Developmental functioning and symptom severity influence age of diagnosis in Canadian preschool children with autism

Lonnie Zwaigenbaum, Eric Duku, Eric Fombonne, Peter Szatmari, Isabel M. Smith, Susan E. Bryson, Pat Mirenda, Tracy Vaillancourt, Joanne Volden, Stelios Georgiades, Wendy Roberts, Teresa Bennett, Mayada Elsabbagh, Charlotte Waddell, Mandy Steiman, Rebecca Simon, Ruth Bruno

Research output: Contribution to journalArticle

Abstract

Background: Early diagnosis of autism spectrum disorder (ASD) is essential in most Canadian jurisdictions to access interventions that improve long-term child outcomes. Our main objective was to identify factors associated with timing of ASD diagnosis in five provinces across Canada. Methods: Factors influencing age of diagnosis were assessed in the analyses of an inception cohort of children diagnosed with ASD between ages 2 and 5 years. We examined bivariate associations and using a series of multiple variable regression models, evaluated the unique contributions of developmental functioning, ASD symptoms and demographic variables. Children with known genetic abnormalities, or severe sensory or motor impairments interfering with assessment were excluded. Results: Participants were 421 children (84.6% boys). The mean age of diagnosis was 38.2 months (SD=8.7), an average of 19 months after parents identified initial concerns. Factors associated with later diagnosis included more advanced language and cognitive skills, and higher levels of restricted repetitive behaviour symptoms. Child sex and family demographics were not associated with age of diagnosis. In regression analyses, language and cognitive skills accounted for 6.8% of variance in age of diagnosis and ASD symptoms contributed an additional 5.5%. Provincial site accounted for 4.0% of variance in age of diagnosis, independent of developmental skills and ASD symptoms. Interpretation: Diagnosis of ASD occurred, on average, 19 months after parents' initial concerns. Language and cognitive skills, symptom severity and provincial site accounted for variation in age of ASD diagnosis in this Canadian cohort. Variable presentation across the developmental continuum must be considered in planning assessment services to ensure timely ASD diagnosis so that outcomes can be improved. Policy and practice leadership is also needed to reduce interprovincial variability.

Original languageEnglish (US)
Pages (from-to)E57-E65
JournalPaediatrics and Child Health (Canada)
Volume24
Issue number1
DOIs
StatePublished - Feb 15 2019

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Preschool Children
Autistic Disorder
Language
Parents
Demography
Autism Spectrum Disorder
Neurobehavioral Manifestations
Age Factors
Delayed Diagnosis
Canada
Early Diagnosis
Cohort Studies
Regression Analysis

Keywords

  • Autism spectrum disorder
  • Cognitive development
  • Early diagnosis
  • Language development

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Developmental functioning and symptom severity influence age of diagnosis in Canadian preschool children with autism. / Zwaigenbaum, Lonnie; Duku, Eric; Fombonne, Eric; Szatmari, Peter; Smith, Isabel M.; Bryson, Susan E.; Mirenda, Pat; Vaillancourt, Tracy; Volden, Joanne; Georgiades, Stelios; Roberts, Wendy; Bennett, Teresa; Elsabbagh, Mayada; Waddell, Charlotte; Steiman, Mandy; Simon, Rebecca; Bruno, Ruth.

In: Paediatrics and Child Health (Canada), Vol. 24, No. 1, 15.02.2019, p. E57-E65.

Research output: Contribution to journalArticle

Zwaigenbaum, L, Duku, E, Fombonne, E, Szatmari, P, Smith, IM, Bryson, SE, Mirenda, P, Vaillancourt, T, Volden, J, Georgiades, S, Roberts, W, Bennett, T, Elsabbagh, M, Waddell, C, Steiman, M, Simon, R & Bruno, R 2019, 'Developmental functioning and symptom severity influence age of diagnosis in Canadian preschool children with autism', Paediatrics and Child Health (Canada), vol. 24, no. 1, pp. E57-E65. https://doi.org/10.1093/pch/pxy076
Zwaigenbaum, Lonnie ; Duku, Eric ; Fombonne, Eric ; Szatmari, Peter ; Smith, Isabel M. ; Bryson, Susan E. ; Mirenda, Pat ; Vaillancourt, Tracy ; Volden, Joanne ; Georgiades, Stelios ; Roberts, Wendy ; Bennett, Teresa ; Elsabbagh, Mayada ; Waddell, Charlotte ; Steiman, Mandy ; Simon, Rebecca ; Bruno, Ruth. / Developmental functioning and symptom severity influence age of diagnosis in Canadian preschool children with autism. In: Paediatrics and Child Health (Canada). 2019 ; Vol. 24, No. 1. pp. E57-E65.
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abstract = "Background: Early diagnosis of autism spectrum disorder (ASD) is essential in most Canadian jurisdictions to access interventions that improve long-term child outcomes. Our main objective was to identify factors associated with timing of ASD diagnosis in five provinces across Canada. Methods: Factors influencing age of diagnosis were assessed in the analyses of an inception cohort of children diagnosed with ASD between ages 2 and 5 years. We examined bivariate associations and using a series of multiple variable regression models, evaluated the unique contributions of developmental functioning, ASD symptoms and demographic variables. Children with known genetic abnormalities, or severe sensory or motor impairments interfering with assessment were excluded. Results: Participants were 421 children (84.6{\%} boys). The mean age of diagnosis was 38.2 months (SD=8.7), an average of 19 months after parents identified initial concerns. Factors associated with later diagnosis included more advanced language and cognitive skills, and higher levels of restricted repetitive behaviour symptoms. Child sex and family demographics were not associated with age of diagnosis. In regression analyses, language and cognitive skills accounted for 6.8{\%} of variance in age of diagnosis and ASD symptoms contributed an additional 5.5{\%}. Provincial site accounted for 4.0{\%} of variance in age of diagnosis, independent of developmental skills and ASD symptoms. Interpretation: Diagnosis of ASD occurred, on average, 19 months after parents' initial concerns. Language and cognitive skills, symptom severity and provincial site accounted for variation in age of ASD diagnosis in this Canadian cohort. Variable presentation across the developmental continuum must be considered in planning assessment services to ensure timely ASD diagnosis so that outcomes can be improved. Policy and practice leadership is also needed to reduce interprovincial variability.",
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AU - Smith, Isabel M.

AU - Bryson, Susan E.

AU - Mirenda, Pat

AU - Vaillancourt, Tracy

AU - Volden, Joanne

AU - Georgiades, Stelios

AU - Roberts, Wendy

AU - Bennett, Teresa

AU - Elsabbagh, Mayada

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AU - Steiman, Mandy

AU - Simon, Rebecca

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