Department of Psychology, Virginia Polytechnic Institute & State University.
Department of Psychology and Brain and Mind Institute, Western University.
J Clin Child Adolesc Psychol. 2021 Sep-Oct;50(5):645-655. doi: 10.1080/15374416.2020.1823850. Epub 2020 Nov 2.
Early identification of autism spectrum disorder (ASD) is an essential healthcare priority. Girls may be at risk for late diagnosis, although research is equivocal regarding how sex and other factors relate to ASD identification. The goals of the current investigation were to (1) identify how child sex, cognitive abilities, and demographic factors relate to age of first concern (AOC) and age of diagnosis (AOD), (2) evaluate trends in AOC/AOD over time, and (3) consider whether main effects of sex on AOC/AOD are moderated by cognitive abilities or time.
Children (N = 365; 20% female; 85.6% identified as White) with ASD participated through the Province of Ontario Neurodevelopmental Disorders (POND) Network. Study records included AOD, date/timing of diagnosis (between 1996 and 2017), age of first parent concern, demographics, and standardized cognitive testing results (24.7% of children had IQ scores below standard scores of 70).
Average AOC occurred before 2 years of age whereas average AOD occurred after 5 years of age. Girls did not differ on AOC but had a later AOD than boys. Higher verbal IQ was associated with later AOD more strongly in girls than boys. Regarding time-related changes, average AOC and AOD increased across the study period, more strongly for girls.
Results support that sex is a key factor underlying delays in ASD identification and highlight the urgent need to improve diagnostic practices among girls. Limitations and implications for improving the diagnostic process are discussed.
ASD=autism spectrum disorder; IQ=intelligence quotient; AOC=parental report of age of first concern; AOD=age of diagnosis.
早期识别自闭症谱系障碍（ASD）是医疗保健的重点。女孩可能存在诊断延迟的风险，尽管关于性别和其他因素与 ASD 识别之间的关系，研究结果并不一致。本研究的目的是：（1）确定儿童性别、认知能力和人口统计学因素与首次关注年龄（AOC）和诊断年龄（AOD）的关系，（2）评估随时间推移 AOC/AOD 的趋势，（3）考虑性别对 AOC/AOD 的主要影响是否受到认知能力或时间的调节。
通过安大略省神经发育障碍（POND）网络，患有 ASD 的儿童（N=365；20%为女性；85.6%为白人）参与了该研究。研究记录包括 AOD、诊断日期/时间（1996 年至 2017 年之间）、首次父母关注的年龄、人口统计学数据和标准化认知测试结果（24.7%的儿童智商得分低于 70 分的标准分数）。
平均 AOC 发生在 2 岁之前，而平均 AOD 发生在 5 岁之后。女孩在 AOC 上没有差异，但 AOD 比男孩晚。女孩的言语智商越高，AOD 越晚，相关性越强。关于时间相关的变化，平均 AOC 和 AOD 在研究期间增加，女孩的增幅更大。
结果支持性别是 ASD 识别延迟的关键因素，并强调迫切需要改善女孩的诊断实践。讨论了限制和改善诊断过程的意义。
