ABSTRACT

Objective

Early identification of autism spectrum disorder (ASD) is an essential healthcare priority. Girls may be at risk for late diagnosis, although research is equivocal regarding how sex and other factors relate to ASD identification. The goals of the current investigation were to (1) identify how child sex, cognitive abilities, and demographic factors relate to age of first concern (AOC) and age of diagnosis (AOD), (2) evaluate trends in AOC/AOD over time, and (3) consider whether main effects of sex on AOC/AOD are moderated by cognitive abilities or time.

Method

Children (N = 365; 20% female; 85.6% identified as White) with ASD participated through the Province of Ontario Neurodevelopmental Disorders (POND) Network. Study records included AOD, date/timing of diagnosis (between 1996 and 2017), age of first parent concern, demographics, and standardized cognitive testing results (24.7% of children had IQ scores below standard scores of 70).

Results

Average AOC occurred before 2 years of age whereas average AOD occurred after 5 years of age. Girls did not differ on AOC but had a later AOD than boys. Higher verbal IQ was associated with later AOD more strongly in girls than boys. Regarding time-related changes, average AOC and AOD increased across the study period, more strongly for girls.

Conclusions

Results support that sex is a key factor underlying delays in ASD identification and highlight the urgent need to improve diagnostic practices among girls. Limitations and implications for improving the diagnostic process are discussed.

Abbreviations: ASD=autism spectrum disorder; IQ=intelligence quotient; AOC=parental report of age of first concern; AOD=age of diagnosis.

中文翻译：

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自闭症谱系障碍儿童诊断和首要关注年龄的性别差异

摘要

客观的

早期识别自闭症谱系障碍 (ASD) 是一项重要的医疗保健优先事项。女孩可能面临晚期诊断的风险，尽管关于性别和其他因素如何与 ASD 识别相关的研究是模棱两可的。当前调查的目标是 (1) 确定儿童的性别、认知能力和人口统计因素与首要关注年龄 (AOC) 和诊断年龄 (AOD) 之间的关系，(2) 评估 AOC/AOD 随时间推移的趋势, (3) 考虑性别对 AOC/AOD 的主要影响是否受认知能力或时间的调节。

方法

患有 ASD 的儿童（N = 365；20% 为女性；85.6% 为白人）通过安大略省神经发育障碍 (POND) 网络参与。研究记录包括 AOD、诊断日期/时间（1996 年至 2017 年）、第一位父母关注的年龄、人口统计数据和标准化认知测试结果（24.7% 的儿童智商分数低于标准分数 70）。

结果

平均 AOC 发生在 2 岁之前，而平均 AOD 发生在 5 岁之后。女孩在 AOC 上没有区别，但 AOD 比男孩晚。与男孩相比，女孩更高的语言智商与后期 AOD 的相关性更强。关于与时间相关的变化，平均 AOC 和 AOD 在整个研究期间都有所增加，对于女孩来说更为明显。

结论

结果支持性别是导致 ASD 识别延迟的关键因素，并强调迫切需要改善女孩的诊断实践。讨论了改进诊断过程的局限性和影响。

缩写： ASD=自闭症谱系障碍；IQ=智商；AOC=第一关注年龄的父母报告；AOD=诊断年龄。