Abstract
BackgroundThe objective of this study is to gain new insights into the relationship between clinical signs and age at diagnosis.MethodWe utilize a new, large, online survey of 1743 parents of children diagnosed with ASD, and use multiple statistical approaches. These include regression analysis, factor analysis, and machine learning (regression tree).ResultsWe find that clinical signs that most strongly predict early diagnosis are not necessarily specific to autism, but rather those that initiate the process that eventually leads to an ASD diagnosis. Given the high correlations between symptoms, only a few signs are found to be important in predicting early diagnosis. For several clinical signs we find that their presence and intensity are positively correlated with delayed diagnosis (e.g., tantrums and aggression). Even though our data are drawn from parents’ retrospective accounts, we provide evidence that parental recall bias and/or hindsight bias did not play a significant role in shaping our results.ConclusionIn the subset of children without early deficits in communication, diagnosis is delayed, and this might be improved if more attention will be given to clinical signs that are not necessarily considered as ASD symptoms. Our findings also suggest that careful attention should be paid to children showing excessive tantrums or aggression, as these behaviors may interfere with an early ASD diagnoses.
Highlights
The objective of this study is to gain new insights into the relationship between clinical signs and age at diagnosis
Utilizing a large survey of parents of children with autism spectrum disorder (ASD), this is the first study that systematically looks at a large set of clinical signs and symptoms, their presence and level of severity, the correlations between them, and how they are related to the age of diagnosis
We show that individual signs play an important role in predicting age of diagnosis beyond what is captured by the overall severity of the child condition
Summary
The objective of this study is to gain new insights into the relationship between clinical signs and age at diagnosis. Most children who are diagnosed with ASD are not diagnosed until after the age of 4, despite the fact that parents often express concerns a year or two before this. While minority children are less likely to be diagnosed with ASD [19], differences in age of diagnosis across racial and ethnic groups are not significant after controlling for parents’ wealth and education [11, 19,20,21]. Other factors shown to be correlated with age of diagnosis are family structure (e.g., the presence of grandparents in the household) [22], birth order, the type of diagnosis (e.g., Asperger being diagnosed later than other conditions), and level of urbanization; children in urban areas are diagnosed significantly earlier [23]
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