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Smith JV, McQuaid GA, Wallace GL, Neuhaus E, Lopez A, Ratto AB, Jack A, Khuu A, Webb SJ, Verbalis A, Pelphrey KA, Kenworthy L. Time is of the essence: Age at autism diagnosis, sex assigned at birth, and psychopathology. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024:13623613241249878. [PMID: 38725306 DOI: 10.1177/13623613241249878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
LAY ABSTRACT Previous research has shown that girls/women are diagnosed later than boys/men with autism. Individuals who are diagnosed later in life, especially girls/women, have greater anxious and depressive symptoms. Previous research has been limited due to narrow inclusionary criteria for enrollment in studies. The present study uses two samples-one clinic-based, large "real-world" sample and another research-based sample with strict criteria for autism diagnosis-to understand the relationships between diagnostic age, sex assigned at birth, and symptoms of anxiety/depression. In both samples, those who were diagnosed later had greater anxious/depressive symptoms, and anxiety was not predicted by sex. In the clinic-based but not research-based sample, those assigned female at birth were diagnosed later than those assigned male at birth. In the clinic-based sample only, individuals assigned female at birth and who were later diagnosed experienced greater symptoms of anxiety/depression compared to those assigned male who benefited from earlier diagnostic timing. Within the research-based sample, those assigned female at birth had greater depressive symptoms than those assigned male. These findings highlight the importance of timely identification of autism, especially for girls/women who are often diagnosed later. Community-based samples are needed to better understand real-world sex-based and diagnostic age-based disparities in mental health.
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Affiliation(s)
- Jessica V Smith
- Children's Research Institute, Children's National Hospital, USA
| | | | - Gregory L Wallace
- Department of Speech, Language, and Hearing Sciences, The George Washington University, USA
| | - Emily Neuhaus
- Center on Child Health, Behavior, and Development, Seattle Children's Research Institute, USA
| | - Andrea Lopez
- Children's Research Institute, Children's National Hospital, USA
| | - Allison B Ratto
- Children's Research Institute, Children's National Hospital, USA
| | - Allison Jack
- Department of Psychology, George Mason University, USA
| | - Alexis Khuu
- Children's Research Institute, Children's National Hospital, USA
| | - Sara J Webb
- Center on Child Health, Behavior, and Development, Seattle Children's Research Institute, USA
| | - Alyssa Verbalis
- Children's Research Institute, Children's National Hospital, USA
| | | | - Lauren Kenworthy
- Children's Research Institute, Children's National Hospital, USA
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2
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Mishra A. A Randomized Controlled Trial Comparing Face-to-Face Versus Remote Delivery of Low-Tech Augmentative and Alternative Communication in Nonspeaking Children With Autism Spectrum Disorder. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2024; 67:1478-1489. [PMID: 38502053 DOI: 10.1044/2024_jslhr-23-00390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Abstract
PURPOSE Thirty percent of children diagnosed with autism spectrum disorder (ASD) do not develop spoken language. To provide a means of communication for this subset of the population, augmentative and alternative communication (AAC) systems are often utilized. Low-tech options have traditionally been delivered through the in-person modality. However, due to the COVID-19 pandemic, changes to service delivery models have been required. This randomized controlled trial was conducted in order to assess the efficacy of low-tech AAC delivered face-to-face versus remotely on communication outcomes in nonspeaking children with ASD. CONCLUSIONS Both participant groups demonstrated similar gains in AAC proficiency, number and type of nonspeaking acts, and number of spoken communication acts. Remote delivery of low-tech AAC treatment is a viable alternative to face-to-face instruction.
