Diagnosis of Autism Spectrum Disorder After Age 5 in Children Evaluated Longitudinally Since Infancy

Sally J Ozonoff, Gregory S. Young, Jessica Brian, Tony Charman, Elizabeth Shephard, Abbie Solish, Lonnie Zwaigenbaum

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Objective: The diagnosis of autism spectrum disorder (ASD) has been found to be remarkably stable but few studies have followed children not initially diagnosed with ASD beyond 3 years of age to examine late or delayed diagnoses. The present study used a prospective familial-risk design to identify children who had undergone multiple comprehensive assessments in preschool and were determined to be negative for ASD only to meet criteria for ASD when tested in middle childhood. Method: Data were pooled across 3 research teams studying later-born siblings of children with ASD. Fourteen children met inclusion criteria for the late-diagnosed group and were compared with a large sample of high- and low-risk siblings from the same sites who had ASD or typical development (TD) outcomes at 3 years of age. Results: As a group, the late-diagnosed children scored between the TD and ASD groups on most measures administered at 3 years and differed significantly from the ASD group on most measures. However, there was significant heterogeneity among the late-diagnosed cases. Seven showed very little evidence of ASD in preschool, whereas 7 demonstrated subtle, subthreshold symptomatology. Conclusion: Some children with ASD might present with a subtle phenotype early in life or show a prolonged time course of symptom development. This emphasizes the need for screening and surveillance schedules that extend past 36 months and continued evaluation of any child who presents with atypical early development and/or high-risk status. The findings also shed light on reasons why the mean age of ASD diagnosis remains older than 4 years.

Original languageEnglish (US)
Pages (from-to)849-857.e2
JournalJournal of the American Academy of Child and Adolescent Psychiatry
Volume57
Issue number11
DOIs
StatePublished - Nov 1 2018

Fingerprint

Delayed Diagnosis
Siblings
Autism Spectrum Disorder
Appointments and Schedules
Phenotype
Research

Keywords

  • autism spectrum disorder
  • diagnosis
  • diagnostic stability

ASJC Scopus subject areas

  • Developmental and Educational Psychology
  • Psychiatry and Mental health

Cite this

Diagnosis of Autism Spectrum Disorder After Age 5 in Children Evaluated Longitudinally Since Infancy. / Ozonoff, Sally J; Young, Gregory S.; Brian, Jessica; Charman, Tony; Shephard, Elizabeth; Solish, Abbie; Zwaigenbaum, Lonnie.

In: Journal of the American Academy of Child and Adolescent Psychiatry, Vol. 57, No. 11, 01.11.2018, p. 849-857.e2.

Research output: Contribution to journalArticle

Ozonoff, Sally J ; Young, Gregory S. ; Brian, Jessica ; Charman, Tony ; Shephard, Elizabeth ; Solish, Abbie ; Zwaigenbaum, Lonnie. / Diagnosis of Autism Spectrum Disorder After Age 5 in Children Evaluated Longitudinally Since Infancy. In: Journal of the American Academy of Child and Adolescent Psychiatry. 2018 ; Vol. 57, No. 11. pp. 849-857.e2.
@article{b26cffe55b5547779aea5c62d9694b88,
title = "Diagnosis of Autism Spectrum Disorder After Age 5 in Children Evaluated Longitudinally Since Infancy",
abstract = "Objective: The diagnosis of autism spectrum disorder (ASD) has been found to be remarkably stable but few studies have followed children not initially diagnosed with ASD beyond 3 years of age to examine late or delayed diagnoses. The present study used a prospective familial-risk design to identify children who had undergone multiple comprehensive assessments in preschool and were determined to be negative for ASD only to meet criteria for ASD when tested in middle childhood. Method: Data were pooled across 3 research teams studying later-born siblings of children with ASD. Fourteen children met inclusion criteria for the late-diagnosed group and were compared with a large sample of high- and low-risk siblings from the same sites who had ASD or typical development (TD) outcomes at 3 years of age. Results: As a group, the late-diagnosed children scored between the TD and ASD groups on most measures administered at 3 years and differed significantly from the ASD group on most measures. However, there was significant heterogeneity among the late-diagnosed cases. Seven showed very little evidence of ASD in preschool, whereas 7 demonstrated subtle, subthreshold symptomatology. Conclusion: Some children with ASD might present with a subtle phenotype early in life or show a prolonged time course of symptom development. This emphasizes the need for screening and surveillance schedules that extend past 36 months and continued evaluation of any child who presents with atypical early development and/or high-risk status. The findings also shed light on reasons why the mean age of ASD diagnosis remains older than 4 years.",
keywords = "autism spectrum disorder, diagnosis, diagnostic stability",
author = "Ozonoff, {Sally J} and Young, {Gregory S.} and Jessica Brian and Tony Charman and Elizabeth Shephard and Abbie Solish and Lonnie Zwaigenbaum",
year = "2018",
month = "11",
day = "1",
doi = "10.1016/j.jaac.2018.06.022",
language = "English (US)",
volume = "57",
pages = "849--857.e2",
journal = "Journal of the American Academy of Child and Adolescent Psychiatry",
issn = "0890-8567",
publisher = "Elsevier Limited",
number = "11",

