Maternal and Child Health Journal

, Volume 22, Issue 7, pp 941–949 | Cite as

Advanced Maternal Age and Maternal Education Disparity in Children with Autism Spectrum Disorder

  • For-Wey Lung
  • Tung-Liang Chiang
  • Shio-Jean Lin
  • Meng-Chih Lee
  • Bih-Ching Shu


Objective Previous studies have shown inconsistent results with regard to the association between advanced parental age and autism spectrum disorder (ASD). The sociodemographic status of parents has been found to be associated with children with ASD, however. Therefore, a pathway analysis was undertaken of the roles of maternal age and education in ASD diagnosis and community screening, in a national birth cohort database, using a propensity score matching (PSM) method. Method The 6- and 66-month Taiwan Birth Cohort Study dataset was used (N = 20,095). The PSM exact matching method was used to select 1700 families (ratio of 1:4 between ASD diagnosis and control) from the Taiwan Birth Cohort Study dataset. Results (1) The results from the complete dataset and the PSM exact matching dataset both show that the risk of a child being diagnosed with ASD was increased by the mother being over 40 years old. (2) Although more children of mothers with lower-than-average education were positive on screening, more children of mothers with higher-than-average education were also diagnosed with ASD. Conclusions for Practice Advanced maternal age had a higher association with the diagnosis of ASD, and maternal educational disparity was found between ASD clinical diagnosis and community screening. Community and primary medical care services should pay more attention to children of parents with lower education during ASD screening to prevent delayed diagnosis.


Taiwan Birth Cohort Study M-CHAT Propensity score matching 



This study was supported by the Bureau of Health Promotion [Grant Nos. DOH94-HP-1802, DOH95-HP-1802, DOH96-HP-1702, DOH99-HP-1702].

Compliance with Ethical Standards

Conflict of interest

All authors have no conflict of interest to disclose.


