Abstract
Obtaining an autism spectrum disorder (ASD) diagnosis is often challenging for parents. The purpose of this study was to better understand this process and examine how elements of the process may influence parent satisfaction. A total of 406 parents of autistic children participated. Participants were administered a survey covering the ASD diagnostic process. Parents had developmental concerns early but experienced long wait times and usually attended many appointments. Mean diagnostic age was 3.26 years and overall delay was 1.20 years. Stress and being told there was “no problem” were significantly associated with parental satisfaction with the process. Findings provide insight into challenges experienced by families of autistic children and can help pinpoint areas where the diagnostic process may be improved.
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References
Altiere, M. J., & Von Kluge, S. (2009). Searching for acceptance: Challenges encountered while raising a child with autism. Journal of Intellectual and Developmental Disability, 34(2), 142–152. https://doi.org/10.1080/13668250902845202
American Academy of Pediatrics. (2006). Identifying infants and young children with developmental disorders in the medical home: An algorithm for developmental surveillance and screening. Pediatrics, 118, 405–420. https://doi.org/10.1542/peds.2006-1231.
Berg, K. L., Acharya, K., Shiu, C. S., & Msall, M. E. (2018). Delayed diagnosis and treatment among children with autism who experience adversity. Journal of Autism and Developmental Disorders, 48(1), 45–54. https://doi.org/10.1007/s10803-017-3294-y.
Bonis, S. A., & Sawin, K. J. (2016). Risks and protective factors for stress self-management in parents of children with autism spectrum disorder: An integrated review of the literature. Journal of Pediatric Nursing. https://doi.org/10.1016/j.pedn.2016.08.006.
Brett, D., Warnell, F., Mcconachie, H., & Parr, J. R. (2016). Factors affecting age at ASD diagnosis in UK: No evidence that diagnosis age has decreased between 2004 and 2014. Journal of Autism and Developmental Disorders, 46(6), 1974–1984. https://doi.org/10.1007/s10803-016-2716-6.
Brookman-Frazee, L., Baker-Ericzen, M., Stadnick, N., & Taylor, R. (2012). Parent perspectives on community mental health services for children with autism spectrum disorders. Journal of Child and Family Studies, 21(4), 533–544. https://doi.org/10.1007/s10826-011-9506-8.
Burkett, K., Morris, E., Manning-Courtney, P., & Shambley-Ebron, J. A. D. (2015). African American families on autism diagnosis and treatment: The influence of culture. Journal of Autism and Developmental Disorders, 45, 3244–3254. https://doi.org/10.1007/s10803-015-2482-x
Chamak, B., Bonniau, B., Oudaya, L., & Ehrenberg, A. (2011). The autism diagnostic experiences of French parents. Autism, 15(1), 83–97. https://doi.org/10.1177/1362361309354756.
Chamak, B., & Bonniau, B. (2013). Changes in the diagnosis of autism: How parents and professionals act and react in France. Culture Medicine and Psychiatry, 37(3), 405–426. https://doi.org/10.1007/s11013-013-9323-1.
Chan, K. K. S., & Lam, C. B. (2017). Trait mindfulness attenuates the adverse psychological impact of stigma on parents of children with autism spectrum disorder. Mindfulness, 8(4), 984–994. https://doi.org/10.1007/s12671-016-0675-9.
Christensen, D. L., Baio, J., Braun, K. V., Bilder, D., Charles, J., Constantino, J. N., Daniels, J., Durkin, M. S., Fitzgerald, R. T., Kurzius-Spencer, M., Lee, L., Pettygrove, S., Robinson, C., Schulz, E., Wells, C., Wingate, M. S., Zahorodny, W., & Yeargin-Allsopp, M. (2016). Prevalence and Characteristics of Autism Spectrum Disorder Among Children Aged 8 Years — Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2012. Centers for Disease Control and Prevention Surveillance Summaries 2016, 65(3), 1–23. https://doi.org/10.15585/mmwr.ss6503a1
Corcoran, J., Berry, A., & Hill, S. (2015). The lived experience of US parents of children with autism spectrum disorders. Journal of Intellectual Disabilities, 19(4), 356–366. https://doi.org/10.1177/1744629515577876
Crane, L., Batty, R., Adeyinka, H., Goddard, L., Henry, L. A., & Hill, E. L. (2018). Autism diagnosis in the United Kingdom: Perspectives of autistic adults, parents and professionals. Journal of Autism and Developmental Disorders, 48(11), 3761–3772. https://doi.org/10.1007/s10803-018-3639-1
Crane, L., Chester, J. W., Goddard, L., Henry, L. A., & Hill, E. (2016). Experiences of autism diagnosis: A survey of over 1000 parents in the United Kingdom. Autism, 20(2), 153–162. https://doi.org/10.1177/1362361315573636.
