Bickel Julie, Bridgemohan Carolyn, Sideridis Georgios, Huntington Noelle
Division of Developmental Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA.
J Dev Behav Pediatr. 2015 Jan;36(1):1-7. doi: 10.1097/DBP.0000000000000117.
To identify child and family characteristics associated with age of diagnosis of autism spectrum disorder (ASD) in a tertiary care setting using objective, standardized assessments ensuring diagnostic validity and timing.
The authors conducted a chart review of children who received their initial ASD diagnosis from 2007 to 2011. Child variables included gender, birth order, cognitive functioning, and for children ≤36 months, language and adaptive assessments. Family variables included insurance, maternal age, maternal education, sibling or family member with ASD, and number of children in the house. Primary outcome was age of ASD diagnosis. The authors ran multiple regression models evaluating the impact of child and family variables on the total sample and on the subsample of children ≤36 months.
Median age of diagnosis was 2.9 years (range, 15 mo-13.8 yr; n = 591). In the total sample, significant predictors of earlier age of diagnosis were later birth order, higher maternal education, fewer children in the house, and a sibling with ASD. In a separate analysis of children ≤36 months of age (n = 315) with additional data for language and adaptive assessments, significant predictors of younger age of diagnosis were higher cognitive and adaptive functioning, lower receptive and expressive language, and having a sibling with ASD.
This study suggests that both family and child characteristics play an important role in the early identification of ASD and that predictive variables may vary based on a child's age. Future research should help to elucidate this finding so that screening measures and policies aimed at early identification can target the most predictive factors.
在三级医疗环境中，通过客观、标准化评估以确保诊断的有效性和及时性，确定与自闭症谱系障碍（ASD）诊断年龄相关的儿童及家庭特征。
作者对2007年至2011年首次被诊断为ASD的儿童进行了病历回顾。儿童变量包括性别、出生顺序、认知功能，对于36个月及以下的儿童，还包括语言和适应性评估。家庭变量包括保险、母亲年龄、母亲教育程度、患有ASD的兄弟姐妹或家庭成员以及家中孩子数量。主要结局是ASD诊断年龄。作者运行了多个回归模型，评估儿童和家庭变量对总样本以及对36个月及以下儿童子样本的影响。
诊断的中位年龄为2.9岁（范围为15个月至13.8岁；n = 591）。在总样本中，诊断年龄较早的显著预测因素是出生顺序靠后、母亲教育程度较高、家中孩子数量较少以及有一个患有ASD的兄弟姐妹。在对36个月及以下儿童（n = 315）进行的单独分析中，纳入了语言和适应性评估的额外数据，诊断年龄较小的显著预测因素是较高的认知和适应性功能、较低的接受性和表达性语言能力以及有一个患有ASD的兄弟姐妹。
本研究表明，家庭和儿童特征在ASD的早期识别中都起着重要作用，并且预测变量可能因儿童年龄而异。未来的研究应有助于阐明这一发现，以便针对早期识别的筛查措施和政策能够针对最具预测性的因素。