}

TY - JOUR

T1 - Diagnosis of Autism Spectrum Disorder After Age 5 in Children Evaluated Longitudinally Since Infancy

AU - Ozonoff, Sally J

AU - Young, Gregory S.

AU - Brian, Jessica

AU - Charman, Tony

AU - Shephard, Elizabeth

AU - Solish, Abbie

AU - Zwaigenbaum, Lonnie

PY - 2018/11/1

Y1 - 2018/11/1

N2 - Objective: The diagnosis of autism spectrum disorder (ASD) has been found to be remarkably stable but few studies have followed children not initially diagnosed with ASD beyond 3 years of age to examine late or delayed diagnoses. The present study used a prospective familial-risk design to identify children who had undergone multiple comprehensive assessments in preschool and were determined to be negative for ASD only to meet criteria for ASD when tested in middle childhood. Method: Data were pooled across 3 research teams studying later-born siblings of children with ASD. Fourteen children met inclusion criteria for the late-diagnosed group and were compared with a large sample of high- and low-risk siblings from the same sites who had ASD or typical development (TD) outcomes at 3 years of age. Results: As a group, the late-diagnosed children scored between the TD and ASD groups on most measures administered at 3 years and differed significantly from the ASD group on most measures. However, there was significant heterogeneity among the late-diagnosed cases. Seven showed very little evidence of ASD in preschool, whereas 7 demonstrated subtle, subthreshold symptomatology. Conclusion: Some children with ASD might present with a subtle phenotype early in life or show a prolonged time course of symptom development. This emphasizes the need for screening and surveillance schedules that extend past 36 months and continued evaluation of any child who presents with atypical early development and/or high-risk status. The findings also shed light on reasons why the mean age of ASD diagnosis remains older than 4 years.

AB - Objective: The diagnosis of autism spectrum disorder (ASD) has been found to be remarkably stable but few studies have followed children not initially diagnosed with ASD beyond 3 years of age to examine late or delayed diagnoses. The present study used a prospective familial-risk design to identify children who had undergone multiple comprehensive assessments in preschool and were determined to be negative for ASD only to meet criteria for ASD when tested in middle childhood. Method: Data were pooled across 3 research teams studying later-born siblings of children with ASD. Fourteen children met inclusion criteria for the late-diagnosed group and were compared with a large sample of high- and low-risk siblings from the same sites who had ASD or typical development (TD) outcomes at 3 years of age. Results: As a group, the late-diagnosed children scored between the TD and ASD groups on most measures administered at 3 years and differed significantly from the ASD group on most measures. However, there was significant heterogeneity among the late-diagnosed cases. Seven showed very little evidence of ASD in preschool, whereas 7 demonstrated subtle, subthreshold symptomatology. Conclusion: Some children with ASD might present with a subtle phenotype early in life or show a prolonged time course of symptom development. This emphasizes the need for screening and surveillance schedules that extend past 36 months and continued evaluation of any child who presents with atypical early development and/or high-risk status. The findings also shed light on reasons why the mean age of ASD diagnosis remains older than 4 years.

KW - autism spectrum disorder

KW - diagnosis

KW - diagnostic stability

UR - http://www.scopus.com/inward/record.url?scp=85055914331&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85055914331&partnerID=8YFLogxK

U2 - 10.1016/j.jaac.2018.06.022

DO - 10.1016/j.jaac.2018.06.022

M3 - Article

C2 - 30392626

AN - SCOPUS:85055914331

VL - 57

SP - 849-857.e2

JO - Journal of the American Academy of Child and Adolescent Psychiatry

JF - Journal of the American Academy of Child and Adolescent Psychiatry

SN - 0890-8567

IS - 11

ER -