title: Agreement between concern about autism spectrum disorder at the time of referral and diagnosis, and factors associated with agreement.
abstract: OBJECTIVE
  This study examined the level of agreement between referral reason and diagnostic outcome for pre-school aged children showing developmental delays and differences. In particular, the level of agreement when there was concern about autism spectrum disorder (ASD) was investigated.
  
  
  METHODS
  Clinical records for children (n = 677) assessed for developmental concerns at a multidisciplinary assessment clinic in Sydney, Australia, were examined. Referral reason and diagnostic outcome were compared. Referral sources and factors including age, developmental level and language functioning, were explored for potential association with the consistency between referral reason and diagnosis.
  
  
  RESULTS
  Approximately 30% of children referred for developmental assessment with ASD concern were not diagnosed with ASD. Agreement between referral reason and diagnosis was similar regardless of referral source and child age. Of children where diagnostic outcome was discordant with referral reason, 24% had delayed language. Variability in cognitive or developmental profiles was common (64%), regardless of diagnostic outcome.
  
  
  CONCLUSIONS
  Referral for ASD diagnostic assessments in the cases where ASD is not the primary cause for a child's difficulties increases pressure on assessment services, can delay access to ASD-specific intervention services for children who do have ASD, and can contribute to parent anxiety unnecessarily. The current evidence that a substantial minority of children were referred for ASD diagnostic assessments when ASD was not the primary cause for the difficulties emphasises the value of adopting a developmental differences framework, focusing on dimensions of behaviour and functioning, rather than an autism-specific service structure.
authors.affiliation: Parramatta Early Childhood Assessment Team, Children's Hospital Westmead, Sydney, New South Wales, Australia.
authors.forename: Bee H
authors.initials: BH
authors.lastname: Lo
authors.affiliation: Developmental Disability and Rehabilitation Research, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.
authors.forename: Felicity
authors.initials: F
authors.lastname: Klopper
authors.affiliation: NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Elizabeth H
authors.initials: EH
authors.lastname: Barnes
authors.affiliation: Developmental Disability and Rehabilitation Research, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.|Neurodevelopment and Disability, The Royal Children's Hospital, Melbourne, Victoria, Australia.|Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Katrina
authors.initials: K
authors.lastname: Williams
mesh_terms: D000067877:Autism Spectrum Disorder / Q000175:diagnosis*; D002648:Child; D002675:Child, Preschool; D032921:Consensus; D005260:Female; D006801:Humans; D007223:Infant; D033183:Interdisciplinary Communication; D008297:Male; D009517:New South Wales; D012017:Referral and Consultation
keywords: autism; autism spectrum disorder; developmental concern; diagnosis; referral reason