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Affiliation(s)
- Avinash Mishra
- Department of Communication Disorders, Sacred Heart University, Fairfield, CT
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3
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Knott R, Mellahn OJ, Tiego J, Kallady K, Brown LE, Coghill D, Williams K, Bellgrove MA, Johnson BP. Age at diagnosis and diagnostic delay across attention-deficit hyperactivity and autism spectrums. Aust N Z J Psychiatry 2024; 58:142-151. [PMID: 37885260 PMCID: PMC10838471 DOI: 10.1177/00048674231206997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
BACKGROUND Despite the known benefits of accurate and timely diagnosis for children with attention-deficit hyperactivity disorder and autism spectrum disorders (autism), for some children this goal is not always achieved. Existing research has explored diagnostic delay for autism and attention-deficit hyperactivity disorder only, and when attention-deficit hyperactivity disorder and autism co-occur, autism has been the focus. No study has directly compared age at diagnosis and diagnostic delay for males and females across attention-deficit hyperactivity disorder, autism and specifically, attention-deficit hyperactivity disorder + autism. METHODS Australian caregivers (N = 677) of children with attention-deficit hyperactivity disorder, autism or attention-deficit hyperactivity disorder + autism were recruited via social media (n = 594) and the Monash Autism and ADHD Genetics and Neurodevelopment Project (n = 83). Caregivers reported on their child's diagnostic process. Diagnostic delay was the mean difference between general initial developmental concerns and the child's attention-deficit hyperactivity disorder and autism diagnosis. RESULTS Children with autism were significantly younger at autism diagnosis than the attention-deficit hyperactivity disorder + autism group (ηp2 = 0.06), whereas children with attention-deficit hyperactivity disorder were significantly older at attention-deficit hyperactivity disorder diagnosis than the attention-deficit hyperactivity disorder + autism group (ηp2 = 0.01). Delay to attention-deficit hyperactivity disorder and autism diagnosis was significantly longer in the attention-deficit hyperactivity disorder + autism group compared to attention-deficit hyperactivity disorder (ηp2 = 0.02) and autism (η2 = 0.04) only. Delay to autism diagnosis for females with autism (η2 = 0.06) and attention-deficit hyperactivity disorder + autism (η2 = 0.04) was longer compared to males. CONCLUSIONS Having attention-deficit hyperactivity disorder + autism and being female were associated with longer delays to diagnosis. The reasons for these delays and possible adverse effects on outcomes require further study.
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Affiliation(s)
- Rachael Knott
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, VIC, Australia
| | - Olivia J Mellahn
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, VIC, Australia
| | - Jeggan Tiego
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, VIC, Australia
| | - Kathryn Kallady
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, VIC, Australia
| | - Louise E Brown
- School of Nursing, Midwifery and Paramedicine, Curtin University, Bentley, WA, Australia
| | - David Coghill
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, VIC, Australia
- Department of Mental Health, The Royal Children's Hospital, Parkville, VIC, Australia
- Neurodevelopment and Disability Research, Murdoch Children's Research Institute, The Royal Children's Hospital, Parkville, VIC, Australia
| | - Katrina Williams
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, VIC, Australia
- Neurodevelopment and Disability Research, Murdoch Children's Research Institute, The Royal Children's Hospital, Parkville, VIC, Australia
- Department of Developmental Paediatrics, Monash Children's Hospital, Clayton, VIC, Australia
- Department of Paediatrics, Monash University, Monash Children's Hospital, Clayton, VIC, Australia
| | - Mark A Bellgrove
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, VIC, Australia
| | - Beth P Johnson
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, VIC, Australia
- Department of Paediatrics, Monash University, Monash Children's Hospital, Clayton, VIC, Australia
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Lai MC, Amestoy A, Bishop S, Brown HM, Giwa Onaiwu M, Halladay A, Harrop C, Hotez E, Huerta M, Kelly A, Miller D, Nordahl CW, Ratto AB, Saulnier C, Siper PM, Sohl K, Zwaigenbaum L, Goldman S. Improving autism identification and support for individuals assigned female at birth: clinical suggestions and research priorities. THE LANCET. CHILD & ADOLESCENT HEALTH 2023; 7:897-908. [PMID: 37973254 DOI: 10.1016/s2352-4642(23)00221-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 08/11/2023] [Accepted: 08/11/2023] [Indexed: 11/19/2023]
Abstract
Emerging evidence suggests that the higher prevalence of autism in individuals who are assigned male than assigned female at birth results from both biological factors and identification biases. Autistic individuals who are assigned female at birth (AFAB) and those who are gender diverse experience health disparities and clinical inequity, including late or missed diagnosis and inadequate support. In this Viewpoint, an international panel of clinicians, scientists, and community members with lived experiences of autism reviewed the challenges in identifying autism in individuals who are AFAB and proposed clinical and research directions to promote the health, development, and wellbeing of autistic AFAB individuals. The recognition challenges stem from the interplay between cognitive differences and nuanced or different presentations of autism in some AFAB individuals; expectancy, gender-related, and autism-related biases held by clinicians; and social determinants. We recommend that professional development for clinicians be supported by health-care systems, professional societies, and governing bodies to improve equitable access to assessment and earlier identification of autism in AFAB individuals. Autistic AFAB individuals should receive tailored support in education, identity development, health care, and social and professional sense of belonging.
