Age of Diagnosis of Autism Spectrum Disorder in an Ethnically Diverse Population before and after the 2007 AAP Recommendation for Universal Screening

Background:  Children with Autism Spectrum Disorder(ASD) benefit from early diagnosis and intervention services. In 2007 the American Academy of Pediatrics(AAP) recommended pediatricians perform screening for ASD at the 18 and 24 month child visits. However, the U.S. Preventive Services Task Force recently concluded there is not enough evidence to recommend universal autism screening of young children for whom no concerns of ASD have been raised by their parents or clinical provider. Children who are Latino or African American are already being diagnosed later and families may be less aware of ASD symptoms, the impact of such recommendation on the age at diagnosis in an ethnically diverse population is important, but unknown.

Objectives:  To compare the age at diagnosis of ASD in two groups, those children born before 2005, prior to universal screening recommendations, and those born in 2005 or later, who would have been of age to undergo ASD screening by 24 months based on the 2007 AAP recommendation.

Methods:  Review of all children initially diagnosed with ASD from 2003 to 2012 in a University Affiliated Developmental Center. Data included demographic and clinical characteristics. Statistics included chi-square, t-test, non parametrics, and logistic regression

Results:  We identified 512 children,78% boys, 16%White, 47%Hispanic, 26%African-American, 38% bilinguals(English/Spanish). Of 512, 295(58%) were born before 2005 and 217(42%) were born during 2005 or after. The mean age at diagnosis of children born before 2005 was 46±15months and those born during or after 2005 was 31±12 months(p<.001). The percentage of children diagnosed with ASD after age 3 decreased from 63% in the group born before 2005 to 26%(p<.001). This decline occurred across all ethnic groups (White 55% to 27%; Hispanic 76% to 23%; African-American 73% to 32%). The association between diagnosis with ASD after age 3 and being born before 2005 remained significant after adjusting for demographics and clinical characteristics (OR=4.2;95^thCI 1.7-10.3).

Conclusions:  In this ethnically diverse population, children who were born before the AAP recommendation for universal screening were diagnosed with ASD significantly later that those born after the AAP recommendation. It is unclear at this point if this was entirely the result of pediatrician universal screening but, since 2007, children are being diagnosed with ASD earlier.