Relationship between ASD Diagnosis and Developmental, Psychiatric, Medical, and Concurrent Diagnoses or Symptoms in Children Age 8 Years in 2002

Susan E. Levy, MD, Division of Child Development, Rehabilitation and Metabolic Disease, Children's Hospital of Philadelphia, 3405 Civic Center Boulevard, Philadelphia, PA 19104, Li-Ching Lee, PhD, Epidemiology, Johns Hopkins Univ. School of Public Health, 615 N. Wolfe St, Suite E6032, Baltimore, MD 21205, Ellen Giarelli, EdD, RN, CRNP, School of Nurisng, University of Pennsylvania, 420 Guardian Drive , Room 436, Philadelphia, PA 19118, Laura Schieve, Ph.D., CDC, National Center on Birth Defects and Developmental Disabilities, Atlanta, GA, Russell S. Kirby, Ph.D., University of Alabama at Birmingham, Birmingham, AL, Christopher Cuniff, MD, University of Arizona College of Medicine, Tucson, AZ, Judith A. Reaven, PhD, UCHSC/JFK Partners, University of Colorado Health Sciences Center, Denver, CO, Joyce Nicholas, PhD, Medical University of South Carolina, Charleston, SC, Jennifer Pinto-Martin, PhD, Univ. of Pennsylvania School of Nursing and School of Medicine, University of Pennsylvania, 420 Guardian Drive , Room 436, Philadelphia, PA 19118, and Catherine E. Rice, PhD, Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities, 1600 Clifton Road MS E-86, Atlanta, GA 30333.

Background: Few studies have examined the population-based prevalence of concurrent medical, developmental, and/or psychiatric conditions in children with ASD; however, studies of referred populations support high frequencies.

Objectives: To examine concurrent diagnoses and symptoms in a population-based sample of 8-year-old children.

Methods: Data were collected by 13 surveillance programs in the Autism and Developmental Disabilities Monitoring (ADDM) Network. Information was abstracted from existing clinical and education evaluation records of 8 year-old children with an indication of an ASD or related condition and reviewed by trained clinicians. This study included 2568 children who met the surveillance case definition for ASD; 73% had been classified with autism or ASD previously.

Results: Eighty-one percent of study children were male; 63% white, 23% black, 14% Hispanic, Asian, or not stated. ASD was classified before age 3 years for 13%, between ages 3-5 years for 23%, after age 5 years for 29%, and age was not specified for 8%. No previous ASD diagnosis or educational eligibility was recorded in evaluation records for 27%, but they had behavioral descriptions consistent with DSM-IV-TR criteria for ASD (and in 41%, suspicion of ASD was also noted). Overall, the prevalence of ³1 concurrent non-ASD developmental diagnoses was 83%, ³1 psychiatric diagnoses was 10%, ³1 medical diagnoses or symptoms was 18%, and a possibly causative genetic or neurologic diagnosis was 4%. For any type of concurrent diagnoses 14.8% of children had none, 59.6% had one and 25.7% had 2 or more. Children with ASD classification based on behavioral description (not a previously documented clinician diagnosis) were more likely to have all four types of concurrent diagnoses than children with a previously documented diagnosis or classification.

Conclusions: Improved understanding of high frequency of co-occurring conditions among children with ASD has implications for understanding etiology, recognition and appropriate treatment of ASD.


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