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Affiliation(s)
- Meng-Chuan Lai
- Child and Youth Mental Health Collaborative at the Centre for Addiction and Mental Health and The Hospital for Sick Children, Toronto, ON, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, ON, Canada; Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, UK; Department of Psychiatry, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
| | - Anouck Amestoy
- Centre for Autism Spectrum Disorders, Aquitaine Institute for Cognitive and Integrative Neurosciences, Charles Perrens Hospital, University of Bordeaux, Bordeaux, France
| | - Somer Bishop
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Heather M Brown
- Faculty of Education, University of Alberta, Edmonton, AB, Canada
| | - Morénike Giwa Onaiwu
- Autistic Women & Nonbinary Network, Lincoln, NE, USA; Rice University Center for the Study of Women, Gender, and Sexuality, School of Humanities, Houston, TX, USA
| | - Alycia Halladay
- Autism Science Foundation, Scarsdale, NY, USA; Department of Pharmacology and Toxicology, Rutgers University, Piscataway, NJ, USA
| | - Clare Harrop
- Department of Health Sciences and TEACCH Autism Program, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Emily Hotez
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Marisela Huerta
- Felicity House, New York, NY, USA; Weill Cornell Medicine, New York, NY, USA
| | - Amy Kelly
- Devereux Advanced Behavioral Health, Villanova, PA, USA
| | - Dylan Miller
- Auxiliary Enterprises, University of Massachusetts, Amherst, MA, USA
| | - Christine Wu Nordahl
- Department of Psychiatry and Behavioral Sciences and MIND Institute, University of California at Davis, Davis, CA, USA
| | - Allison B Ratto
- Center for Autism Spectrum Disorders, Division of Neuropsychology, Children's National Hospital, Washington, DC, USA
| | - Celine Saulnier
- Neurodevelopmental Assessment and Consulting Services, Decatur, GA, USA
| | - Paige M Siper
- Seaver Autism Center for Research and Treatment, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kristin Sohl
- ECHO Autism Communities, Department of Child Health, University of Missouri School of Medicine, Columbia, MO, USA
| | | | - Sylvie Goldman
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA.
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Sunagawa M. How much of my true self can i show? social adaptation in autistic women: a qualitative study. BMC Psychol 2023; 11:144. [PMID: 37138313 PMCID: PMC10155366 DOI: 10.1186/s40359-023-01192-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 04/26/2023] [Indexed: 05/05/2023] Open
Abstract
BACKGROUND Social adaptation is often aimed at supporting autistic people, yet its specific goals may not include their actual perspectives. That is, the state of adaptation is judged based on the standards and values of non-autistic people. This qualitative study focused on autistic women's perceptions of social adaptation and examined their lived experiences in daily life, as adaptive behaviors have often been reported as a "female autism phenotype." METHODS Semi-structured interviews were conducted face-to-face with ten autistic women aged 28-50 years (M = 36.7; standard SD = 7.66). The analysis was conducted based on the grounded theory approach. RESULTS Two core perceptions were identified: maintaining stable relationships and fulfilling social roles based on past experiences of "maladaptation." The participants sought adaptations within a reasonable range and adjusted their balance with society to maintain stability in their daily lives. CONCLUSION The findings indicated that autistic women's perceptions of adaptation were based on the accumulation of past negative experiences. Further harmful efforts should be prevented. Support for autistic people to make their own choices in life is also important. Moreover, autistic women need a place where they can be themselves and be accepted as they are. This study showed the importance of changing the environment rather than modifying autistic people to adapt to a society.
