Autism Spectrum Disorder (ASD) is a neurodevelopmental condition characterized by persistent challenges in social communication and interaction, alongside restricted interests and repetitive behaviors. Globally, there has been an observable increase in autism diagnoses since the 1990s. This trend is often attributed to improved public health awareness, advancements in case identification, and changes in diagnostic criteria. This article explores the specific context of autism rates within China.
Understanding Autism Prevalence in China
Recent studies suggest that the prevalence of autism in China is estimated to be around 1 in 100 children. A meta-analysis of 21 studies (2017-2023) found the ASD prevalence among children in mainland China to be 0.7% (7 per 1000). This represents an upward trend compared to the prevalence of 26.50 per 10,000 reported for 2000 to 2016.
Prevalence figures in China are typically derived from various methodologies, including population-based surveys and data collected from hospitals. For example, one nationwide study utilized a multistage convenient cluster sampling to screen over 125,000 children aged 6 to 12 years using the Modified Chinese Autism Spectrum Rating Scale. This study reported an observed prevalence rate of 0.29%, which adjusted to an estimated 0.70% after accounting for response rates.
While these rates reflect a rising trend, the overall prevalence in China remains lower than figures reported in some Western countries. The variation in reported prevalence across different regions within China, such as Ningbo reporting 1.15 per 1000 and Zhongshan city reporting 10.2 per 1000 for preschool children, highlights the need for more large-scale, multicenter studies to provide comprehensive epidemiological data.
Unique Influences on Diagnosis and Reporting
The identification and reporting of autism in China are shaped by several distinct factors. Historically, autism was not formally recognized in China until 1982. Public and professional awareness has gradually improved since then, but a lack of understanding persists among a portion of the population. Studies have indicated that public awareness of autism in China ranges from 57% to 65%, which is lower than the 86% to 91% reported in the United States.
Cultural perceptions also play a significant role. In traditional Chinese culture, autism has been frequently misunderstood, sometimes viewed as an illness or a contagious disease that can be cured. This incorrect viewpoint can lead to parents being blamed for their child’s condition. The societal emphasis on achievement, good manners, and conformity, rooted in Confucian tradition, can further contribute to stigma, as behaviors associated with autism may be seen as bringing shame upon the family. This fear of discrimination can cause families to delay seeking a diagnosis or to live in isolation, avoiding formal support.
The healthcare infrastructure also presents challenges. There is a scarcity of child psychiatrists and pediatricians, particularly in rural areas, leading to disparities in the accessibility of diagnostic services. This means accessing qualified specialists often requires substantial time and financial investment. Furthermore, while China adopts international diagnostic criteria such as the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition) and ICD-11 (International Classification of Diseases, Eleventh Revision), and previously ICD-10, their consistent application across all regions can be uneven. The Chinese medical system also uses its own criteria, CCMD-3, which aligns with international standards but may still contribute to variations in diagnosis.
Evolving Support and Awareness
China has made notable progress in developing support systems and increasing awareness surrounding autism. In July 2024, the China Disabled Persons’ Federation, alongside several ministries, released the “Implementation Plan for the Care and Development of Autistic Children (2024-28).” This five-year action plan aims to improve the quality of education, social security, and medical security for children with autism, ensuring their equal development rights. Shenzhen also released its own comprehensive support plan in October 2023, outlining commitments in policy, rehabilitation, education, employment, and family support.
Government initiatives include efforts to enhance early detection and intervention, with a trial protocol for autism screening and intervention services for children under six years old introduced in 2022. Special education reforms are also underway, with 61 cities, counties, and districts designated as national pilot areas to establish a coherent special education system from preschool to high school. This includes exploring the construction of specialized schools for autistic children and implementing teaching assistant systems for personalized support. Some cities, like Shenyang, provide rehabilitation subsidies for autistic children.
Non-governmental organizations (NGOs) have emerged as significant forces in providing intervention programs and parent training. Beijing Stars and Rain Institution, established in 1993, was the first NGO for autism in China, focusing on applied behavior analysis and professional support. The number of autism-focused NGOs has been increasing, with a 12% growth from 2016 to 2019 and a 30% increase in service capacity during that period.