Factors Influencing Age of Diagnosis with Autism Spectrum Disorder: Implications for Equity in the Diagnostic Process

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Abstract

Early identification of Autism Spectrum Disorder (ASD) is associated with positive outcomes, including increased social communication skills. Previous research suggests that geographic location and socioeconomic status (SES) may influence age of ASD diagnosis. More recently, the effect of diagnostic overshadowing has been considered, namely that the presence of other, co-occurring conditions may delay an ASD diagnosis. To date, no study has examined the combined influence of multiple co-occurring conditions in the context of environmental and demographic variables to determine which factors capture unique variance in the age of ASD diagnosis. The current study examined the influence of system-level, parent demographic, and child demographic factors on parent-reported age of ASD diagnosis in a sample of 304 children, aged 6-17 (M = 11.6, SD = 3.7). The average age of ASD diagnosis was 67.75 months, or about five and half years old. A multiple linear regression revealed an earlier age of ASD diagnosis for children from higher socioeconomic backgrounds (β = -6.39, SE = 2.73, p =.019), as well as those who received more developmental services (β = -15.18, p <.001). A later age of ASD diagnosis was found for children living in the Midwest of the United States (β = 15.87, SE = 7.05, p =.024) as well as for children with co-occurring diagnoses of anxiety (β = 9.91, SE = 4.15, p =.017), a mood disorder (β = 12.45, SE = 5.80, p =.032), or Disruptive Mood Dysregulation Disorder (DMDD; β = 31.30, SE = 9.93, p =.002).The average age of ASD diagnosis obtained in the sample is over three years later than when autism can be reliably diagnosed (Lord et al., 2006). This discrepancy is an affront to social justice because access to services and receipt of their benefits are contingent on early identification. Findings replicate literature highlighting the importance of addressing service disparities by geographic region and SES. The novel contribution is the role of several mood and anxiety disorders in delaying ASD diagnosis. This suggests the need for more targeted efforts in the Midwest and low-SES areas to increase ASD awareness and access to services, as well as additional provider training in identifying and conceptualizing ASD in the context of anxiety and mood symptoms.

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