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Affiliation(s)
- Mebuki Sunagawa
- Department of Psychology, Ochanomizu University, 2-1-1 Otsuka, Bunkyo-ku, Tokyo, 112- 8610, Japan.
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Bölte S, Neufeld J, Marschik PB, Williams ZJ, Gallagher L, Lai MC. Sex and gender in neurodevelopmental conditions. Nat Rev Neurol 2023; 19:136-159. [PMID: 36747038 PMCID: PMC10154737 DOI: 10.1038/s41582-023-00774-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2023] [Indexed: 02/08/2023]
Abstract
Health-related conditions often differ qualitatively or quantitatively between individuals of different birth-assigned sexes and gender identities, and/or with different gendered experiences, requiring tailored care. Studying the moderating and mediating effects of sex-related and gender-related factors on impairment, disability, wellbeing and health is of paramount importance especially for neurodivergent individuals, who are diagnosed with neurodevelopmental conditions with uneven sex/gender distributions. Researchers have become aware of the myriad influences that sex-related and gender-related variables have on the manifestations of neurodevelopmental conditions, and contemporary work has begun to investigate the mechanisms through which these effects are mediated. Here we describe topical concepts of sex and gender science, summarize current knowledge, and discuss research and clinical challenges related to autism, attention-deficit/hyperactivity disorder and other neurodevelopmental conditions. We consider sex and gender in the context of epidemiology, behavioural phenotypes, neurobiology, genetics, endocrinology and neighbouring disciplines. The available evidence supports the view that sex and gender are important contributors to the biological and behavioural variability in neurodevelopmental conditions. Methodological caveats such as frequent conflation of sex and gender constructs, inappropriate measurement of these constructs and under-representation of specific demographic groups (for example, female and gender minority individuals and people with intellectual disabilities) limit the translational potential of research so far. Future research and clinical implementation should integrate sex and gender into next-generation diagnostics, mechanistic investigations and support practices.
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Affiliation(s)
- Sven Bölte
- Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research; Department of Women's and Children's Health, Karolinska Institutet & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden.
- Child and Adolescent Psychiatry, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden.
- Curtin Autism Research Group, Curtin School of Allied Health, Curtin University, Perth, WA, Australia.
| | - Janina Neufeld
- Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research; Department of Women's and Children's Health, Karolinska Institutet & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
- Swedish Collegium for Advanced Study (SCAS), Uppsala, Sweden
| | - Peter B Marschik
- Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research; Department of Women's and Children's Health, Karolinska Institutet & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Center Göttingen and Leibniz ScienceCampus Primate Cognition, Göttingen, Germany
- iDN - interdisciplinary Developmental Neuroscience, Division of Phoniatrics, Medical University of Graz, Graz, Austria
| | - Zachary J Williams
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
- Vanderbilt Brain Institute, Vanderbilt University, Nashville, TN, USA
- Frist Center for Autism and Innovation, Vanderbilt University, Nashville, TN, USA
| | - Louise Gallagher
- Department of Psychiatry, School of Medicine, Trinity College Dublin, Dublin, Ireland
- Child and Youth Mental Health Collaborative at the Centre for Addiction and Mental Health, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, and Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Meng-Chuan Lai
- Child and Youth Mental Health Collaborative at the Centre for Addiction and Mental Health, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, and Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, UK.
- Department of Psychiatry, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan.