Curran, P. G. (2016). Methods for the detection of carelessly invalid responses in survey data. Journal of Experimental Social Psychology, 66, 4–19. https://doi.org/10.1016/j.jesp.2015.07.006
Daniels, A. M., & Mandell, D. S. (2014). Explaining differences in age at autism spectrum disorder diagnosis: A critical review. Autism, 18(5), 583–597. https://doi.org/10.1177/1362361313480277.
Dixon, W. J., & Tukey, J. W. (1968). Approximate behavior of the distribution of winsorized t (Trimming/Winsorization 2). Technometrics, 10(1), 83–98. https://doi.org/10.2307/1266226
Elder, J. H., Brasher, S., & Alexander, B. (2016). Identifying the barriers to early diagnosis and treatment in underserved individuals with Autism Spectrum Disorders (ASD) and their families: A qualitative study. Issues in Mental Health Nursing, 37(6), 412–420. https://doi.org/10.3109/01612840.2016.1153174.
Falk, N. H., Norris, K., & Quinn, M. G. (2014). The factors predicting stress, anxiety and depression in the parents of children with autism. Journal of Autism and Developmental Disorders, 44(12), 3185–3203. https://doi.org/10.1007/s10803-014-2189-4.
Gaspar de Alba, M. J., & Bodfish, J. W. (2011). Research in autism spectrum disorders addressing parental concerns at the initial diagnosis of an autism spectrum disorder. Research in Autism Spectrum Disorders, 5, 633–639. https://doi.org/10.1016/j.rasd.2010.07.009.
Goin-Kochel, R. P., Mackintosh, V. H., & Myers, B. J. (2006). How many doctors does it take to make an autism spectrum diagnosis? Autism, 10(5), 439–451. https://doi.org/10.1177/1362361306066601.
Gordon-Lipkin, E., Foster, J., & Peacock, G. (2016). Whittling down the wait time: Exploring models to minimize the delay from initial concern to diagnosis and treatment of autism spectrum disorder. Pediatric Clinics of North America, 63(5), 851–859. https://doi.org/10.1016/j.pcl.2016.06.007.
Herlihy, L., Knoch, K., Vibert, B., & Fein, D. (2015). Parents’ first concerns about toddlers with autism spectrum disorder: Effect of sibling status. Autism, 19(1), 20–28. https://doi.org/10.1177/1362361313509731.
Hine, J. F., Herrington, C. G., Rothman, A. M., Mac, R. L., Patterson, B. L., Carlson, K. L., & Warren, Z. E. (2018). Embedding autism spectrum disorder diagnosis within the medical home: Decreasing wait times through streamlined assessment. Journal of Autism and Developmental Disorders, 48(8), 2846–2853. https://doi.org/10.1007/s10803-018-3548-3.
Hine, J. F., Allin, J., Allman, A., Black, M., Browning, B., Ramsey, B. … Allen, W. (2020). Increasing access to autism spectrum disorder diagnostic consultation in rural and underserved communities: Streamlined evaluation within primary care. Journal of Developmental & Behavioral Pediatrics, 41(1), 16–22. doi: https://doi.org/10.1097/DBP.0000000000000727
Howlin P., & Asgharian, A. (1999) The diagnosis of autism and Asperger syndrome: Findings from a survey of 770 families. Developmental Medicine and Child Neurology, 41(12), 834–839. https://doi.org/10.1017/s0012162299001656
Howlin, P., & Moore, A. (1997). Diagnosis in autism: A survey of over 1200 patients in the UK. Autism: The International Journal of Research and Practice, 1(2), 135–162. https://doi.org/10.1177/1362361397012003
Jellett, R., Wood, C. E., Giallo, R., & Seymour, M. (2015). Family functioning and behaviour problems in children with autism spectrum disorders: The mediating role of parent mental health. Clinical Psychologist, 19(1), 39–48. https://doi.org/10.1111/cp.12047.
Johnson, C. P., & Myers, S. M. (2007). Identification and evaluation of children with autism spectrum disorders. Pediatrics, 120(5), 1183–1215. https://doi.org/10.1542/peds.2007-2361.
