Predictors of an earlier diagnosis of Autism Spectrum Disorder in children and adolescents: a systematic review (1987–2017)

Loubersac, Julie; Michelon, Cécile; Ferrando, Laetitia; Picot, Marie‐Christine; Baghdadli, Amaria

doi:10.1007/s00787-021-01792-9

Cited by 19 publications

(20 citation statements)

References 87 publications

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“…Similarly, children received a diagnostic assessment approximately 16.7 months earlier when mothers had a postgraduate level of education, relative to mothers who had primary or secondary school levels of education. This aligns with prior findings18 33 and highlights the importance of focusing on parental education as a modifiable risk factor when considering contributors to diagnostic delays. Maternal education in particular is acknowledged as the single best predictor of child health status and development outcomes,34–36 and lower education is closely associated with limited health literacy 37.…”

Section: Discussionsupporting

confidence: 87%

“…In contrast, studies tracking patient-level data within clinics typically use small sample sizes, research networks or private clinical services. These studies have reported mixed results to suggest that child gender [14][15][16] and symptom severity, 17 parental education, 18 marital status 19 and a culturally and linguistically diverse (CALD) background [20][21][22] may be associated with assessment and diagnosis delays (see also Daniels and Mandell for a review 23 ). These mixed findings are largely specific to autism specialist assessment clinics.…”

Section: Introductionmentioning

confidence: 99%

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Diagnostic delay in children with neurodevelopmental conditions attending a publicly funded developmental assessment service: findings from the Sydney Child Neurodevelopment Research Registry

et al. 2023

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ObjectivesEarly developmental assessment is crucial for effective support and intervention. This study examined factors that contribute to (a) older child age when caregivers first became concerned about their child’s development and (b) older child age at the point of entry into developmental and diagnostic assessment. We also quantified how factors contributed to risk of children not receiving an assessment by 5 years and considered the acceptability of electronic data capture for families.DesignThis cross-sectional study collected information about caregiver developmental concerns, family history and child characteristics.SettingChildren and families entered a large, publicly funded hospital-based paediatric developmental assessment service.ParticipantsConsecutively enrolled children (N=916) aged 6 months to 17 years with neurodevelopmental concerns and their caregivers.Main outcomes and measuresA developmental history questionnaire completed by caregivers.ResultsThe average age that caregivers identified developmental concerns was 3.0 years of age but the average age of a receiving a developmental assessment was 6.6 years. Only 46.4% of children received a diagnostic assessment by 5 years of age, even though 88.0% of caregivers were concerned about their child’s development by that age. Parental age, relationship status, education level, prior use of support services and being from a culturally and linguistically diverse background contributed to age at identification of concern, age at diagnostic assessment and the likelihood of receiving a diagnostic assessment by 5 years. Electronic data capture had high acceptability, with 88.2% of caregivers reporting a preference for electronic completion of questionnaires.ConclusionsThe study shows a substantial delay in diagnostic assessments that leaves most vulnerable children without an assessment by school age and highlights contributors to delays. These delays highlight the complexity of delivering early intervention and support policies that rely on swift and appropriate developmental assessment to vulnerable families.

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Section: Discussionsupporting

confidence: 87%

Section: Introductionmentioning

confidence: 99%

Diagnostic delay in children with neurodevelopmental conditions attending a publicly funded developmental assessment service: findings from the Sydney Child Neurodevelopment Research Registry

et al. 2023

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“…Indeed, in a study on VABSII subdomain scores, Balboni et al (2016) showed that the socialization delay in pre school children with ASD appeared to be mostly related to the play and imitation skills, which appear later in develop ment. This could explain contrasting results about VABSII socialization scores and AoD in the literature as the results depend on the age of the studied population (Alvares et al, 2020;Loubersac et al, 2021;Mishaal et al, 2014). Third, parental descriptions (through the ADIR) of early signs of nonverbal communication impairment were associated with earlier diagnosis.…”

Section: Discussionmentioning

confidence: 86%

Factors associated with age of diagnosis in children with autism spectrum disorders: Report from a French cohort