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7
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Ratto AB, Bascom J, daVanport S, Strang JF, Anthony LG, Verbalis A, Pugliese C, Nadwodny N, Brown LX, Cruz M, Hector BL, Kapp SK, Giwa Onaiwu M, Raymaker DM, Robison JE, Stewart C, Stone R, Whetsell E, Pelphrey K, Kenworthy L. Centering the Inner Experience of Autism: Development of the Self-Assessment of Autistic Traits. AUTISM IN ADULTHOOD 2023; 5:93-105. [PMID: 36941856 PMCID: PMC10024271 DOI: 10.1089/aut.2021.0099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Current tools for identifying autism are critiqued for their lack of specificity and sensitivity, especially in autistic people who are older, have higher verbal ability or significant compensatory skills, and are not cisgender boys. This may reflect the following: the historical focus of autism research on White (cisgender) male, upper and middle class children; limited interest in the inner, lived experience of autism; and the predominance of a deficit-based model of autism. We report here on the first attempt of which we are aware to develop a clinical self-report measure of autistic traits as described by autistic people. We believe this is an advance in methodology because prior work in the development of autistic trait/diagnostic measures has prioritized the perspectives of nonautistic clinicians and scientists. The measure was developed under the leadership of two autistic researchers and constructed by leveraging descriptions of autism by autistic people to generate items designed to encompass the range of the autistic experience, using strength-based, accessible language. The team utilized iterative feedback from a panel of autistic experts to refine and enhance the measure, called the Self Assessment of Autistic Traits (SAAT). It is intended for people 16 years or older and uses a format that is designed to increase its accessibility and acceptability for autistic respondents. Future work will report on the preliminary psychometrics of the SAAT, with a long-term goal of advancing our understanding of the inner autistic experience and enhancing the clinical and scientific assessment of autism.
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Affiliation(s)
- Allison B. Ratto
- Center for Autism Spectrum Disorders, Division of Neuropsychology, Children's National Hospital, Washington, DC, USA
| | - Julia Bascom
- Autistic Self Advocacy Network, Washington, DC, USA
| | | | - John F. Strang
- Gender and Autism Program, Children's National Hospital, Washington, DC, USA
| | - Laura G. Anthony
- Department of Psychiatry, University of Colorado School of Medicine, Anschutz Medical Campus, Denver, CO, USA
| | - Alyssa Verbalis
- Center for Autism Spectrum Disorders, Division of Neuropsychology, Children's National Hospital, Washington, DC, USA
| | - Cara Pugliese
- Center for Autism Spectrum Disorders, Division of Neuropsychology, Children's National Hospital, Washington, DC, USA
| | - Nicole Nadwodny
- Department of Developmental Medicine, Boston Children's Hospital, Brookline, MA, USA
| | - Lydia X.Z. Brown
- Department of Disability Studies and Women's and Gender Studies, Georgetown University, Washington, DC, USA
| | - Mallory Cruz
- Private Consultant, Hitachiomiya, Ibaraki, Japan
| | | | - Steven K. Kapp
- Department of Psychology, University of Portsmouth, Portsmouth, UK
| | - Morénike Giwa Onaiwu
- Center for the Study of Women, Gender, and Sexuality, Rice University, & Autistic Women & Nonbinary Network, Houston, TX, USA
| | - Dora M. Raymaker
- School of Social Work, Portland State University, Portland, OR, USA
| | - John Elder Robison
- Neurodiversity Working Group, The College of William and Mary, Williamsburg, VA, USA
| | | | - Ren Stone
- Autistic Women & Nonbinary Network, Washington, DC, USA
| | | | - Kevin Pelphrey
- Department of Neurology, University of Virginia, Charlottesville, VA, USA
| | - Lauren Kenworthy
- Center for Autism Spectrum Disorders, Division of Neuropsychology, Children's National Hospital, Washington, DC, USA
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Boulton KA, Hodge MA, Jewell A, Ong N, Silove N, Guastella AJ. Diagnostic delay in children with neurodevelopmental conditions attending a publicly funded developmental assessment service: findings from the Sydney Child Neurodevelopment Research Registry. BMJ Open 2023; 13:e069500. [PMID: 36725093 PMCID: PMC9896183 DOI: 10.1136/bmjopen-2022-069500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVES Early developmental assessment is crucial for effective support and intervention. This study examined factors that contribute to (a) older child age when caregivers first became concerned about their child's development and (b) older child age at the point of entry into developmental and diagnostic assessment. We also quantified how factors contributed to risk of children not receiving an assessment by 5 years and considered the acceptability of electronic data capture for families. DESIGN This cross-sectional study collected information about caregiver developmental concerns, family history and child characteristics. SETTING Children and families entered a large, publicly funded hospital-based