Early Diagnoses of Autism Spectrum Disorders in Massachusetts Birth Cohorts, 2001–2005

28 Jun

More kids are being diagnosed autistic before age 3, at least if data from Massachusetts are generalizable. Early Diagnoses of Autism Spectrum Disorders in Massachusetts Birth Cohorts, 2001–2005 is a study in the journal Pediatrics. Of course the question will be posed: is this due to a shift to earlier ages of diagnosis, a true increase in the number of autistic children or a combination of the two.

Here is the abstract:

OBJECTIVE: We examined trends in autism spectrum disorder diagnoses by age 36 months (early diagnoses) and identified characteristics associated with early diagnoses.

METHODS: Massachusetts birth certificate and early-intervention program data were linked to identify infants born between 2001 and 2005 who were enrolled in early intervention and receiving autism-related services before age 36 months (through December 31, 2008). Trends in early autism spectrum disorders were examined using Cochran-Armitage trend tests. ?2 Statistics were used to compare distributions of selected characteristics for children with and without autism spectrum disorders. Multivariate logistic regression analyses were conducted to identify independent predictors of early diagnoses.

RESULTS: A total of 3013 children (77.5 per 10 000 study population births) were enrolled in early intervention for autism spectrum disorder by age 36 months. Autism spectrum disorder incidence increased from 56 per 10 000 infants among the 2001 birth cohort to 93 per 10 000 infants in 2005. Infants of mothers younger than 24 years of age, whose primary language was not English or who were foreign-born had lower odds of an early autism spectrum disorder diagnosis. Maternal age older than 30 years was associated with increased odds of an early autism spectrum disorder diagnosis. Odds of early autism spectrum disorders were 4.5 (95% confidence interval: 4.1–5.0) times higher for boys than girls.

CONCLUSIONS: Early autism spectrum disorder diagnoses are increasing in Massachusetts, reflecting the national trend observed among older children. Linkage of early-intervention program data with population-based vital statistics is valuable for monitoring autism spectrum disorder trends and planning developmental and educational service needs.

There is a lower “risk” for children of younger mothers and for children whose mothers do not use English as a primary language. This is consistent with many studies showing lower prevalence rates amongst disadvantaged groups.

The study above was interesting to me in that another study (which I can’t find as of yet on the Pediatrics website, but is in the news) has come out which shows Many Pediatricians Aren’t Testing Tots for Developmental Delays. According to the news story about the study,

MONDAY, June 27 (HealthDay News) — Although there’s been some improvement in the number of pediatricians checking toddlers for developmental delays, more than half still don’t routinely do so, a new study finds.

In 2002, just 23 percent of pediatricians reported always or almost always using one or more standardized developmental screening tools for infants and toddlers up to 35 months of age. By 2009, that number had risen to just under 48 percent, reported the study.

Pediatricians are doing more formal screening for developmental delays. This should push the average age of diagnoses even lower. But even as recently as 2009, only about half of pediatricians were doing these evaluations.

But, if there is any constant to the world of autism research news, it is that reports conflict. Just a few weeks ago, there was a bunch of stories about another Pediatrics study. For example: Not enough evidence for routine screening for autism, Canadian researchers say

Why not screen for autism routinely? Here’s a section of that story:

He expressed concern about the impact on parents and children if there is a false positive or false negative for autism spectrum disorder. The neurodevelopmental disorder has symptoms that can include differences in social and communication skills, motor skills and sometimes intellectual abilities.

“And with any test there is always a risk that you assume that the test will say you have autism when in fact you don’t have autism.”

Gorter is also quick to say that parents who have any concerns about their child’s functioning should seek help, and “if they do have a diagnosis of autism, to be on the wait list and get the services.”

“If a child is healthy, there are no parental concerns, is then screening better than not screening? That is the question.”

Well, this is one of those questions where I have an opinion. Yes, it is good to screen. I’ve dealt with both false positives and false negatives. Yes, both are difficult (to put it mildly). Leave aside the questions of how important getting early services may be: I think they are valuable. Also, over time I’ve read many accounts of parents being disillusioned by doctors who missed their children’s autism. This is a factor which I believe plays a significant role in much of what goes wrong in the autism parent communities. Pediatricians need to keep the trust of the parents, and early diagnosis is something which can go a long way towards achieving that goal.

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2 Responses to “Early Diagnoses of Autism Spectrum Disorders in Massachusetts Birth Cohorts, 2001–2005”

  1. Liz Ditz June 28, 2011 at 17:20 #

    Also see Jon Brock’s post on early diagnosis and screening, http://crackingtheenigma.blogspot.com/2011/06/screening-for-autism-in-infants-and.html

    Also covers

    Barbaro, J., & Dissanayake, C. (2010). Prospective Identification of Autism Spectrum Disorders in Infancy and Toddlerhood Using Developmental Surveillance: The Social Attention and Communication Study Journal of Developmental & Behavioral Pediatrics, 31 (5), 376-385 DOI: 10.1097/DBP.0b013e3181df7f3c

    Discussion with authors in comments

  2. Laurie June 29, 2011 at 15:43 #

    Many medical professionals contact our office and discuss with us the importance of a parent being fully informed about risks of treatment and alternative treatment once a diagnosis has been made. Parental rights and informed consent is everyone’s basic human right.

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