  1. Autism and Developmental Disabilities Monitoring Network Surveillance Year 2002 Principal Investigators, & Centers for Disease Control and Prevention (2007). Prevalence of autism spectrum disorders: Autism and Developmental Disabilities Monitoring Network, 14 sites, United States, 2002. MMWR Surveillance Summaries, 56, 12–28.Google Scholar
  2. Centers for Disease Control and Prevention. (2009). Prevalence of autism spectrum disorders—Autism and developmental disabilities monitoring network, United States, 2006. MMWR Surveillance Summaries, 58, 1–20.Google Scholar
  3. Chien, I. C., Lin, C. H., Chou, Y. J., & Chou, P. (2011). Prevalence and incidence of autism spectrum disorders among national health insurance enrollees in Taiwan from 1996 to 2005. Journal of Child Neurology, 26, 830–834.CrossRefPubMedGoogle Scholar
  4. Cnattingius, S., Forman, M. R., Berendes, H. W., & Isotalo, L. (1992). Delayed childbearing and risk of adverse perinatal outcome. A population-based study. JAMA, 268, 886–890.CrossRefPubMedGoogle Scholar
  5. Conti, E., Mazzotti, S., Calderoni, S., Saviozzi, I., & Guzzetta, A. (2013). Are children born after assisted reproductive technology at increased risk of autism spectrum disorders? A systematic review. Human Reproduction, 28, 3316–3327.CrossRefPubMedGoogle Scholar
  6. Croen, L. A., Najjar, D. V., Fireman, B., & Grether, J. K. (2007). Maternal and paternal age and risk of autism spectrum disorders. Archives of Pediatrics and Adolescent Medicine, 161, 334–340.CrossRefPubMedGoogle Scholar
  7. Developmental Disabilities Monitoring Network Surveillance Year 2010 Principal Investigators and Centers for Disease Control and Prevention. (2014). Prevalence of autism spectrum disorder among children aged 8 years—Autism and developmental disabilities monitoring network, 11 sites, United States, 2010. Morbidity and Mortality Weekly Report Surveillance Summaries, 63, 1–21.Google Scholar
  8. Fujiwara, T. (2014). Socioeconomic status and the risk of suspected autism spectrum disorders among 18-month-old toddlers in Japan: A population-based study. Journal of Autism and Developmental Disorders, 44, 1323–1331.CrossRefPubMedGoogle Scholar
  9. Gardener, H., Spiegelman, D., & Buka, S. L. (2011). Perinatal and neonatal risk factors for autism: A comprehensive meta-analysis. Pediatrics, 128, 344–355.CrossRefPubMedPubMedCentralGoogle Scholar
  10. Gillberg, C., & Schaumann, H. (1982). Social class and infantile autism. Journal of Autism and Developmental Disorders, 12, 223–228.CrossRefPubMedGoogle Scholar
  11. Glascoe, F. P., Macias, M. M., Wegner, L. M., & Robertshaw, N. S. (2007). Can a broadband developmental-behavioral screening test identify children likely to have autism spectrum disorder? Clinical Pediatrics, 46, 801–805.CrossRefPubMedGoogle Scholar
  12. Glasson, E. J., Bower, C., Petterson, B., de Klerk, N., Chaney, G., & Hallmayer, J. F. (2004). Perinatal factors and the development of autism: A population study. Archives of General Psychiatry, 61, 618–627.CrossRefPubMedGoogle Scholar
  13. Grether, J. K., Anderson, M. C., Croen, L. A., Smith, D., & Windham, G. C. (2009). Risk of autism and increasing maternal and paternal age in a large north American population. American Journal of Epidemiology, 170, 1118–1126.CrossRefPubMedGoogle Scholar
  14. Hultman, C. M., Sandin, S., Levine, S. Z., Lichtenstein, P., & Reichenberg, A. (2011). Advancing paternal age and risk of autism: New evidence from a population-based study and a meta-analysis of epidemiological studies. Molecular psychiatry, 16, 1203–1212.CrossRefPubMedGoogle Scholar
  15. Hvidtjørn, D., Schieve, L., Schendel, D., Jacobsson, B., Svaerke, C., & Thorsen, P. (2009). Cerebral palsy, autism spectrum disorders, and developmental delay in children born after assisted conception: A systematic review and meta-analysis. Archives of Pediatrics & Adolescent Medicine, 163, 72–83.CrossRefGoogle Scholar
  16. Idring, S., Magnusson, C., Lundberg, M., Ek, M., Rai, D., Svensson, A. C., et al. (2014). Parental age and the risk of autism spectrum disorders: Findings from a Swedish population-based cohort. International Journal of Epidemiology, 43, 107–115.CrossRefPubMedGoogle Scholar
  17. Kalkbrenner, A. E., Windham, G. C., Serre, M. L., Akita, Y., Wang, X., Hoffman, K., et al. (2015). Particulate matter exposure, prenatal and postnatal windows of susceptibility, and autism spectrum disorders. Epidemiology, 26, 30–42.CrossRefPubMedGoogle Scholar
  18. Khowaja, M. K., Hazzard, A. P., & Robins, D. L. (2015). Sociodemographic barriers to early detection of autism: Screening and Evaluation Using the M-CHAT, M-CHAT-R, and Follow-Up. Journal of Autism and Developmental Disorders, 45, 1797–1808.CrossRefPubMedPubMedCentralGoogle Scholar
  19. Lai, D. C., Tseng, Y. C., Hou, Y. M., & Guo, H. R. (2012). Gender and geographic differences in the prevalence of autism spectrum disorders in children: Analysis of data from the national disability registry of Taiwan. Research in Developmental Disabilities, 33, 909–915.CrossRefPubMedGoogle Scholar
  20. Lauritsen, M. B., Pedersen, C. B., & Mortensen, P. B. (2005). Effects of familial risk factors and place of birth on the risk of autism: A nationwide register-based study. Journal of Child Psychology and Psychiatry, 46, 963–971.CrossRefPubMedGoogle Scholar
