Early ASD diagnosis may fade by school age: Study

More than a third of children diagnosed with autism spectrum disorder (ASD) before age three may not meet the criteria by the time they start school, a recently published US study says.
 
As a result, the new research suggests that children with an early diagnosis may require monitoring over time to clarify their diagnosis and ongoing treatment recommendations.
 
To reach their findings, the authors tracked a cohort of 213 children who received a clinical ASD diagnosis at 12–36 months and were then re-assessed at age 5–7 years.
 
They found that 37% of toddlers diagnosed before the age of three are unlikely to meet the criteria for ASD by school age, and ‘higher baseline adaptive functioning’ and gender are linked with non-persistent ASD diagnoses.
 
Dr James Best is Chair of RACGP Specific Interests Child and Young Person’s Health and an ASD expert.
 
He told newsGP while the research produced some interesting findings, its interpretation requires caution.
 
‘If approximately a third of people who receive a diagnosis early are then being re-assessed and not maintaining that diagnosis for ASD later on, that could be misinterpreted as having to be wary about early diagnosis,’ he said.
 
‘And I think that is a bit concerning and I would hope that people would not interpret it in that way, because my feeling is it is more important that we don’t miss diagnoses and preferably get them early, and if you get a diagnosis and then lose it, it’s actually not a loss.
 
‘It may well be that both the diagnosis and re-diagnosis, or lack of diagnosis, were both accurate.
 
‘Especially with the impact of early intervention, it may mean that children early on do meet the criteria, but within dimensions that their autistic traits are impacts and it is no longer necessarily a disorder that is requiring help of some degree.’
 
The study’s investigators, all from Boston Children’s Hospital, noted while the prevalence of ASD continues to grow and early diagnosis is important, there is ‘limited information’ on outcomes for children diagnosed with ASD in early childhood using ‘contemporary diagnostic criteria’.
 
They concluded higher baseline adaptive functioning – classified as a measure of communication skills, daily living skills, socialisation, and motor skills – and female sex were the only variables associated with increased odds of being in the non-persistent ASD group at six years.
 
The intensity of therapies and interventions were not linked to ASD persistence.
 
Despite the findings, Dr Best said missed diagnoses should remain the focus.
 
‘My concern is that we don’t miss diagnosis and have late diagnoses – that’s more important than having early diagnoses that probably are appropriate at the time,’ he said.
 
‘As the authors state, early diagnosis should be followed up, and I think that’s appropriate.
 
‘[It may] occur that people have been reticent to make an early diagnosis, and in fear of distressing parents or carers with a diagnosis, that distress needs to be balanced with an appropriate early diagnosis leading to a lack of access to early intervention.
 
‘That to me is much more of a concern.’
 
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