Factors associated with age of diagnosis among children with autism spectrum disorders
Factors associated with age of diagnosis among children with autism spectrum disorders
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DOI：
10.1542/peds.2005-0185
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发表时间：
2005-12-01
期刊：
影响因子：
8
通讯作者：
Zubritsky, CD
中科院分区：
文献类型：
--
作者：
Mandell, DS;Novak, MM;Zubritsky, CD
Objective.自闭症谱系障碍（ASD）儿童的早期诊断至关重要，但往往推迟到学龄。很少有研究确定了可能延迟诊断的因素。本研究试图找出这些因素与ASD的儿童社区样本。调查数据收集于宾夕法尼亚州的969名ASD儿童的照顾者，他们的服务经验年龄小于21岁。采用线性回归分析确定与诊断年龄相关的临床和人口统计学特征。自闭症儿童的平均诊断年龄为3.1岁，广泛性发育障碍的平均诊断年龄为3.9岁，而其他疾病的平均诊断年龄为7.2岁。平均诊断年龄每增加一岁增加0.2岁。农村儿童比城市儿童晚0.4年获得诊断。接近贫困的儿童比收入超过贫困线100%的儿童晚0.9年获得诊断。患有严重语言障碍的儿童平均比其他儿童早1.2年得到诊断。手拍打，脚趾走路，和持续的奇怪的游戏与诊断年龄的减少有关，而对疼痛和听力障碍的过度敏感与增加有关。在诊断前有4名或更多初级保健医生的儿童比其他儿童晚0.5年获得诊断，而那些儿科医生将其转介给专家的儿童则早0.3年获得诊断。这些发现表明，随着时间的推移，ASD儿童，特别是功能较高的儿童，接受诊断的年龄有所改善。它们还表明，农村地区和接近贫困的家庭缺乏资源，以及持续儿科护理和专科转诊的重要性。只有某些ASD相关行为，其中一些不需要满足诊断标准，降低了诊断年龄，这表明继续医生教育的重要性。
Objective. Early diagnosis of children with autism spectrum disorders ( ASD) is critical but often delayed until school age. Few studies have identified factors that may delay diagnosis. This study attempted to identify these factors among a community sample of children with ASD.Methods. Survey data were collected in Pennsylvania from 969 caregivers of children who had ASD and were younger than 21 years regarding their service experiences. Linear regression was used to identify clinical and demographic characteristics associated with age of diagnosis.Results. The average age of diagnosis was 3.1 years for children with autistic disorder, 3.9 years for pervasive developmental disorder not otherwise specified, and 7.2 years for Asperger's disorder. The average age of diagnosis increased 0.2 years for each year of age. Rural children received a diagnosis 0.4 years later than urban children. Near-poor children received a diagnosis 0.9 years later than those with incomes > 100% above the poverty level. Children with severe language deficits received a diagnosis an average of 1.2 years earlier than other children. Hand flapping, toe walking, and sustained odd play were associated with a decrease in the age of diagnosis, whereas oversensitivity to pain and hearing impairment were associated with an increase. Children who had 4 or more primary care physicians before diagnosis received a diagnosis 0.5 years later than other children, whereas those whose pediatricians referred them to a specialist received a diagnosis 0.3 years sooner.Conclusion. These findings suggest improvements over time in decreasing the age at which children with ASD, especially higher functioning children, receive a diagnosis. They also suggest a lack of resources in rural areas and for near-poor families and the importance of continuous pediatric care and specialty referrals. That only certain ASD-related behaviors, some of which are not required to satisfy diagnostic criteria, decreased the age of diagnosis suggests the importance of continued physician education.