Jónsdóttir, S. L., Saemundsen, E., Antonsdóttir, I. S., Sigurdardóttir, S., & Ólason, D. (2011). Children diagnosed with autism spectrum disorder before or after the age of 6 years. Research in Autism Spectrum Disorders, 5(1), 175–184. https://doi.org/10.1016/j.rasd.2010.03.007.
Keenan, B. M., Newman, L. K., Gray, K. M., & Rinehart, N. J. (2016). Parents of children with ASD experience more psychological distress, parenting stress, and attachment-related anxiety. Journal of Autism and Developmental Disorders, 46(9), 2979–2991. https://doi.org/10.1007/s10803-016-2836-z.
Lord, C., Rutter, M., DiLavore, P. C., Risi, S., Gotham, K., & Bishop, S. (2012). Autism diagnostic observation schedule (2nd ed.). Western Psychological Services.
Lord, C., Rutter, M., Goode, S., Heemsbergen, J., Jordan, H., Mawhood, L., & Schopler, E. (1989). Austism diagnostic observation schedule: A standardized observation of communicative and social behavior. Journal of Autism and Developmental Disorders, 19(2), 185–212. https://doi.org/10.1007/BF02211841.
Lord, C., Rutter, M., & Le Couteur, A. (1994). Autism diagnostic interview-revised: A revised version of a diagnostic interview for caregivers of individuals with possible pervasive developmental disorders. Journal of Autism and Developmental Disorders, 24(5), 659–685. https://doi.org/10.1007/BF02172145.
Maenner, M. J., Schieve, L. A., Rice, C. E., Cunniff, C., Giarelli, E., Kirby, R. S. … Durkin, M. S. (2013). Frequency and Pattern of Documented Diagnostic Features and the Age of Autism Identification. Journal of the American Academy of Child and Adolescent Psychiatry, 52(4), 401–413. https://doi.org/10.1016/j.jaac.2013.01.014
Mandell, D. S., Ittenbach, R. F., Levy, S. E., & Pinto-Martin, J. A. (2007). Disparities in diagnoses received prior to a diagnosis of autism spectrum disorder. Journal of Autism and Developmental Disorders, 37(9), 1795–1802. https://doi.org/10.1007/s10803-006-0314-8.
Martinez, M., Thomas, K. C., Williams, C. S., Christian, R., Crais, E., Pretzel, R., & Hooper, S. R. (2018). Family experiences with the diagnosis of autism spectrum disorder: System barriers and facilitators of efficient diagnosis. Journal of Autism and Developmental Disorders, 48, 2368–2378. https://doi.org/10.1007/s10803-018-3493-1.
Mazurek, M. O., Handen, B. L., Wodka, E. L., Nowinski, L., Butter, E., & Engelhardt, C. R. (2014). Age at first autism spectrum disorder diagnosis. Journal of Developmental & Behavioral Pediatrics, 35(9), 561–569. https://doi.org/10.1097/dbp.0000000000000097.
McMorris, C. A., Cox, E., Hudson, M., Liu, X., & Bebko, J. M. (2013). The diagnostic process of children with autism spectrum disorder: Implications for early identification and intervention. Journal on Developmental Disabilities, 19(2), 42.
McNally Keehn, R., Ciccarelli, M., Szczepaniak, D., Tomlin, A., Lock, T., & Swigonski, N. (2020). A statewide tiered system for screening and diagnosis of autism spectrum disorder. Pediatrics. 146(2), e20193876. https://doi.org/10.1542/peds.2019-3876.
Ooi, K. L., Ong, Y. S., Jacob, S. A., & Khan, T. M. (2016). A meta-synthesis on parenting a child with autism. Neuropsychiatric Disease and Treatment, 12, 745–762. https://doi.org/10.2147/NDT.S100634
Oswald, D. P., Haworth, S. M., Mackenzie, B. K., & Willis, J. H. (2017). Parental report of the diagnostic process and outcome: ASD compared with other developmental disabilities. Focus on Autism and Other Developmental Disabilities, 32(2), 152–160. https://doi.org/10.1177/1088357615587500.
Padden, C., & James, J. E. (2017). Stress among parents of children with and without autism spectrum disorder: A comparison involving physiological indicators and parent self-reports. Journal of Developmental and Physical Disabilities, 29(4), 567–586. https://doi.org/10.1007/s10882-017-9547-z.
Rogers, C. L., Goddard, L., Hill, E. L., Henry, L. A., & Crane, L. (2016). Experiences of diagnosing autism spectrum disorder: A survey of professionals in the United Kingdom. Autism, 20(7), 820–831. https://doi.org/10.1177/1362361315611109.
