Researchers say children with autism who were born before the 2007 recommendation by the American Academy of Pediatrics (AAP) that all children be screened for the disorder at the 18- and 24-month well child visits were diagnosed significantly later than they are today. The findings suggest the policy may help identify children with autism sooner so they can benefit from early intervention.
An abstract of the study, "Age of Diagnosis of Autism Spectrum Disorder in an Ethnically Diverse Population Before and after the 2007 AAP Recommendation for Universal Screening," will be presented at the Pediatric Academic Societies 2016 Meeting on May 1, 2016.
Researchers compared two groups of children initially diagnosed with autism spectrum disorder (ASD) between 2003 and 2012 at a university-affiliated developmental center in the Bronx: those born before 2005, a pivotal year because children born then would have been 24 months old when the AAP recommendation was issued, and those born in 2005 or later. They found the average age of diagnosis for those born before 2005 was just under four years old; for those born during or after 2005, it was roughly two-and-a-half years old.
"Our research shows that children evaluated before the AAP recommended universal pediatric screening were more likely to be diagnosed at an older age and with more severe autistic symptoms and more impaired adaptive functioning,"said lead author Maria Valicenti-McDermott, M.D., M.S. an assistant professor of pediatrics at Albert Einstein College of Medicine and an attending physician at the Children's Evaluation and Rehabilitation Center at Montefiore Health System. "This shift has been critical in light of research showing the significant impact early intervention can have for children with ASD," she said.
Dr. Valicenti-McDermott said the significant drop in age of diagnoses affected all ethnic groups, including Latino and African American children. This is important, she said, because demographic factors such as race and ethnicity are linked with later diagnoses, fewer concerns about possible symptoms of autism being expressed by families or asked about by providers, and possible worse overall outcomes.
"Despite data supporting the benefit of earlier therapy for children with autism and ongoing efforts to overcome obstacles to delays in diagnosis, children who are Latino or African-American are still diagnosed later than white children," Dr. Valicenti-McDermott said. She said additional research is needed to confirm the effectiveness of universal autism screening. Earlier this year, the U.S. Preventive Services Task Force concluded there wasn't enough evidence to recommend universal autism screening of young children when no concerns of autism spectrum disorder have been raised by their parents or clinical provider.
"It remains unclear at this point whether the significant drop in average age of diagnosis we found was entirely the result of pediatrician universal screening or the effect of the national campaign to increase awareness of ASD in general and the importance of an early diagnosis in particular," Dr. Valicenti-McDermott said. "But given the undisputed benefit of early identification of autism, sorting out the contribution of universal screening to this pattern will be an important next step to address the concerns of the U.S. Preventive Services Task Force regarding the benefits of early screening."
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