paediatric developmental assessment service. PARTICIPANTS Consecutively enrolled children (N=916) aged 6 months to 17 years with neurodevelopmental concerns and their caregivers. MAIN OUTCOMES AND MEASURES A developmental history questionnaire completed by caregivers. RESULTS The average age that caregivers identified developmental concerns was 3.0 years of age but the average age of a receiving a developmental assessment was 6.6 years. Only 46.4% of children received a diagnostic assessment by 5 years of age, even though 88.0% of caregivers were concerned about their child's development by that age. Parental age, relationship status, education level, prior use of support services and being from a culturally and linguistically diverse background contributed to age at identification of concern, age at diagnostic assessment and the likelihood of receiving a diagnostic assessment by 5 years. Electronic data capture had high acceptability, with 88.2% of caregivers reporting a preference for electronic completion of questionnaires. CONCLUSIONS The study shows a substantial delay in diagnostic assessments that leaves most vulnerable children without an assessment by school age and highlights contributors to delays. These delays highlight the complexity of delivering early intervention and support policies that rely on swift and appropriate developmental assessment to vulnerable families.
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Affiliation(s)
- Kelsie A Boulton
- Clinic for Autism and Neurodevelopment (CAN) research, Brain and Mind Centre, Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Child Neurodevelopment and Mental Health Team, Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Marie-Antoinette Hodge
- Child Neurodevelopment and Mental Health Team, Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
- Child Development Unit, Children's Hospital at Westmead, Sydney Children's Hospital Network, Westmead, New South Wales, Australia
| | - Ailsa Jewell
- Clinic for Autism and Neurodevelopment (CAN) research, Brain and Mind Centre, Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Natalie Ong
- Child Development Unit, Children's Hospital at Westmead, Sydney Children's Hospital Network, Westmead, New South Wales, Australia
| | - Natalie Silove
- Child Neurodevelopment and Mental Health Team, Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
- Child Development Unit, Children's Hospital at Westmead, Sydney Children's Hospital Network, Westmead, New South Wales, Australia
| | - Adam J Guastella
- Clinic for Autism and Neurodevelopment (CAN) research, Brain and Mind Centre, Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Child Neurodevelopment and Mental Health Team, Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
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9
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Saure E, Castrén M, Mikkola K, Salmi J. Intellectual disabilities moderate sex/gender differences in autism spectrum disorder: a systematic review and meta-analysis. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2023; 67:1-34. [PMID: 36444668 DOI: 10.1111/jir.12989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 10/19/2022] [Accepted: 10/19/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Girls/women with autism spectrum disorder (ASD) are suggested to exhibit different symptom profiles than boys/men with ASD. Accumulating evidence suggests that intellectual disability (ID) may affect sex/gender differences in ASD. However, a systematic review and meta-analysis on this topic is missing. METHODS Two databases (MEDLINE and PsycINFO) were used to search for studies reporting sex/gender differences (girls/women versus boys/men) in social communication and interaction, restrictive and repetitive behaviour and interests (RRBIs), sensory processing, and linguistic and motor abilities in ASD. The final sample consisted of 79 studies. The meta-analysis was performed with Review Manager using a random-effects model. Participants with ASD without and with ID were analysed as separate subgroups, and the effects in these two subgroups were also compared with each other. RESULTS Girls/women with ASD without ID displayed fewer RRBIs, more sensory symptoms and less problems in linguistic abilities than their boys/men counterparts. In contrast, girls/women with ASD with ID displayed more social difficulties and RRBIs, poorer linguistic abilities and more motor problems than boys/men with ASD with ID. Comparisons of groups of participants with ASD without ID versus participants with ASD with ID confirmed differences in sex/gender effects on social difficulties, sensory processing, linguistic abilities and motor abilities. CONCLUSIONS Our results clearly suggest that the female phenotype of ASD is moderated by ID. Among individuals with ASD with ID, girls/women seem to be more severely affected than boys/men, whereas among individuals with ASD without ID, girls/women with ASD may have less symptoms than boys/men. Such phenotypic differences could be a potential cause of underrecognition of girls/women with ASD, and it is also possible that observed phenotypic differences may reflect underdiagnosing of girls/women with ASD.