Rattaz

Loubersac

Michelon

et al. 2022

Autism

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Early diagnosis of autism spectrum disorder is challenging due to its phenotypic and etiological heterogeneity, but critical for implementation of early interventions. We examined the age of autism spectrum disorder diagnosis in a sample of 554 children and adolescents enrolled in the ELENA cohort study in France with regard to the influences of child clinical characteristics, family antecedents, and socio-economic factors. The mean age of diagnosis was 4.9 years (±2.8 years) with prediction of diagnosis before 3 years of age related to co-occurring intellectual disability, higher autism spectrum disorder symptom severity, and lower communicative abilities. Children in low socio-economic status families tended to have earlier autism spectrum disorder diagnosis compared to those in high socio-economic status families, but they also had greater severity of intellectual impairment. The age of autism spectrum disorder diagnosis was not associated with the presence of an older sibling with autism spectrum disorder. The trend for an inverse relationship between socio-economic status and age of diagnosis suggests equity in the current diagnostic services in France where health coverage is universal and free. Nonetheless, better screening of more subtle/less severe forms of autism spectrum disorder is also needed, as well as further assessment of the link between co-occurrence of autism spectrum disorder and severity of intellectual impairment in lower socio-economic status families. Lay Abstract Autism spectrum disorder is an early onset neurodevelopmental disorder and diagnosis can be made as early as 18 months of age. Early diagnosis of autism spectrum disorder is critical as it leads to early intervention. Age of autism spectrum disorder diagnosis has been linked to the child profile as autism spectrum disorder is characterized by strong heterogeneity, but is also influenced by socio-economic factors. There is paucity of data on age of diagnosis of autism spectrum disorder in France. We therefore examined the age of autism spectrum disorder diagnosis in 554 children and adolescents enrolled in the ELENA cohort study with respect to the influences of child profile, family antecedents, and socio-economic factors. The mean age of diagnosis was 4.9 years (±2.8 years). Early diagnosis, before 3 years of age, was related to the co-occurrence of intellectual disability, higher autism spectrum disorder symptom severity, and lower communicative abilities. Children in low socio-economic status families tended to have an earlier diagnosis, but these children also had greater degree of intellectual impairment compared to children in high socio-economic status families. The age of autism spectrum disorder diagnosis was not associated with the presence of an older sibling with autism spectrum disorder. The observed current trend of an inverse relationship between socio-economic status and age of diagnosis of autism spectrum disorder suggests equitable access to autism spectrum disorder services in France where health coverage is universal and free. Better screening of more subtle/less severe forms of autism spectrum disorder is needed, as well as further assessment of the link between the co-occurrence of autism spectrum disorder and intellectual impairment in children in lower socio-economic status families.

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“…Genomic microarrays are now indicated as a first-level diagnostic test for individuals with developmental delay, intellectual disability, multiple congenital anomalies, and ASD [ 13 ]. In some cases, genetic tests can identify possible causes of ASD or co-occurring medical conditions, thus helping in the development of more specific treatment plans [ 14 ]. Better identification of genetic causes of autism could increase the accuracy of genetic counseling for parents of children with ASD and other families considered at higher risk [ 15 ].…”

Section: Introductionmentioning

confidence: 99%

Working with Children with Autism Undergoing Health-Care Assessments in a Day Hospital Setting: A Perspective from the Health-Care Professionals

et al. 2023

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Background: Hospitals can be especially stressful for children with autism spectrum disorder (ASD) due to the communication and social skills deficits, lower capacity to adapt to disruption, and sensory hypersensitivity that are typical of these patients. Purpose: This study investigated how health-care professionals (HPs) experienced the clinical care and management of children with ASD undergoing medical testing in a day hospital setting, and assessed the rate of successful completion of laboratory tests and instrumental examinations. Methods: A cross-sectional questionnaire was administered to 45 HPs, inquiring about their experience in obtaining blood and urine tests, ECG, audiometry, and EEG from children with ASD. The clinical sample included 153 consecutively referred children with ASD (74.5% males, mean age 5.6 years) undergoing a medical diagnostic work-up as part of their diagnostic evaluation. The success rate of completing the various assessments was examined. Results: HPs identified aggressive behavior and communication deficits as the major challenges when providing care to children with ASD. The parents were seen as an important resource for managing the children. The completion rate of the laboratory tests and instrumental examinations was high (between 88.5% and 98.4% according to the specific type of examination). The lowest non-completion rate was found for the EEG (12.5%). Conclusions: Despite considerable challenges being reported by HPs in managing children with ASD, the scheduled assessments could be completed in the large majority of cases. Targeted approaches to preventing aggressive behaviors and obviating the communication barriers in children with ASD undergoing hospital exams are warranted.

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Predictors of an earlier diagnosis of Autism Spectrum Disorder in children and adolescents: a systematic review (1987–2017)

Cited by 19 publications

References 87 publications

Diagnostic delay in children with neurodevelopmental conditions attending a publicly funded developmental assessment service: findings from the Sydney Child Neurodevelopment Research Registry

Diagnostic delay in children with neurodevelopmental conditions attending a publicly funded developmental assessment service: findings from the Sydney Child Neurodevelopment Research Registry

Factors associated with age of diagnosis in children with autism spectrum disorders: Report from a French cohort

Working with Children with Autism Undergoing Health-Care Assessments in a Day Hospital Setting: A Perspective from the Health-Care Professionals

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