  21. Lung, F. W., Chiang, T. L., Lin, S. J., & Shu, B. C. (2016). Urban and Education Disparity for autism spectrum disorders in Taiwan Birth Cohort Study. Journal of Autism and Developmental Disorders, 47, 599–606 [Epub ahead of print].Google Scholar
  22. Lung, F. W., Chiang, T. L., Lin, S. J., Shu, B. C., & Lee, M. C. (2011). Developing and refining the Taiwan Birth Cohort Study (TBCS): Five years of experience. Research in Developmental Disabilities, 32, 2697–2703.CrossRefPubMedGoogle Scholar
  23. Lung, F. W., Shu, B. C., Chiang, T. L., & Lin, S. J. (2009). Twin-singleton influence on infant development: A national birth cohort study. Child: Care, Health and Development, 35, 409–418.Google Scholar
  24. Luo, S., Lawson, A. B., He, B., Elm, J. J., & Tilley, B. C. (2016). Bayesian multiple imputation for missing multivariate longitudinal data from a Parkinson’s disease clinical trial. Statistical Methods in Medical Research, 25, 821–837.CrossRefPubMedGoogle Scholar
  25. Mandell, D. S., Novak, M. M., & Zubritsky, C. D. (2005). Factors associated with age of diagnosis among children with autism spectrum disorders. Pediatrics, 116, 1480–1486.CrossRefPubMedPubMedCentralGoogle Scholar
  26. Mathews, T. J., & Hamilton, B. E. (2002). Mean age of mother, 1970–2000. National Vital Statistics Reports, 51(1), 1–14.PubMedGoogle Scholar
  27. Ozonoff, S., Young, G. S., Steinfeld, M. B., Hill, M. M., Cook, I., Hutman, T., et al. (2009). How early do parent concerns predict later autism diagnosis? Journal of Developmental and Behavioral Pediatrics, 30, 367–375.CrossRefPubMedPubMedCentralGoogle Scholar
  28. Parner, E. T., Baron-Cohen, S., Lauritsen, M. B., Jørgensen, M., Schieve, L. A., Yeargin-Allsopp, M., et al. (2012). Parental age and autism spectrum disorders. Annals of Epidemiology, 22, 143–150.CrossRefPubMedPubMedCentralGoogle Scholar
  29. Petersen, L., Mortensen, P. B., & Pedersen, C. B. (2011). Paternal age at birth of first child and risk of schizophrenia. The American Journal of Psychiatry, 168, 82–88.CrossRefPubMedGoogle Scholar
  30. Rai, D., Lewis, G., Lundberg, M., Araya, R., Svensson, A., Dalman, C., et al. (2012). Parental socioeconomic status and risk of offspring autism spectrum disorders in a Swedish population-based study. Journal of the American Academy of Child and Adolescent Psychiatry, 51, 467–476.CrossRefPubMedGoogle Scholar
  31. Reichenberg, A., Gross, R., Weiser, M., Bresnahan, M., Silverman, J., Harlap, S., et al. (2006). Advancing paternal age and autism. Archives of General Psychiatry, 63, 1026–1032.CrossRefPubMedGoogle Scholar
  32. Reichenberg, A., Mill, J., & MacCabe, J. H. (2009). Epigenetics, genomic mutations and cognitive function. Cognitive Neuropsychiatry, 14, 377–390.CrossRefPubMedGoogle Scholar
  33. Robins, D. L., Fein, D., Barton, M. L., & Green, J. A. (2001). the modified checklist for autism in toddlers: An initial study investigating the early detection of autism and pervasive developmental disorders. Journal of Autism and Developmental Disorders, 31, 131–144.CrossRefPubMedGoogle Scholar
  34. Rosenbaum, P. R., & Rubin, D. B. (1983). The central role of the propensity score in observational studies for causal effects. Biometrika, 70, 41–55.CrossRefGoogle Scholar
  35. Runkel, P. (2012). Large samples: Too much of a good thing? Accessed 4 July 2012.
  36. Sandin, S., Hultman, C. M., Kolevzon, A., Gross, R., MacCabe, J. H., & Reichenberg, A. (2012). Advancing maternal age is associated with increasing risk for autism: A review and meta-analysis. Journal of the American Academy of Child and Adolescent Psychiatry, 51, 477–486.CrossRefPubMedGoogle Scholar
  37. Thoemmes, F. (2012). Propensity score matching in SPSS. Accessed 24 July 2013.
  38. Thomas, P., Zahorodny, W., Peng, B., Kim, S., Jani, N., Halperin, W., & Brimacombe, M. (2012). The association of autism diagnosis with socioeconomic status. Autism, 16, 201–213.CrossRefPubMedGoogle Scholar
  39. Volk, H. E., Lurmann, F., Penfold, B., Hertz-Picciotto, I., & McConnell, R. (2013). Traffic-related air pollution, particulate matter, and autism. JAMA Psychiatry, 70, 71–77.CrossRefPubMedPubMedCentralGoogle Scholar
  40. 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, 1431–1439.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Calo Psychiatric CenterPingtung CountyTaiwan
  2. 2.Graduate Institute of Medical ScienceNational Defense Medical CenterTaipeiTaiwan
  3. 3.College of Public Health, Institute of Health Policy and ManagementNational Taiwan UniversityTaipeiTaiwan
  4. 4.Genetic Counseling CenterChi Mei Medical CenterTainanTaiwan
  5. 5.Department of Family MedicineTaichung HospitalTaichungTaiwan
  6. 6.Institute of Population Health SciencesNational Health Research InstitutesMiaoliTaiwan
  7. 7.Institute of MedicineChung Shan Medical UniversityTaichungTaiwan
  8. 8.College of HealthNational Taichung University of Science and TechnologyTaichungTaiwan
  9. 9.Department of Nursing and Institute of Allied Health SciencesNational Cheng Kung UniversityTainanTaiwan

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