Early diagnosis of mild autism spectrum disorder and its relationship with self-efficacy beliefs

This study assessed the relationship of timeliness of autism spectrum disorder (ASD) diagnosis with current use of ASD-related services in a nationally representative sample of U.S. children. The Centers for Disease Control's (CDC's) Survey of Pathways to Diagnosis and Services was used to assess experiences of 722 children ages six to 11 with ASD. Bivariate and multivariate analyses were used to explore associations between age at ASD diagnosis and delay in ASD diagnosis and use of health services. Health services included current use of behavioral intervention (BI) therapy, school-based therapy, complementary and alternative medicine (CAM), and psychotropic medications. Mean age at ASD diagnosis was 4.4 years, and mean diagnostic delay was 2.2 years. In adjusted analysis, older age at diagnosis (≥4 versus <4) was associated with lower likelihood of current BI or school-based therapy use and higher likelihood of current psychotropic medication use. Analyses that treated age at diagnosis as a continuous variable found that likelihood of current psychotropic medication use increased with older age at diagnosis. A delay of two or more years between parents' first discussion of concerns with a provider and ASD diagnosis was associated with higher likelihood of current CAM use. Likelihood of current CAM use increased as delay in diagnosis became longer. Both older age at diagnosis and longer delay in diagnosis were associated with different health services utilization patterns among younger children with ASD. Prompt and early diagnosis may be associated with increased use of evidence-based therapies for ASD.

Objectives:Autism spectrum disorders and personality disorders are spectrum conditions with shared clinical features. Despite similarities, previous attempts to synthesise literature on co-existing prevalence and shared traits have employed a unidirectional focus, assessing personality characteristics of individuals with an autism spectrum disorder diagnosis. Here, we assess the prevalence of autism spectrum disorder diagnosis and/or traits among persons diagnosed with a personality disorder.Methods:We systematically reviewed the English-language literature following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, according to a pre-registered protocol (PROSPERO: CRD 42021264106). Peer-reviewed quantitative studies reporting the prevalence of autism spectrum disorder diagnosis or traits in persons with an established personality disorder diagnosis were included. Studies were critically appraised using the Appraisal tool for Cross-Sectional Studies.Results:Fifteen studies were identified, including 72,902 participants (median: 48, interquartile range: 30–77). Diagnoses included borderline, schizotypal and obsessive-compulsive personality disorders, and cohorts with unspecified personality disorder diagnoses. There was significant heterogeneity in diagnostic methodology and assessment tools used. We identified preliminary evidence of an increased prevalence of co-existing autism spectrum disorder diagnosis and traits among those diagnosed with a personality disorder, although significant limitations of the literature were identified.Conclusion:Our research suggests clinicians should consider conducting a careful developmental assessment when assessing service-users with possible or confirmed personality disorder. Future research directions may include larger studies featuring clinical control groups, an exploration of shared and differentiating behavioural-cognitive features of the two conditions, and investigation into potentially shared aetiological factors. Research investigating demographic factors that may contribute to potential diagnostic overshadowing would also be welcomed.

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.

There is little research looking at the experience of individuals diagnosed with autism spectrum disorder as adults. Adults diagnosed with autism spectrum disorder face different challenges than children, and more research is needed to better understand those challenges. For this review, autistic and non-autistic researchers looked at research on the experience of receiving a diagnosis of autism spectrum disorder as an adult. We looked for themes in people's experience leading up to diagnosis, going through the diagnostic process, and living their life after diagnosis. We analyzed 24 studies and found three overarching themes that captured thirty-two themes describing the experience of diagnosis. The three overarching themes expressed issues with identity and relationships before and after the diagnosis and identified that the diagnosis of autism spectrum disorder in adulthood impacted people's adaptation to and assimilation (i.e. the making sense of and internalizing the diagnosis) of autism spectrum disorder. While the diagnostic process itself was confusing and disappointing for many, it often led to a sense of relief and clarity regarding past experiences and had effects on identity and self-esteem. It created opportunities to connect with other autistic individuals and to access services, though appropriate supports were widely lacking. Recommendations are made that the impact of the diagnosis on people's identity and choices about telling others about their diagnosis, and whether and how people want to make adaptations, should be discussed and thought through in the process of diagnosis.

