Determinants of an autism spectrum disorder diagnosis in childhood and adolescence: Evidence from the UK Millennium Cohort Study.
Determinants of an autism spectrum disorder diagnosis in childhood and adolescence: Evidence from the UK Millennium Cohort Study.
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DOI：
10.1177/1362361320913671
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发表时间：
2020-08
期刊：
影响因子：
--
通讯作者：
Cable N
中科院分区：
文献类型：
--
作者：
Hosozawa M;Sacker A;Mandy W;Midouhas E;Flouri E;Cable N
这项研究旨在确定晚期自闭症谱系障碍诊断的决定因素，包括“非常晚”的诊断（即，在青春期），使用千年队列研究，在英国全国代表性的人口为基础的队列。14岁时被诊断为自闭症谱系障碍的儿童（N = 581）被纳入并按父母报告的诊断时间分组：上学前（最多5岁），小学期间（5-11岁）和中学期间（11-14岁）。诊断时间的预测，在儿童，家庭和学校的水平，进行了调查，使用多项逻辑回归。大多数（79%）自闭症谱系障碍儿童在入学后被诊断出来，28%直到中学才被诊断出来。在那些直到中学才被诊断出来的儿童中，75%的儿童在5岁时被父母和/或老师确定为有社会行为困难。入学后被诊断为贫困（校正的相对风险比：小学= 1.90，95%置信区间：1.03-3.53;中学= 2.15，1.05-4.42）和/或没有最初的父母的关注（小学= 0.32，0.15-0.70;中学= 0.19，0.09-0.43）。具有典型范围的智力也可以预测中学期间的诊断。结果表明，那些没有认知延迟和贫穷的儿童有“很晚”（即青少年）诊断的风险。促进早期识别的战略，针对小学入学年龄，可以帮助那些更有可能被诊断晚。 尽管政策强调早期识别，但许多患有自闭症谱系障碍的儿童很晚才被诊断出来，有些人甚至在青春期才被诊断出来。然而，缺乏证据表明是什么决定了自闭症谱系障碍诊断的时间，包括青春期诊断的儿童。了解这些决定因素，特别是在那些诊断晚于理想的情况下，可以为制定有效的策略提供信息，以改善自闭症谱系障碍的早期识别。这项研究使用了一个在英国具有全国代表性的基于人群的队列，以探索儿童，家庭和学校水平的自闭症谱系障碍诊断时间的预测因素。在英国，79%的自闭症谱系障碍儿童在进入小学后被诊断出来，28%在中学期间被诊断出来。在那些直到中学才被诊断出来的孩子中，75%的人在5岁时就表现出了被父母和/或老师注意到的社交困难。研究结果表明，医疗保健提供者应该意识到，即使是在普遍的医疗保健系统中，那些生活在贫困中且智力较高的人也最有可能错过及时的诊断。促进学龄儿童早期诊断的战略，包括以小学入学年龄（即5岁左右）为目标，并鼓励在第一次报告时转诊接受正式评估，以了解对儿童社会发展的关切，这可能会使那些本来会在以后得到诊断的儿童受益。
This study aimed to identify determinants of a late autism spectrum disorder diagnosis, including diagnoses made ‘very late’ (i.e., in adolescence), using the Millennium Cohort Study, a nationally representative population-based cohort in the United Kingdom. Children diagnosed with autism spectrum disorder by age 14 (N = 581) were included and grouped by the parent-reported timing of diagnosis: before school (up to age 5), during primary school (age 5–11) and during secondary school (age 11–14). Predictors of diagnostic timing, at the child, family and school levels, were investigated using multinomial logistic regression. Most (79%) children with autism spectrum disorder were diagnosed after school entry, and 28% were not diagnosed until secondary school. Among those not diagnosed until secondary school, 75% had been identified at age 5 years by a parent and/or teacher as having socio-behavioural difficulties. Being diagnosed after starting school was predicted by living in poverty (adjusted relative risk ratio: primary = 1.90, 95% confidence interval: 1.03–3.53; secondary = 2.15, 1.05–4.42) and/or having no initial parental concerns (primary = 0.32, 0.15–0.70; secondary = 0.19, 0.09–0.43). Having typical-range intelligence also predicted diagnosis during secondary school. The result indicates that those without cognitive delays and poorer children were at risk of ‘very late’ (i.e. adolescent) diagnosis. Strategies to promote earlier identification, targeting age at primary school entry, could help those more likely to be diagnosed late. Lay abstract Despite policy emphasis on early identification, many children with autism spectrum disorder are diagnosed late, with some being diagnosed as late as in adolescence. However, evidence on what determines the timing of autism spectrum disorder diagnosis including children diagnosed in adolescence is lacking. Understanding these determinants, particularly in those diagnosed later than is ideal, can inform the development of effective strategies to improve earlier identification of autism spectrum disorder. This study used a nationally representative population-based cohort in the United Kingdom to explore child, family and school level predictors of timing of autism spectrum disorder diagnosis. In the United Kingdom, 79% of the children with autism spectrum disorder were diagnosed after entering primary school and 28% during secondary school. Among those not diagnosed until secondary school, 75% had shown social difficulties noticed by parents and/or teachers at age 5 years. The results suggest that healthcare providers should be aware that, even for universal systems of care, those living in poverty and having higher intelligence are most likely to miss out on a timely diagnosis. Strategies to promote earlier identification among school-aged children, including targeting primary school entry age (i.e. around age 5) and that encouraging referrals for a formal assessment at the first report of concerns over the child’s social development may benefit those children who would otherwise be diagnosed later.
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影响因子：
7.6
作者：
Mandy, William;Pellicano, Liz;Heron, Jon
通讯作者：
Heron, Jon
影响因子：
3.9
作者：
Hull, Laura;Petrides, K. V.;Mandy, William
通讯作者：
Mandy, William
影响因子：
8.2
作者：
Livingston LA;Happé F
通讯作者：
Happé F
DOI：
10.1111/j.1469-7610.2012.02607.x
发表时间：
2013-02
期刊：
Journal of child psychology and psychiatry, and allied disciplines
影响因子：
--
作者：
Corsello CM;Akshoomoff N;Stahmer AC
通讯作者：
Stahmer AC
影响因子：
8
作者：
Mandell, DS;Novak, MM;Zubritsky, CD
通讯作者：
Zubritsky, CD