Missed Diagnosis of Autism Spectrum Disorder (ASD) in a Psychiatric Population

Background: Autism spectrum disorder (ASD) is a severe handicapping condition often diagnosed by 5 years of age. To a considerable extent, its timely diagnosis determines its long-term outcomes (Rogers et al., 2018). However, in the presence of comorbid psychiatric disorders, its diagnosis can be delayed. Relatively little is known about the risk factors that delay the diagnosis of ASD.

Objectives: To examine the characteristics of children admitted to a psychiatric unit in whom the diagnosis of ASD was missed.

Methods: Children with suspected ASD were recruited from a consecutive series of 991 patients admitted to a short-term 14-bed academic child and adolescent psychiatry inpatient unit over a two-year period. Diagnosis of ASD and comorbid psychiatric disorders was made by a multidisciplinary team.

Results: 14 children (aged 9-17 years) with suspected ASD were identified out of which eight received a final diagnosis of ASD. 13 (93%) had received at least one psychiatric diagnosis. None of the patients had intellectual disability. The most common psychiatric diagnoses initially diagnosed in this sample were ADHD (n=7); Depression (n=6); Anxiety Disorder (n=5); Aggression/Impulse Control Disorder (n=4); and one each of Bipolar Disorder, Psychosis, and Obsessive-Compulsive Disorder. Multiple psychiatric comorbidity was a common characteristic of the children with a missed diagnosis of ASD.

Conclusions: Children with multiple psychiatric symptoms beginning early in life should be screened for ASD.