Sex Differences in Age of Diagnosis and First Concern among Children with Autism Spectrum Disorder

McDonnell, Christina G.; DeLucia, Elizabeth A.; Hayden, Elizabeth P.; Penner, Melanie; Curcin, Kristina; Anagnostou, Evdokia; Nicolson, Rob; Kelley, Elizabeth; Georgiades, Stelios; Liu, Xudong; Stevenson, Ryan A.

doi:10.1080/15374416.2020.1823850

Cited by 39 publications

(26 citation statements)

References 40 publications

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“…Of importance, none of the sociodemographic variables, including age, sex, race, ethnicity or maternal education were found to be significant predictors of clinician uncertainty, in either the quantitative analyses or in clinicians' stated reasons for their diagnostic uncertainty. Importantly, however, there was a (a non-significant) trend for the sex variable to be associated with clinician uncertainty, although it went in the opposite direction than suggested by the literature (McDonnell et al, 2021), with a higher percentage of boys rather than girls falling among the cases deemed by clinicians as uncertain. Given the importance of sociodemographic variables for actionable steps that could be taken to improve equitable access to early diagnosis, and given that we were not able to replicate some of the sociodemographic findings in the McDonnell and colleagues' study (McDonnell et al, 2019), additional research is warranted.…”

Section: Discussionmentioning

confidence: 62%

Expert Clinician Certainty in Diagnosing Autism Spectrum Disorder in 16–30-Month-Olds: A Multi-site Trial Secondary Analysis

Klaiman

White

Richardson

et al. 2022

J Autism Dev Disord

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Section: Discussionmentioning

confidence: 62%

Expert Clinician Certainty in Diagnosing Autism Spectrum Disorder in 16–30-Month-Olds: A Multi-site Trial Secondary Analysis

Klaiman

White

Richardson

et al. 2022

J Autism Dev Disord

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“…Initially, we aimed to account for the age of first recorded autism diagnosis, which was shown to influence co-occurring disorders in childhood. 15 Underdiagnosis, misdiagnosis, or late diagnosis of autistic women 36,49 alongside delays in support access 50 may further exacerbate their psychiatric difficulties. 19,37 However, outpatient care was only covered from 2001, restricting follow-up time.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

Sex Differences in Mental Health Problems and Psychiatric Hospitalization in Autistic Young Adults

et al. 2022

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ImportancePsychiatric disorders are common among autistic children and adults. Little is known about sex differences in psychiatric disorders and hospitalization in early adulthood.ObjectiveTo examine sex differences in psychiatric diagnoses and hospitalizations in autistic compared with nonautistic young adults.Design, Setting, and ParticipantsThis population-based cohort study assessed all individuals born in Sweden between 1985 and 1997. A total of 1 335 753 individuals, including 20 841 autistic individuals (7129 [34.2%] female individuals), were followed up from age 16 through 24 years between 2001 and 2013. Analysis took place between June 2021 and August 2022.ExposuresAutism was defined as having received at least 1 clinical diagnosis of autism based on the International Classification of Diseases.Main Outcomes and MeasuresThe cumulative incidence of 11 psychiatric diagnoses up until age 25 years was estimated, and birth year–standardized risk difference was used to compare autistic female and male individuals directly. Sex-specific birth year–adjusted hazard ratios (HRs) with 95% CIs were calculated using Cox regression. Analyses were repeated for inpatient diagnoses to assess psychiatric hospitalization.ResultsOf 1 335 753 individuals included in this study, 650 314 (48.7%) were assigned female at birth. Autism was clinically diagnosed in 20 841 individuals (1.6%; 7129 [34.2%] female) with a mean (SD) age of 16.1 (5.1) years (17.0 [4.8] years in female individuals and 15.7 [5.2] years in male individuals) for the first recorded autism diagnosis. For most disorders, autistic female individuals were at higher risk for psychiatric diagnoses and hospitalizations. By age 25 years, 77 of 100 autistic female individuals and 62 of 100 autistic male individuals received at least 1 psychiatric diagnosis. Statistically significant standardized risk differences were observed between autistic female and male individuals for any psychiatric disorder (−0.18; 95% CI, −0.26 to −0.10) and specifically for anxiety, depressive, and sleep disorders. Risk differences were larger among autistic than nonautistic individuals. Compared with nonautistic same-sex individuals, autistic female individuals (HR range [95% CI], 3.17 [2.50-4.04.]-20.78 [18.48-23.37]) and male individuals (HR range [95% CI], 2.98 [2.75-3.23]-18.52 [17.07-20.08]) were both at increased risk for all psychiatric diagnoses. Any psychiatric hospitalization was statistically significantly more common in autistic female individuals (32 of 100) compared with autistic male individuals (19 of 100). However, both autistic female and male individuals had a higher relative risk for psychiatric hospitalization compared with nonautistic female and male individuals for all disorders (female individuals: HR range [95% CI], 5.55 [4.63-6.66]-26.30 [21.50-32.16]; male individuals: HR range [95% CI], 3.79 [3.22-4.45]-29.36 [24.04-35.87]).Conclusions and RelevanceThese findings highlight the need for profound mental health services among autistic young adults. Autistic female individuals, who experience more psychiatric difficulties at different levels of care, require increased clinical surveillance and support.

