San Diego, the southernmost major city in California, shares a border with Mexico and contains rich geographic, racial, and ethnic diversity. Using a surveillance region defined within San Diego County, California joined the ADDM Network for the first time during the previous funding cycle, where higher ASD prevalence rates were found in US children than any previous surveillance period. Specifically, our California ADDM site (CA ADDM) had the highest prevalence for both 4- and 8-year-olds, the lowest age of diagnosis, the lowest proportion of children with Intellectual Disability (ID), and one of the more racially and ethnically diverse populations. This, in turn, led to the overall population of the ADDM Network being more racially and ethnically diverse than in previous years (Maenner et al., 2021; Shaw et al., 2021). As underscored by 14 MOUs/LOSs, in the current application our team at the UCSD Autism Center of Excellence proposes to further develop population-based, multiple-source, surveillance programs for ASD within this unique region. To achieve this objective, we will expand our previous surveillance region to now include a confirmed new school district partner, Santee, and have plans to expand our community partners and surveillance region even further with an additional 11 MOUs pending from school districts, health systems, and early intervention treatment providers. Underscoring the success of our participation in ADDM, all partners from the previous round of funding have enthusiastically agreed to continue to support the mission of the ADDM Network. Our unique surveillance region, just a few miles from the border with Mexico, will continue to contain the highest density of children of Hispanic descent (40%) relative to all current ADDM Network sites. Our surveillance team, led by long-time autism researcher, Dr. Karen Pierce, and supported by our epidemiology trained Project Coordinator (PC) Andrea Grzybowski, and highly experien
ced Data Manager (DM), Dr. Srinivasa Nalabolu was extremely successful during the previous round of funding with high QAQC metrics often exceeding 94% reliability with the PC, and delivery of clean, birth certificate linked data to the CDC often ahead of deadlines. Our team is well versed in ADDM operating procedures and tools including REDCap, SAS and associated Link-King software, as well as in obtaining birth certificate data and in creating ‘community snapshots’ to disseminate site-specific ADDM findings and enhance community partnerships. Moreover, we often worked collaboratively with the CDC to field test and troubleshoot technical and logistical operations vital to the entire ADDM Network. Using ADDM methodology, we will continue to address a range of public health issues as they relate to ASD including determining: (1) prevalence rates within a designated surveillance area defined by FIPS codes that includes four school districts containing more than 15,000 children in both the four-year and eight-year old cohorts (with a high likelihood for additional expansion); (2) differences in prevalence among racial and ethnic groups; (3) intellectual functioning; (4), and age at first diagnostic evaluation. The performance of our surveillance program will be closely tracked using key measures reported at weekly team meetings including: (1) number of health records in tracking system and abstracted; (2) number of education records in tracking and abstracted; (3) number of early service provider records in tracking and abstracted. Expected immediate outcomes include increased collection of multisource data; enhanced partnerships between the UCSD Autism Center of Excellence and community partners; increased reliability and efficiency of ADDM surveillance and increased dissemination of ADDM data. We are confident that the overall long-term outcome of our participation will be improved policies, plans and services for children with ASD not only in our area but in the US
as a whole.