Specific developmental concerns can distinguish between an early versus later diagnosis of autism spectrum disorder (ASD). Caregiver survey responses of children ≥ 9 years-of-age (2012) with ASD were used to evaluate developmental concerns and associations with age of diagnosis [early (< 3 years: n = 106) vs. later (≥ 3 years: n = 432)] using logistic regression. Concerns arose at mean age 18 and 35-months for children diagnosed early versus later, respectively. Concerns about poor eye contact (aOR 1.81, CI 1.08, 3.05), pointing/gesturing (aOR 2.74, CI 1.60, 4.70), response to own name (aOR 3.03, CI 1.75, 5.23), and babbling/speaking (aOR 1.67, CI 0.98, 2.82) were associated with an early diagnosis. Caregivers and pediatricians are critical in early identification and timely entry into intervention.
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American Academy of Pediatrics. (2017). Periodicity schedule. Retrieved July 12, 2017, from https://www.aap.org/en-us/Documents/periodicity_schedule.pdf.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: American Psychiatric Association.
Autism and Developmental Disabilities Monitoring Network Surveillance Year 2006 Principal Investigators, & Centers for Disease Control and Prevention. (2009). Prevalence of autism spectrum disorders—Autism and developmental disabilities monitoring network, United States, 2006. MMWR. Surveillance Summaries: Morbidity and Mortality Weekly Report. Surveillance Summaries/CDC, 58(10), 1–20.
Baron-Cohen, S., Wheelwright, S., Cox, A., Baird, G., Charman, T., Swettenham, J., … Doehring, P. (2000). Early identification of autism by the CHecklist for Autism in Toddlers (CHAT). Journal of the Royal Society of Medicine, 93(10), 521–525.
Becerra, T. A., Massolo, M. L., Yau, V. M., Owen-Smith, A. A., Lynch, F. L., Crawford, P. M., … Croen, L. A. (2017). A survey of parents with children on the autism spectrum: Experience with services and treatments. The Permanente Journal. https://doi.org/10.7812/TPP/16-009.
Becerra, T. A., von Ehrenstein, O. S., Heck, J. E., Olsen, J., Arah, O. A., Jeste, S. S., … Ritz, B. (2014). Autism spectrum disorders and race, ethnicity, and nativity: A population-based study. Pediatrics 134(1), e63–e71
Centers for Disease Control and Prevention. (n.d.). CDC | Milestones | Learn the Signs. Act Early. | NCBDDD. Retrieved June 15, 2017, from https://www.cdc.gov/ncbddd/actearly/milestones/index.html.
Christensen, D. L., Baio, J., Van Naarden Braun, K., Bilder, D., Charles, J., & Constantino, J. N., … Centers for Disease Control and Prevention (CDC). (2016). Prevalence and characteristics of autism spectrum disorder among children aged 8 years—Autism and developmental disabilities monitoring network, 11 sites, United States, 2012. Morbidity and Mortality Weekly Report. Surveillance Summaries, 65(3), 1–23. https://doi.org/10.15585/mmwr.ss6503a1.
Colbert, A. M., Webber, J., & Graham, R. (2016). Factors that influence autism knowledge in Hispanic cultures: A Pilot Study. Journal of Racial and Ethnic Health Disparities. https://doi.org/10.1007/s40615-016-0213-4.
Coleman, K. J., Lutsky, M. A., Yau, V., Qian, Y., Pomichowski, M. E., Crawford, P. M., … Croen, L. A. (2015). Validation of autism spectrum disorder diagnoses in large healthcare systems with electronic medical records. Journal of Autism and Developmental Disorders, 45(7), 1989–1996. https://doi.org/10.1007/s10803-015-2358-0.
Committee on Children With Disabilities. (2001). American Academy of Pediatrics: The pediatrician’s role in the diagnosis and management of autistic spectrum disorder in children. Pediatrics, 107(5), 1221–1226.
Coonrod, E. E., & Stone, W. L. (2004). Early concerns of parents of children with autistic and nonautistic disorders. Infants & Young Children, 17(3), 258–268.
De Giacomo, A., & Fombonne, E. (1998). Parental recognition of developmental abnormalities in autism. European Child & Adolescent Psychiatry, 7(3), 131–136.
Fountain, C., & Bearman, P. (2011). Risk as social context: Immigration policy and autism in California. Sociological Forum, 26(2), 215–240. https://doi.org/10.1111/j.1573-7861.2011.01238.x.
Fountain, C., King, M. D., & Bearman, P. S. (2011). Age of diagnosis for autism: Individual and community factors across 10 birth cohorts. Journal of Epidemiology and Community Health, 65(6), 503–510. https://doi.org/10.1136/jech.2009.104588.
Green, D., Chandler, S., Charman, T., Simonoff, E., & Baird, G. (2016). Brief report: DSM-5 sensory behaviours in children with and without an autism spectrum disorder. Journal of Autism and Developmental Disorders, 46(11), 3597–3606. https://doi.org/10.1007/s10803-016-2881-7.
Guinchat, V., Chamak, B., Bonniau, B., Bodeau, N., Perisse, D., Cohen, D., & Danion, A. (2012). Very early signs of autism reported by parents include many concerns not specific to autism criteria. Research in Autism Spectrum Disorders, 6(2), 589–601. https://doi.org/10.1016/j.rasd.2011.10.005.
Herlihy, L., Knoch, K., Vibert, B., & Fein, D. (2015). Parents’ first concerns about toddlers with autism spectrum disorder: Effect of sibling status. Autism: The International Journal of Research and Practice, 19(1), 20–28. https://doi.org/10.1177/1362361313509731.
IDEA - Building The Legacy of IDEA 2004. (n.d.). Retrieved September 8, 2017, from http://idea.ed.gov/part-c/search/new.html.
