The Influence of Social and Developmental Factors on the Timing of Autism Spectrum Disorder Diagnosis of Preschool-Aged Children: Evidence from a Specialized Chilean Center.

Abstract

We investigated the influence of developmental and social factors on the age of autismdiagnosis (AoD) in a cohort of toddlers living in Chile. A cross-sectional study was conducted among 509 preschool childrendiagnosed with autismspectrum disorder [M = 40.2months (SD = 8.6), girls: 32%] in the neurodevelopmental unit of a university clinic in Santiago, Chile (2015-2023). Structural changes in the annual trend of AoD were tested. Generalized linear models (gamma distribution)with and without interaction terms were used for themultivariate analysis, adjusting for gender, residential area, year of diagnosis, developmental variables (language regression, delayed walking, and use of expressive verbal language), andprimary caregiver age and education level (CEL). 95% confidence intervals of the unstandardized regression coefficients (B) were calculated using 1000 bootstrap resampling to estimate associations. AoD increased between2021-2022 and decreased in 2023. Female gender (B = 2.72 [1.21-4.23]), no history of language regression (B = 3.97 [1.66-6.28]), and the presence of expressive verbal languageat diagnosis (B = 1.57 [0.05-3.08]) were associated with higher AoD. Children whose caregivers had tertiary education were diagnosed earlier than those with ≤ 12years of formal education. Although the influence ofCEL increased with caregiver age, differences between CEL groups were significant only for caregivers aged ≥ 30years. Improved education and early screening for clinical features of autism among healthcare professionals and the community, with a focuson young childrenwithout highly apparent developmental concerns and those from vulnerable social groups, are warranted.