Rosenberg, R. E., Law, P. A., Landa, R., Law, J. K., & Stuart, E. A. (2011). Factors affecting age at initial autism spectrum disorder diagnosis in a national survey. Autism Research and Treatment. https://doi.org/10.1155/2011/874619.
Rutherford, M., Burns, M., Gray, D., Bremner, L., Clegg, S., Russell, L. … Rutherford, M. (2018). Improving Efficiency and Quality of the Children ’ s ASD Diagnostic Pathway: Lessons Learned from Practice. Journal of Autism and Developmental Disorders, 48(5), 1579–1595. https://doi.org/10.1007/s10803-017-3415-7
Rutter, M., Bailey, A., & Lord, C. (2003). SCQ The Social Communication Questionnaire. Western Psychological Services.
Strunk, J., Leisen, M., & Schubert, C. (2017). Using a multidisciplinary approach with children diagnosed with autism spectrum disorder. Journal of Interprofessional Education and Practice, 8, 60–68. https://doi.org/10.1016/j.xjep.2017.03.009
Taylor LJ, Eapen V, Maybery MT, Midford S, Paynter J, Quarmby L, Smith T, Williams K, Whitehouse AJ (2016) Diagnostic evaluation for autism spectrum disorder: A survey of health professionals in Australia. BMJ 6:1–8. https://doi.org/10.1136/bmjopen-2016-012517
Tomeny, T. S. (2017). Parenting stress as an indirect pathway to mental health concerns among mothers of children with autism spectrum disorder. Autism, 21(7), 907–911. https://doi.org/10.1177/1362361316655322.
Twyman, K. A., Maxim, R. A., Leet, T. L., & Ultmann, M. H. (2009). Parents’ developmental concerns and age variance at diagnosis of children with autism spectrum disorder. Research in Autism Spectrum Disorders, 3(2), 489–495. https://doi.org/10.1016/j.rasd.2008.10.002.
Uljarević, M., Frazier, T. W., Phillips, J. W., Jo, B., Littlefield, S., & Hardan, A. Y. (2021). Quantifying research domain criteria social communication subconstructs using the Social Communication Questionnaire in youth. Journal of Clinical Child and Adolescent Psychology, 50(5), 609–618. https://doi.org/10.1080/15374416.2019.1669156.
Wong, V., Yu, Y., Keyes, M. L., & McGrew, J. H. (2017). Pre-diagnostic and diagnostic stages of autism spectrum disorder: A parent perspective. Child Care in Practice, 23(2), 195–217. https://doi.org/10.1080/13575279.2016.1199537.
Zuckerman, K. E., Lindly, O. J., & Sinche, B. K. (2015). Parental concerns, provider response, and timeliness of autism spectrum disorder diagnosis. Journal of Pediatrics, 166(6), 1431-1439e1. https://doi.org/10.1016/j.jpeds.2015.03.007.
Zwaigenbaum L, Bauman ML, Fein D, Pierce K, Buie T, Davis PA, Newschaffer C, Robins DL, Wetherby A, Choueiri R, Kasari C, Stone WL, Yirmiya N, Estes A, Hansen RL, McPartland JC, Natowicz MR, Carter A, Granpeesheh D, Mailloux Z, Smith Roley S, Wagner S (2015) Early Screening of Autism Spectrum Disorder: Recommendations for Practice and Research. Pediatrics 136(Supplement):S41–S59. https://doi.org/10.1542/peds.2014-3667d
Zwaigenbaum, L., & Penner, M. (2018). Autism spectrum disorder: Advances in diagnosis and evaluation. The BMJ, 361(k1674), 1–16. https://doi.org/10.1136/bmj.k1674.
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KTM was responsible for study conception and all authors contributed to study design. Data collection was managed by KTM in collaboration with the SPARK Research Match program. Data analysis was performed by KTM and SME. The first draft of the manuscript was written by KTM and all authors critically revised later versions of the manuscript. All authors read and approved the final manuscript.
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MacKenzie, K.T., Mazefsky, C.A. & Eack, S.M. Obtaining a First Diagnosis of Autism Spectrum Disorder: Descriptions of the Diagnostic Process and Correlates of Parent Satisfaction from a National Sample. J Autism Dev Disord 53, 3799–3812 (2023). https://doi.org/10.1007/s10803-022-05673-1
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DOI: https://doi.org/10.1007/s10803-022-05673-1