title: Factors associated with age of diagnosis among children with autism spectrum disorders.
abstract: OBJECTIVE
  Early diagnosis of children with autism spectrum disorders (ASD) is critical but often delayed until school age. Few studies have identified factors that may delay diagnosis. This study attempted to identify these factors among a community sample of children with ASD.
  
  
  METHODS
  Survey data were collected in Pennsylvania from 969 caregivers of children who had ASD and were younger than 21 years regarding their service experiences. Linear regression was used to identify clinical and demographic characteristics associated with age of diagnosis.
  
  
  RESULTS
  The average age of diagnosis was 3.1 years for children with autistic disorder, 3.9 years for pervasive developmental disorder not otherwise specified, and 7.2 years for Asperger's disorder. The average age of diagnosis increased 0.2 years for each year of age. Rural children received a diagnosis 0.4 years later than urban children. Near-poor children received a diagnosis 0.9 years later than those with incomes >100% above the poverty level. Children with severe language deficits received a diagnosis an average of 1.2 years earlier than other children. Hand flapping, toe walking, and sustained odd play were associated with a decrease in the age of diagnosis, whereas oversensitivity to pain and hearing impairment were associated with an increase. Children who had 4 or more primary care physicians before diagnosis received a diagnosis 0.5 years later than other children, whereas those whose pediatricians referred them to a specialist received a diagnosis 0.3 years sooner.
  
  
  CONCLUSIONS
  These findings suggest improvements over time in decreasing the age at which children with ASD, especially higher functioning children, receive a diagnosis. They also suggest a lack of resources in rural areas and for near-poor families and the importance of continuous pediatric care and specialty referrals. That only certain ASD-related behaviors, some of which are not required to satisfy diagnostic criteria, decreased the age of diagnosis suggests the importance of continued physician education.
authors.affiliation: Center for Mental Health Policy and Services Research, Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA. mandelld@mail.med.upenn.edu
authors.forename: David S
authors.initials: DS
authors.lastname: Mandell
authors.forename: Maytali M
authors.initials: MM
authors.lastname: Novak
authors.forename: Cynthia D
authors.initials: CD
authors.lastname: Zubritsky
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D001321:Autistic Disorder / Q000175:diagnosis*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D010414:Pennsylvania; D012959:Socioeconomic Factors