Socioeconomic Factors and Clinical Characteristics Associated with Age at Autism Spectrum Disorder Diagnosis
DOI:
https://doi.org/10.33192/smj.v76i9.268770Keywords:
Autism Spectrum Disorder, Age at Diagnosis, Early Intervention, Screening, Socioeconomic FactorsAbstract
Objective: Investigate factors influencing autism spectrum disorder (ASD) diagnosis in children under and over 36 months, and determine the average age for ASD diagnosis at Charoenkrung Pracharak Hospital, Bangkok, Thailand, after implementing ASD screening.
Materials and Methods: A retrospective cross-sectional study of 252 children with ASD aged 1-15 years from 2014 to 2023, classified into ≤36 months (n=104) and >36 months (n=148) at diagnosis. Demographic, clinical data and child/family factors were analyzed using multivariate regression analysis.
Results: Mean age at ASD diagnosis was 44.77 ± 19.91 months. Attending well-baby clinics (aOR 2.64, p=0.038), higher family income ≥ 814 US dollars per month (aOR 2.33, p=0.020), and higher parental education (aOR 3.43, p=0.011) were significantly associated with diagnosis before 36 months. Hyperactivity as the main complaint (aOR 0.07, p=0.001) and global developmental delay/intellectual disability (aOR 0.45, p=0.023) predicted later diagnosis. Child’s gender, being an only child, sibling order, and parental age had no significant impact.
Conclusion: Over half of all ASD diagnoses occurred after age 3, with an average age around 44 months. Regular attendance in well-child clinics allowing ASD screening, and higher socioeconomic status and parental education facilitated earlier diagnosis. In contrast, concerns about hyperactivity and global developmental delay often lead to delayed ASD assessment. Enhancing awareness of ASD among families with limited resources can promote timely diagnosis and access to intervention.
References
American Psychiatric Association D-TF. Diagnostic and statistical manual of mental disorders: DSM-5. 5th ed. Washington, DC: American Psychiatric Publishing, 2013.
Maenner MJ, Warren Z, Williams AR, Amoakohene E, Bakian AV, Bilder DA, et al. Prevalence and Characteristics of Autism Spectrum Disorder Among Children Aged 8 Years-Autism and Developmental Disabilities Monitoring Network, 11 sites, United States, 2020. MMWR Surveill Summ. 2023;72(2):1-14.
Asia-Pacific Development Center on Disability. Autism at a Glance in ASEAN Under the Autism Mapping Project in the ASEAN Region: Part II Country Profiles. Bangkok, Thailand: Asia-Pacific Development Center on Disability Foundation; 2020. 428 p.
Buescher AV, Cidav Z, Knapp M, Mandell DS. Costs of autism spectrum disorders in the United Kingdom and the United States. JAMA Pediatr. 2014;168(8):721-8.
Zwaigenbaum L, Brian JA, Ip A. Early detection for autism spectrum disorder in young children. Paediatr Child Health. 2019;24(7):424-32.
Shaw KA, Maenner MJ, Bakian AV, Bilder DB, Durkin MS, Furnier SM, et al. Early identification of autism spectrum disorder among children aged 4 years-Autism and Developmental Disabilities Monitoring Network, 11 sites, United States, 2018. MMWR Surveill Summ. 2021;70(10):1-14.
Chamak B, Bonniau B, Oudaya L, Ehrenberg A. The autism diagnostic experiences of French parents. Autism. 2011;15(1):83-97.
Bhat S, Acharya UR, Adeli H, Bairy GM, Adeli A. Autism: cause factors, early diagnosis and therapies. Rev Neurosci. 2014;25(6):841-50.
Thompson L, Gillberg C, Landberg S, Kantzer AK, Miniscalco C, Barnevik Olsson M, et al. Autism With and Without Regression: A Two-Year Prospective Longitudinal Study in Two Population-Derived Swedish Cohorts. J Autism Dev Disord. 2019;49(6):2281-90.
Rattaz C, Loubersac J, Michelon C, Geoffray MM, Picot MC, Munir K, et al. Factors associated with age of diagnosis in children with autism spectrum disorders: Report from a French cohort. Autism. 2022;26(8):2108-16.
Sicherman N, Loewenstein G, Tavassoli T, Buxbaum JD. Grandma knows best: Family structure and age of diagnosis of autism spectrum disorder. Autism. 2018;22(3):368-76.
Mishaal RA, Ben-Itzchak E, Zachor DA. Age of autism spectrum disorder diagnosis is associated with child’s variables and parental experience. Res Autism Spectr Disord. 2014;8(7):878-80.
Bickel J, Bridgemohan C, Sideridis G, Huntington N. Child and family characteristics associated with age of diagnosis of autism spectrum disorder in a tertiary care setting. J Dev Behav Pediatr. 2015;36(1):1-7.
Hrdlicka M, Vacava M, Oslejskova H, Gondzova V, Vadlejchova I, Kocourkova J. et al.. Age at diagnosis of autism spectrum disorders: is there an association with socioeconomic status and family self-education about autism? Neuropsychiatr Dis Treat. 2016;12:1639-44.
Pickard KE, Ingersoll BR. Quality versus quantity: The role of socioeconomic status on parent-reported service knowledge, service use, unmet service needs, and barriers to service use. Autism. 2016;20(1):106-15.
Teekavanich S, Wannapaschaiyong P. Factors Associated with Age at Diagnosis of Autism Spectrum Disorder in Pediatric Patients at Sawanpracharak Hospital, Thailand. Siriraj Med J. 2023;75(11):778-83.
Chlebowski C, Robins DL, Barton ML, Fein D. Large-scale use of the modified checklist for autism in low-risk toddlers. Pediatrics. 2013;131(4):e1121-7.
Primo PG, Weber C, Posada de la Paz M, Fellinger J, Dirmhirn A, Holzinger D. Explaining Age at Autism Spectrum Diagnosis in Children with Migrant and Non-Migrant Background in Austria. Brain Sci. 2020;10(7):448.
Sheldrick RC, Maye MP, Carter AS. Age at First Identification of Autism Spectrum Disorder: An Analysis of Two US Surveys. J Am Acad Child Adolesc Psychiatry. 2017;56(4):313-20.
Hoch J, Spofford L, Dimian A, Tervo R, MacLean WE, Symons FJ. A Direct Comparison of Self-Injurious and Stereotyped Motor Behavior Between Preschool-Aged Children With and Without Developmental Delays. J Pediatr Psychol. 2016;41(5):566-72.
Miodovnik A, Harstad E, Sideridis G, Huntington N. Timing of the Diagnosis of Attention-Deficit/Hyperactivity Disorder and Autism Spectrum Disorder. Pediatrics. 2015;136(4):e830-7.
Yee MC, Millichap JG. Relationship between Age at Diagnosis of ADHD and ASD. Pediatr Neurol Briefs. 2015;29(10):78.
Published
How to Cite
Issue
Section
Categories
License
Copyright (c) 2024 Siriraj Medical Journal
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Authors who publish with this journal agree to the following conditions:
Copyright Transfer
In submitting a manuscript, the authors acknowledge that the work will become the copyrighted property of Siriraj Medical Journal upon publication.
License
Articles are licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND 4.0). This license allows for the sharing of the work for non-commercial purposes with proper attribution to the authors and the journal. However, it does not permit modifications or the creation of derivative works.
Sharing and Access
Authors are encouraged to share their article on their personal or institutional websites and through other non-commercial platforms. Doing so can increase readership and citations.