2 Joint Undertaking, the NIHR Cambridge Biomedical Research Centre, and the NIHR Collaboration for Leadership in Applied Health Research and Care East of England at Cambridgeshire and Peterborough NHS Foundation Trust.
About this autism research news
Source: University of Cambridge
Contact: Craig Brierley – University of Cambridge
Image: The image is in the public domain
Original Research: Open access. “Association of Race/Ethnicity and Social Disadvantage With Autism Prevalence in 7 Million School Children in England” by Roman-Urrestarazu R et al. JAMA Pediatrics
Abstract
Association of Race/Ethnicity and Social Disadvantage With Autism Prevalence in 7 Million School Children in England
Importance
Global estimates place autism spectrum disorder (ASD) prevalence at roughly 1%–2% of the population, but evidence from Black, Asian, and other racial/ethnic minority groups remains limited. Reliable prevalence estimates are essential for planning diagnostic, educational, health, and social care services and for identifying potential barriers to access and inequalities linked to social determinants of health.
Objective
To assess whether socioeconomic disadvantage is associated with recorded ASD prevalence and the likelihood of accessing ASD-related services among racial/ethnic minority and disadvantaged groups in England.
Design, Setting, and Participants
This case-control prevalence cohort study used the Spring School Census 2017 from the Pupil Level Annual Schools Census within the National Pupil Database. The dataset is a total population sample including all children, adolescents, and young adults aged 2 to 21 years in state-funded education in England. Data were collected on January 17, 2017, and analyses were performed between August 2, 2018, and January 28, 2020.
Exposures
Analyses adjusted for age and sex and examined associations between ASD status and (1) race/ethnicity, (2) social disadvantage, (3) first language spoken, (4) Education, Health and Care Plan or ASD special educational needs and disability support status, and (5) mediation effects of social disadvantage and language on ASD status.
Main Outcomes and Measures
Sex- and age-standardized ASD prevalence by race/ethnicity and across 326 English local authority districts for pupils aged 5 to 19 years.
Results
The study population comprised 7,047,238 pupils (50.99% male; mean [SD] age, 10.18 [3.47] years), including 119,821 pupils with ASD, of whom 21,660 also had learning difficulties (18.08%). The standardized ASD prevalence was 1.76% (95% CI, 1.75%–1.77%), with prevalence of 2.81% in males (95% CI, 2.79%–2.83%) and 0.65% in females (95% CI, 0.64%–0.66%), giving a male-to-female ratio of 4.32:1. Standardized prevalence was highest in Black pupils (2.11%; 95% CI, 2.06%–2.16%) and lowest in Roma/Irish Traveller pupils (0.85%; 95% CI, 0.67%–1.03%). Pupils with ASD were more likely to experience social disadvantage (adjusted prevalence ratio, 1.61; 95% CI, 1.59–1.63) and less likely to speak English as a first language (adjusted prevalence ratio, 0.64; 95% CI, 0.63–0.65). Mediation analysis indicated that the impact of race/ethnicity on ASD status was partly mediated by social disadvantage, with the largest mediated effect observed for Black pupils.
Conclusions and Relevance
These findings indicate meaningful differences in recorded ASD prevalence across racial and ethnic groups and geographic areas within England. The variation may reflect true differences in population prevalence, differential detection, referral practices, or access to diagnostic services among racial and ethnic minority groups. The results underscore the need for targeted efforts to ensure equitable identification, diagnostic assessment, and support for autistic children across diverse and disadvantaged communities.