Diagnosis of Autism in School Age and Adolescence in an Ethnically Diverse Population.

Despite policy emphasis on early identification, many children with Autism are diagnosed late, with some being diagnosed as late as adolescence. The objective of this study was to examine the demographics and clinical characteristics of school-age children and adolescents initially diagnosed with Autism age 7 and older, in an urban, university-affiliated multidisciplinary center that evaluates/treats youth with developmental disabilities. A chart review of all school-age children and adolescents referred for evaluation to determine if the child has developmental disabilities from January 2019 to May 2023 was performed. Of all children evaluated in that period (n = 825), 164 (19.8%) were diagnosed with Autism, 123 (75%) had a previous diagnosis, and 41 (25%) were newly diagnosed with Autism. Patients newly diagnosed with Autism age ≥7 were more likely to be diagnosed with Language Disorder (100% vs. 82%, p = 0.001) and Anxiety Disorder (27% vs. 13%, p = 0.04), be prescribed with an antidepressant (10% vs. 1%, p = 0.03), and less likely to be diagnosed with Intellectual Disabilities (13% vs. 34%, p = 0.001) than those who had a previous diagnosis of Autism, with no other differences in demographics or developmental diagnosis between the groups. Of the 136 patients referred for evaluation with a previous diagnosis of Autism, 13 (9.5%) did not meet the criteria for Autism any longer after multidisciplinary evaluations but continued to present developmental disorders, including Language Disorder (100%), attention-deficit/hyperactivity disorder (46%), and Speech Sound Disorder (38%). Of the 87 families who were concerned about Autism (without a previous diagnosis), 32 (36.8%) confirmed the diagnosis of Autism, 9 (1.5%) patients were newly diagnosed with Autism, and there were no parental concerns. In conclusion, in this ethnically diverse group of school-age children and adolescents with developmental disabilities, 25% received an initial diagnosis of Autism after age 7. Similar to previous reports, children who received a later diagnosis were more likely to present a language impairment, anxiety, and higher cognitive skills. Longitudinal studies, in ethnically diverse populations, are necessary to understand the trajectory and clinical profile of Autism.

Comorbidities in School-Age Children and Adolescents with Autism in an Ethnically Diverse Population: Brief Report.

Objectives: (1) To examine psychiatric and developmental comorbidities in school-age children and adolescents with Autism in a university-affiliated urban developmental center that serves children with developmental disabilities, and (2) to compare comorbidities by age groups. Methods: Review of all school-age children and adolescents evaluated and diagnosed with autism from 1/2019 to 1/2022. Data included: Demographics (age, gender, race/ethnic group, bilingual English/Spanish households) and other developmental and psychiatric diagnoses besides autism, including language disorder, specific learning disorders (LD), attention-deficit/hyperactivity disorder (ADHD), intellectual disabilities (ID), anxiety disorders (i.e., generalized anxiety disorder, anxiety disorder, unspecified, social anxiety disorder), and depressive disorders (i.e., major depressive disorder, depressive disorder, unspecified). Statistics included chi-square, and nonparametric tests, comorbidities were compared between school-age children and adolescents. Results: Of all children evaluated in that period (n = 599), 119 (20%) were diagnosed with autism, 97 (81%) boys, age 11.8 ± 3 years old, 46 (39%) bilingual English/Spanish households; 65 (55%) were school-age children and 54 (45%) were adolescents (age = 12-18). Of the 119, 115 (96%) presented with one or more co-occurring conditions, including language disorder in 101 (85%), LD in 23 (19%), ADHD in 50 (42%), and ID in 30 (25%). Psychiatric co-occurring conditions included anxiety disorders in 24 (20%) and depressive disorders in 8 (6%). School-age children with autism were more likely to be diagnosed with ADHD combined type (42% vs. 22%, p = 0.04) and language disorders (91% vs. 73%, p = 0.04), whereas adolescents with autism were more likely to be diagnosed with depressive disorders (13% vs. 1%, p = 0.03), with no other differences between the groups. Conclusion: In this urban, ethnically diverse group of children with autism, the vast majority presented with one or more comorbid diagnoses. School-age children were more likely to be diagnosed with language disorder and ADHD, while adolescents were more likely to be diagnosed with depression. Early detection and treatment of co-occurring conditions in autism are necessary.

Screening for Depression in Adolescents with Developmental Disabilities: Brief Report.

Objectives: (1) To examine adherence of universal screening for adolescent depression at initial visits by using an established screening instrument (Patient Health Questionnaire 9 [PHQ-9]) in a university-affiliated urban developmental center that serves children with developmental disabilities (DDs); (2) to study the frequency of positive screening for depression in adolescents with DD. Methods: Review of all adolescents referred for multidisciplinary evaluation in a developmental center in 2019. Data included demographics, DD diagnoses, and use of and scores on the PHQ-9 at initial visit. Statistics included chi-square and non-parametrics. Results: Of all the children evaluated in 2019 (n = 240), 52 were adolescents, 35 boys (63%)/17 girls (37%), age 14 ± 2 years old, and 27 (54%) belonging to a bilingual English-Spanish household. DD: Developmental Language Disorder (88%), Learning Disabilities (54%), attention-deficit/hyperactivity disorder (44%), Autism Spectrum Disorder (25%), Intellectual Disabilities (12%), and Phonological Disorder (8%). The PHQ-9 was administered to 30 (58%) individuals. Scores varied from minimal depression for 17 (57%), mild for 10 (33%), and moderate and severe for 3 (10%); 3 patients endorsed suicidality. Females were more likely to obtain higher scores on the PHQ-9 than males. Adolescents diagnosed with Autism Spectrum Disorder, Intellectual Disabilities, and Phonological Disorder were less likely to be screened. Conclusion: More than half of the sample of urban adolescents with DD were screened for depression at initial visit, and 10% screened positive for moderate to severe depression. Efforts to follow the U.S. Preventive Services Task Force recommendation of universal screening of adolescent depression should continue. However, given challenges with reading and verbal abilities, screening modifications (reading to them) should be considered.