Family socioeconomic status has been associated with autism spectrum disorder (ASD) diagnoses. Less is known regarding the role of neighborhood disadvantage in the United States, particularly when children have similar access to health insurance. To evaluate the association between neighborhood disadvantage and the diagnosis of ASD and potential effect modification by maternal and child demographic characteristics. This cohort study examined a retrospective birth cohort from Kaiser Permanente Southern California (KPSC), an integrated health care system. Children born in 2001 to 2014 at KPSC were followed up through KPSC membership records. Electronic medical records were used to obtain an ASD diagnosis up to December 31, 2019, or the last follow-up. Data were analyzed from February 2022 to September 2023. Socioeconomic disadvantage at the neighborhood level, an index derived from 7 US census tract characteristics using principal component analysis. Clinical ASD diagnosis based on electronic medical records. Associations between neighborhood disadvantage and ASD diagnosis were determined by hazard ratios (HRs) from Cox regression models adjusted for birth year, child sex, maternal age at delivery, parity, severe prepregnancy health conditions, maternal race and ethnicity, and maternal education. Effect modification by maternal race and ethnicity, maternal education, and child sex was assessed. Among 318 372 mothers with singleton deliveries during the study period, 6357 children had ASD diagnoses during follow-up; their median age at diagnosis was 3.53 years (IQR, 2.57-5.34 years). Neighborhood disadvantage was associated with a higher likelihood of ASD diagnosis (HR, 1.07; 95% CI, 1.02-1.11, per IQR = 2.70 increase). Children of mothers from minoritized racial and ethnic groups (African American or Black, Asian or Pacific Islander, Hispanic or Latinx groups) had increased likelihood of ASD diagnosis compared with children of White mothers. There was an interaction between maternal race and ethnicity and neighborhood disadvantage (difference in log-likelihood = 21.88; P < .001 for interaction under χ24); neighborhood disadvantage was only associated with ASD among children of White mothers (HR, 1.17; 95% CI, 1.09-1.26, per IQR = 2.00 increase). Maternal education and child sex did not significantly modify the neighborhood-ASD association. In this study, children residing in more disadvantaged neighborhoods at birth had higher likelihood of ASD diagnosis among a population with health insurance. Future research is warranted to investigate the mechanisms behind the neighborhood-related disparities in ASD diagnosis, alongside efforts to provide resources for early intervention and family support in communities with a higher likelihood of ASD.

Introduction This study analyzes the rise in autism spectrum disorder (ASD) diagnoses by comparing pre-pandemic (2017-2019) and pandemic period (2021-2023) data from two private pediatric practices with different populations in New York. The year 2020 was out of the analysis to focus on the impact after the shutdowns on ASD, and there were disruptions in clinic operations during that year. Clinic I primarily served an African-American ethnic population, while Clinic II primarily served an Asian population.MethodsA retrospective analysis was conducted using de-identified patient numbers from the electronic medical records (EMR) of two private clinics. Only the numbers of new patients diagnosed each year were included from January 1, 2017, to December 31, 2019 (pre-pandemic), and January 1, 2021, to December 31, 2023 (pandemic). Sixteen ASD International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) codes were included in this analysis. Descriptive and inferential statistics were used to find important patterns and determine statistical significance.ResultsThe study included 537 patients, 182 from Clinic I and 355 from Clinic II. Clinic I demonstrated a significant increase in ASD diagnoses, from 63 (pre-pandemic) to 119 (pandemic) (χ2=17.23; p=0.000033). Clinic II demonstrated a significant increase in ASD diagnoses, from 149 (pre-pandemic) to 206 (pandemic) (χ2=9.15; p=0.00248).ConclusionThe significant increase in ASD diagnoses in two private pediatric practices with different populations indicates a notable association with the shutdown periods and the pandemic. Factors such as disrupted routines, changes in access to healthcare services, and increased parental awareness may have contributed to this rise. Further longitudinal studies are needed to understand the long-term impacts of the pandemic on ASD diagnoses and care.

PurposeNeuroscience is providing new tools to potentially improve diagnosis and classification of autism spectrum disorder (ASD) based on biomarkers. The purpose of this paper, is to describe certain applications of fractal analysis, a tool used to measure information complexity observed within electroencephalograph (EEG) signals and neurogenetic code. It is argued here that a better method of diagnosis of ASD may exist based on these new tools.Design/methodology/approachSelective review of literature focused on the diagnosis of ASD and recent technological advances in scientific approaches to diagnosis of ASD. It is argued that higher levels of complex, coherent data are inversely related to pathology; in biological systems, lower complexity EEG during specific tasks may reveal pathology.FindingsClinicians and researchers are exploring new ways to describe mental illness based on biomarkers to improve reliability and validity of diagnostic methods. Specific application of chaos theory in the form of fractal analysis shows promise as one possible method.Originality/valueThis is a conceptual paper addressing the advantages of employing fractal analysis of EEG and genomics for the diagnosis of ASD.