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Affiliation(s)
- E Saure
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- BABA Center and Department of Clinical Neurophysiology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - M Castrén
- Department of Physiology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - K Mikkola
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - J Salmi
- Department of Neuroscience and Biomedical Engineering, Aalto University, Espoo, Finland
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10
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Ji Y, Ji Y, Zhu HL, Cheng SM, Zou XB, Zhu FL. Examine sex differences in autism spectrum disorder in school-aged children and adolescents with fluent language. Front Psychiatry 2023; 14:1151596. [PMID: 37091718 PMCID: PMC10117662 DOI: 10.3389/fpsyt.2023.1151596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 03/13/2023] [Indexed: 04/25/2023] Open
Abstract
There are noteworthy sex disparities in the prevalence of autism spectrum disorders (ASD), while findings regarding the sex differences in core symptoms are inconsistent. There are few relevant studies on sex differences in mainland China. This study was dedicated to a deeper understanding of the impact of sex differences on the clinical presentation of ASD with fluent language. We retrospectively studied 301 children with ASD (58 females) and utilized raw scores from the ADI-R and ADOS and the intelligence quotient (IQ) to measure symptomatology. Based on the Full-Scale IQ (FS-IQ), a binary split of average, above-average IQ (high-IQ), and below-average IQ (low IQ) occurs at 85. Across the entire sample, males and females are comparable in the FS-IQ, while males scored higher in the Perceptual Reasoning Index (PRI) (F = 7.812, p = 0.006). ADI-R did not find any statistically significant sex differences in the diagnostic cutoff score satisfaction or the raw domain scores. While a significant effect of sex on ADOS social affect domain scores was found in the total sample [λ = 0.970, partial η2 = 0.030, F (3,295) = 3.019, p = 0.030]. Tests of between-subjects effects revealed that males scored higher than females mainly in the ADOS reciprocal social interaction subcategory (partial η2 = 0.022, F = 6.563, p = 0.011). Stratified analysis revealed that the effect of sex on ADOS reciprocal social interaction subcategory scores only significant in the low-IQ children with ASD (partial η2 = 0.092, F = 10.088, p = 0.002). In general, overall cognitive functioning is similar across males and females with ASD, while males have a higher perceptual reasoning ability. Females with ASD are more likely to have comorbid intellectual impairment than males, and they could require additional intervention support. Autistic children with low IQs are more likely to exhibit sex differences in their core symptoms than children with high IQs. Intelligence plays a key role in sex-based differences in the core symptoms of ASD.
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Williams EDG, Smith MJ, Sherwood K, Lovelace TS, Bishop L. Brief Report: Initial Evidence of Depressive Symptom Disparities among Black and White Transition Age Autistic Youth. J Autism Dev Disord 2021; 52:3740-3745. [PMID: 34417653 PMCID: PMC8858325 DOI: 10.1007/s10803-021-05242-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2021] [Indexed: 11/28/2022]
Affiliation(s)
| | - Matthew J Smith
- School of Social Work, University of Michigan, Ann Arbor, MI, USA
| | - Kari Sherwood
- School of Social Work, University of Michigan, Ann Arbor, MI, USA.,Department of Psychology, University of Michigan, Ann Arbor, MI, USA
| | - Temple S Lovelace
- Department of Counseling, Psychology, and Special Education, Duquesne University, Pittsburgh, PA, USA
| | - Lauren Bishop
- Waisman Center, University of Wisconsin, Madison, WI, USA.,Sandra Rosenbaum School of Social Work, University of Wisconsin, Madison, WI, USA
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