Objective: 

Our study evaluates whether having an alternate developmental behavioral disorder (DBDs) diagnosis before diagnosis of autism spectrum disorders (ASD) is associated with delays in diagnosis in a nationally representative sample.

Methods: 

Data were obtained from the 2011 National Survey of Pathways to Diagnosis and Services, a survey of children aged 6 to 17 years with ASD, developmental delay, or intellectual disability. A total of 1049 children met inclusion criteria for this study. Of these, 799 children were identified as “late” diagnosis if >12 months elapsed between the age parents reported concerns to a provider and age of ASD diagnosis and 250 as “timely” diagnosis if the gap was ≤12 months. Univariate and multivariate logistic regressions were used to look for association between having an alternate DBDs diagnosed before ASD and “timely” versus “late” ASD diagnosis.

Results: 

The mean time elapsed between the age parents reported concerns to a provider and age of ASD diagnosis was 51 months for children with an alternate DBDs diagnosis before receiving ASD diagnosis and 29 months for those diagnosed with alternate DBDs concurrently with ASD. Having alternate DBDs diagnosis before diagnosis with ASD was associated with “late” ASD diagnosis as follows: developmental delay (adjusted odds ratio [aOR,] 3.46; 95% confidence interval [CI], 1.86–6.42; p < 0.001), intellectual disability (aOR, 9.75; 95% CI, 3.0–31.60; p = 0.04), attention-deficit disorder (aOR, 11.07; 95% CI, 3.43–35.71; p < 0.001), depression (aOR, 8.05; 95% CI, 1.07–60.03; p = 0.0495), and behavioral conduct disorder (aOR, 9.9; 95% CI, 3.55–27.62; p < 0.001).

Conclusion: 

These findings highlight the importance of research to improve the early diagnosis of ASD even in the presence of coexisting developmental behavioral disorders.

中文翻译：

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诊断患有共存发育行为障碍儿童自闭症谱系障碍的时间

客观的： 

我们的研究评估了在诊断自闭症谱系障碍 (ASD) 之前进行替代性发育行为障碍 (DBD) 诊断是否与全国代表性样本中的诊断延迟相关。

方法： 

数据来自 2011 年全国诊断和服务途径调查，该调查针对 6 至 17 岁患有自闭症谱系障碍 (ASD)、发育迟缓或智力障碍的儿童。共有 1049 名儿童符合本研究的纳入标准。其中，如果父母向服务提供者报告担忧的年龄与自闭症谱系障碍诊断年龄之间相隔超过 12 个月，则 799 名儿童被确定为“晚期”诊断；如果差距≤12 个月，则 250 名儿童被确定为“及时”诊断。使用单变量和多变量逻辑回归来寻找 ASD 之前诊断出的替代 DBD 与“及时”与“晚期”ASD 诊断之间的关联。

结果： 

对于在接受 ASD 诊断之前被诊断为替代 DBD 的儿童，父母向医疗服务提供者报告担忧的年龄与 ASD 诊断年龄之间的平均时间间隔为 51 个月，对于同时诊断为替代 DBD 和 ASD 的儿童，平均间隔时间为 29 个月。在诊断 ASD 之前进行替代 DBD 诊断与“晚期”ASD 诊断相关，如下：发育迟缓（调整后优势比 [aOR，] 3.46；95% 置信区间 [CI]，1.86–6.42；p < 0.001）、智力障碍（aOR，9.75；95% CI，3.0–31.60；p = 0.04）、注意力缺陷障碍（aOR，11.07；95% CI，3.43–35.71；p < 0.001）、抑郁症（aOR，8.05；95% CI， 1.07–60.03；p = 0.0495）和行为行为障碍（aOR，9.9；95% CI，3.55–27.62；p < 0.001）。

结论： 

这些发现凸显了即使在同时存在发育行为障碍的情况下，研究改善自闭症谱系障碍早期诊断的重要性。