Recent research has investigated the capability of the Diagnostic and Statistical Manual for Mental Disorders (DSM-5) descriptions to identify individuals who should receive a diagnosis of Autism Spectrum Disorder (ASD) using standardised diagnostic instruments. Building on previous research investigating behaviours essential for the diagnosis of DSM-5 ASD, the current study investigated the sensitivity and specificity of a set of 14 items derived from the Diagnostic Interview for Social and Communication Disorders (DISCO Signposting set) that have potential for signposting the diagnosis of autism according to both the new DSM-5 criteria for ASD and ICD-10 criteria for Childhood Autism. An algorithm threshold for the Signposting set was calculated in Sample 1 (n=67), tested in an independent validation sample (Sample 2; n=78), and applied across age and ability sub-groups in Sample 3 (n=190). The algorithm had excellent predictive validity according to best estimate clinical diagnosis (Samples 1 and 2) and excellent agreement with established algorithms for both DSM-5 and ICD-10 (all samples). The signposting set has potential to inform our understanding of the profile of ASD in relation to other neurodevelopmental disorders and to form the basis of a Signposting Interview for use in clinical practice.

Perspective taking refers to the ability to understand others’ thoughts, feelings and perspectives. From previous studies, it emerges that children with a diagnosis of autism spectrum disorder show many difficulties in understanding the other’s point of view, especially in terms of thoughts and emotions. The aims of the present study were: (1) to verify the effectiveness of group training in promoting perspective taking in a small group of preschoolers including two children with diagnosis of high-functioning autism spectrum disorder; and (2) to verify whether the learning in the perspective taking skills could be transferred to everyday situations in terms of prosocial behaviors. Twelve children (mean age: 54.5 months), 10 with typical development and 2 with high-functioning autism spectrum disorder, participated in the study. The effectiveness of training was evaluated in a pre/post-test design both via experimental tests and direct observations. The results highlighted the effectiveness of the training in enhancing perspective taking ability and prosocial behaviors of preschoolers, including the two children with a diagnosis of high-functioning autism spectrum disorder. The use of non-clinical and educational methodologies can contribute to the development of children's perspective taking skills by means of daily educational activities in small group including children with high-functioning autism spectrum disorder. These results have great applicative relevance for early childhood education and care centers.

This study explores whether providing information about a juvenile defendant's autism spectrum disorder (ASD) diagnosis, the type of offense (violent/nonviolent), and their race influences laypersons' credibility evaluations and legal decisions (verdicts/sentencing). We expected participants to render more not guilty verdicts and show leniency in sentencing when the defendant is White, has an ASD diagnosis, and is charged with a nonviolent offense. We anticipated credibility evaluations would mediate the relationships between ASD diagnosis and race, type of offense and sentencing views. Using a mock-juror paradigm, 466 participants read a vignette in which the juvenile defendant's diagnosis (ASD + information vs. no diagnosis), race (White vs. Black), and the charged offense (violent vs. nonviolent) were experimentally manipulated. Participants were highly unlikely to render guilty verdicts (p < .001, OR = 0.33) and harsh sentences (p < .001, ηp² = .11) when the defendant had an ASD diagnosis, even less so for violent offenses (p = .005, ηp² = .02). The defendant's likability (p < .001, ηp² = .04), honesty (p < .001, ηp² = .11), and believability (p < .001, ηp² = .09) were rated higher when the defendant had an ASD diagnosis, and these considerations led to significantly more lenient sentences compared to the no diagnosis condition. Participants were also twice as likely to find the White defendant guilty (p = .003, OR = 1.95) and reported being significantly more certain in their verdicts for the White defendant (p = .017, ηp² = .02). These results highlight the complex interplay between defendant characteristics and public perceptions of ASD in criminal legal proceedings. Findings highlight the need for judicial education, clearer guidelines on presenting ASD information in court, and further research on how race and neurodevelopmental diagnoses influence legal decisions. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Rates of autism spectrum disorder diagnoses for children and adolescents in the Hutt Valley Region of New Zealand between 2012 and 2016