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“…Research indicates delayed language and communication skills are generally the first developmental concerns noted by caregivers of children later diagnosed with autism (De Giacomo & Fombonne, 1998; Kozlowski et al, 2011). Complicating factors that affect ASD diagnosis include gender, verbal IQ (McDonnell et al, 2020), race, ethnicity, and socioeconomic status (Maenner et al, 2020). For example, autistic girls with higher verbal reasoning abilities are at increased risk for later age of diagnosis (McDonnell et al, 2020).…”

Section: Identifying Autism In School and Clinical Settingsmentioning

confidence: 99%

“…Complicating factors that affect ASD diagnosis include gender, verbal IQ (McDonnell et al, 2020), race, ethnicity, and socioeconomic status (Maenner et al, 2020). For example, autistic girls with higher verbal reasoning abilities are at increased risk for later age of diagnosis (McDonnell et al, 2020). Also concerning, racially/ethnically minoritized and socioeconomically disadvantaged children are identified later than their White peers in both school and clinical contexts (Maenner et al, 2020; Sullivan et al, 2013; Travers & Krezmien, 2018), contributing to the documented disparities in access to intervention services (Smith et al, 2020).…”

Section: Identifying Autism In School and Clinical Settingsmentioning

confidence: 99%

Identification of autism spectrum disorder and interprofessional collaboration between school and clinical settings

Gardner

Campbell

Gilchrest

et al. 2022

Psychology in the Schools

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Providing high‐quality services to autistic students and their caregivers requires interprofessional collaboration. This paper highlights the importance of collaboration between clinical and school settings to promote integrated and comprehensive care for autistic students and their caregivers. First, we present how autistic students are identified and diagnosed in school and clinical settings, with particular attention to how these processes impact access to services. Next, we present interprofessional collaborative practice (IPC) as a framework to facilitate increased collaboration between school and clinical providers working with autistic students. Key tenets of IPC that address barriers to collaboration and several examples of IPC are outlined. To assure readiness to engage in collaborative practice, we discuss graduate interprofessional education (IPE) as a means to train emerging professionals in IPC for autistic students. Finally, we highlight several examples of IPE training programs specific to autism and related developmental disabilities.

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Sex Differences in Age of Diagnosis and First Concern among Children with Autism Spectrum Disorder

Cited by 39 publications

References 40 publications

Expert Clinician Certainty in Diagnosing Autism Spectrum Disorder in 16–30-Month-Olds: A Multi-site Trial Secondary Analysis

Expert Clinician Certainty in Diagnosing Autism Spectrum Disorder in 16–30-Month-Olds: A Multi-site Trial Secondary Analysis

Sex Differences in Mental Health Problems and Psychiatric Hospitalization in Autistic Young Adults

Identification of autism spectrum disorder and interprofessional collaboration between school and clinical settings

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