Kishore, M. T., & Basu, A. (2011). Early concerns of mothers of children later diagnosed with autism: Implications for early identification. Research in Autism Spectrum Disorders, 5(1), 157–163. https://doi.org/10.1016/j.rasd.2010.03.005.
Luyster, R., Gotham, K., Guthrie, W., Coffing, M., Petrak, R., Pierce, K., … Lord, C. (2009). The autism diagnostic observation schedule—Toddler module: A new module of a standardized diagnostic measure for autism spectrum disorders. Journal of Autism and Developmental Disorders, 39(9), 1305–1320. https://doi.org/10.1007/s10803-009-0746-z.
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 & Adolescent Psychiatry, 52(4), 401–413.e8. https://doi.org/10.1016/j.jaac.2013.01.014.
Magaña, S., Lopez, K., Aguinaga, A., & Morton, H. (2013). Access to diagnosis and treatment services among latino children with autism spectrum disorders. Intellectual and Developmental Disabilities, 51(3), 141–153. https://doi.org/10.1352/1934-9556-51.3.141.
Matheis, M., Matson, J. L., Burns, C. O., Jiang, X., Peters, W. J., Moore, M., … Estabillo, J. (2016). Factors related to parental age of first concern in toddlers with autism spectrum disorder. Developmental Neurorehabilitation. https://doi.org/10.1080/17518423.2016.1211186.
Ozonoff, S., Iosif, A.-M., Baguio, F., Cook, I. C., Hill, M. M., Hutman, T., … Young, G. S. (2010). A prospective study of the emergence of early behavioral signs of autism. Journal of the American Academy of Child & Adolescent Psychiatry, 49(3), 256.e2–266.e2. https://doi.org/10.1016/j.jaac.2009.11.009.
Ozonoff, S., Young, G. S., Steinfeld, M. B., Hill, M. M., Cook, I., Hutman, T., … Sigman, M. (2009). How early do parent concerns predict later autism diagnosis? Journal of Developmental and Behavioral Pediatrics: JDBP, 30(5), 367–375.
Paul, H.. Brookes Publishing Co., Inc. (2017). Ages & Stages Questionnaires. Retrieved October 2, 2017, from http://agesandstages.com/.
Richards, M., Mossey, J., & Robins, D. L. (2016). Parents’ concerns as they relate to their child’s development and later diagnosis of autism spectrum disorder. Journal of Developmental and Behavioral Pediatrics: JDBP, 37(7), 532–540. https://doi.org/10.1097/DBP.0000000000000339.
Sacrey, L.-A. R., Zwaigenbaum, L., Bryson, S., Brian, J., Smith, I. M., Roberts, W., … Armstrong, V. (2015). Can parents’ concerns predict autism spectrum disorder? A prospective study of high-risk siblings from 6 to 36 months of age. Journal of the American Academy of Child and Adolescent Psychiatry, 54(6), 470–478. https://doi.org/10.1016/j.jaac.2015.03.014.
Shattuck, P. T., & Grosse, S. D. (2007). Issues related to the diagnosis and treatment of autism spectrum disorders. Mental Retardation and Developmental Disabilities Research Reviews, 13(2), 129–135. https://doi.org/10.1002/mrdd.20143.
Szatmari, P., Chawarska, K., Dawson, G., Georgiades, S., Landa, R., Lord, C., … Halladay, A. (2016). Prospective longitudinal studies of infant siblings of children with autism: Lessons learned and future directions. Journal of the American Academy of Child and Adolescent Psychiatry, 55(3), 179–187. https://doi.org/10.1016/j.jaac.2015.12.014.
Vivanti, G., Hudry, K., Trembath, D., Barbaro, J., Richdale, A., & Dissanayake, C. (2013). Towards the DSM-5 criteria for autism: Clinical, cultural, and research implications. Australian Psychologist, 48(4), 258–261. https://doi.org/10.1111/ap.12008.
Zablotsky, B., Colpe, L. J., Pringle, B. A., Kogan, M. D., Rice, C., & Blumberg, S. J. (2017). Age of parental concern, diagnosis, and service initiation among children with autism spectrum disorder. American Journal on Intellectual and Developmental Disabilities, 122(1), 49–61. https://doi.org/10.1352/1944-7558-122.1.49.
Zwaigenbaum, L., Bauman, M. L., Stone, W. L., Yirmiya, N., Estes, A., Hansen, R. L., … Wetherby, A. (2015). Early identification of autism spectrum disorder: Recommendations for practice and research. Pediatrics, 136(Supplement 1), S10–S40. https://doi.org/10.1542/peds.2014-3667C.
Zwaigenbaum, L., Bryson, S., Rogers, T., Roberts, W., Brian, J., & Szatmari, P. (2005). Behavioral manifestations of autism in the first year of life. International Journal of Developmental Neuroscience: The Official Journal of the International Society for Developmental Neuroscience, 23(2–3), 143–152. https://doi.org/10.1016/j.ijdevneu.2004.05.001.
This project was funded by a grant from National Institute of Mental Health (Grant # 1U19MH092201).
This project was funded by a Grant from National Institute of Mental Health (Grant # 1U19MH092201).
Conflict of interest
None of the authors have financial relationships or any conflicts of interest relevant to this article to disclose.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the Institutional and/or National Research Committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this study analyses, formal consent was not required.
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Becerra-Culqui, T.A., Lynch, F.L., Owen-Smith, A.A. et al. Parental First Concerns and Timing of Autism Spectrum Disorder Diagnosis. J Autism Dev Disord 48, 3367–3376 (2018). https://doi.org/10.1007/s10803-018-3598-6
- Autism spectrum disorder
- Developmental concerns
- Early diagnosis