Autism spectrum disorder (ASD) and gender dysphoria (GD) frequently cooccur. However, existing research has primarily used smaller samples, limiting generalizability and the ability to assess further demographic variation. The purpose of this study was to (1) examine the prevalence of cooccurring ASD and GD diagnoses among US adolescents aged 9 to 18 and (2) identify demographic differences in the prevalence of cooccurring ASD and GD diagnoses. This secondary analysis used data from the PEDSnet learning health system network of 8 pediatric hospital institutions. Analyses included descriptive statistics and adjusted mixed logistic regression testing for associations between ASD and GD diagnoses and interactions between ASD diagnosis and demographic characteristics in the association with GD diagnosis. Among 919 898 patients, GD diagnosis was more prevalent among youth with an ASD diagnosis compared with youth without an ASD diagnosis (1.1% vs 0.6%), and adjusted regression revealed significantly greater odds of GD diagnosis among youth with an ASD diagnosis (adjusted odds ratio = 3.00, 95% confidence interval: 2.72-3.31). Cooccurring ASD/GD diagnoses were more prevalent among youth whose electronic medical record-reported sex was female and those using private insurance, and less prevalent among youth of color, particularly Black and Asian youth. Results indicate that youth whose electronic medical record-reported sex was female and those using private insurance are more likely, and youth of color are less likely, to have cooccurring ASD/GD diagnoses. This represents an important step toward building services and supports that reduce disparities in access to care and improve outcomes for youth with cooccurring ASD/GD and their families.

Signes cliniques précoces chez les enfants porteurs d’un TSA léger : description et effet de genre

The administration requirements of the Autism Diagnostic Observation Schedule and the Autism Diagnostic Interview-Revised, widely used in high-income countries, make them less feasible for diagnosis of autism spectrum disorder in low- and middle-income countries. The flexible administration requirements of the Childhood Autism Rating Scale have resulted in its use in both high-income countries and low- and middle-income countries. This study examines the agreement between assessments using the Childhood Autism Rating Scale with those using the Autism Diagnostic Observation Schedule or Autism Diagnostic Observation Schedule, Second Edition and Autism Diagnostic Interview-Revised in Jamaica. Children aged 2-8 years (n = 149) diagnosed with autism by an experienced clinician using the Childhood Autism Rating Scale were re-evaluated using the Autism Diagnostic Observation Schedule and Autism Diagnostic Interview-Revised. The proportion diagnosed with autism spectrum disorder using the Autism Diagnostic Observation Schedule, Autism Diagnostic Observation Schedule, Second Edition, and Autism Diagnostic Interview-Revised was determined and mean domain scores compared using analysis of variance (ANOVA). The mean age was 64.4 (standard deviation = 21.6) months; the male:female ratio was 6:1. The diagnostic agreement of the Childhood Autism Rating Scale with the Autism Diagnostic Observation Schedule and Autism Diagnostic Observation Schedule, Second Edition was 100.0% and 98.0%, respectively. Agreement with the Autism Diagnostic Interview-Revised was 94.6%. Domain scores were highest for children with more severe symptoms (p < 0.01). Despite a high level of agreement of the Childhood Autism Rating Scale with the Autism Diagnostic Observation Schedule, Autism Diagnostic Observation Schedule, Second Edition, and Autism Diagnostic Interview-Revised, the Childhood Autism Rating Scale should be evaluated further with a broader range of autism spectrum disorder symptomatology, and by clinicians with varying experience before recommendation for use in low- and middle-income countries.

Background: It is well established that diagnoses of autism spectrum disorders are increasing in numbers nationally. There has been a recent and growing awareness amongst clinicians of females on the autism spectrum having unique and different presentations, and that these females may be overlooked for diagnoses until later in life. This focus on females has not been reflected in published research; there is a paucity of research on the unique experiences of females on the autism spectrum. Furthermore, whilst research indicates that some young autistic adults aspire to have, and enter, romantic relationships, previous studies have had a quantitative focus and have not explored the unique experiences of females, hence the need for qualitative research on the lived experiences of romantic relationships of young autistic women. Current research: This qualitative study used semi-structured interviews with six young women (aged 19-29) to gather data on their experiences and aspirations about romantic relationships. Five of these young women had received a formal diagnosis of an autism spectrum disorder and one had self-diagnosed. This study takes a social constructivist epistemological perspective and used interpretative phenomenological analysis to analyse data. Key findings and implications: Key themes for individual participants included relationship violence and abuse, child sexual exploitation and grooming, non-monogamy, unassertiveness in relationships, and rejection. Themes which were found across more than one participant included vulnerability and naivety, asexuality and non-heterosexuality, gender identity and confusion about flirting. The implications of these findings are that young autistic women may be vulnerable to relationship abuse or exploitation. This is the first qualitative study where autistic young women have spoken about their non-typical gender identities and sexualities. A committed romantic partnership is an aspiration for some autistic young women and with an increasing focus on aspirations and preparing for adulthood, educational psychologists will have a role in helping support young women to reach these outcomes.