Age At Diagnosis of Autism Spectrum Disorders: Experience of a Tertiary Care Hospital in North India

Background:

Early identification of autism spectrum disorders (ASDs) has been recommended as timely enrolment in intervention programs is associated with better outcome. There is little empirical data investigating factors that delay the diagnosis of ASDs in India. This study endeavored to address this gap in the literature by examining the factors which are related to the age of diagnosis.  

Objectives:

To examine the demographic and clinical factors related to the age of diagnosis among children with ASDs.

Methods:

The case records of 586 children (January 1997 to September 2012) with a diagnosis of ASD maintained at the Pediatric Psychology Clinic of the Department of Pediatrics of a tertiary care teaching hospital in North India were reviewed. Referrals to the centre are made by pediatricians, school teachers, and parents. The diagnosis of autism was made strictly as per the DSM IV criteria by the two authors and confirmed by the Childhood Autism Rating Scale (CARS, Schopler, Reichler, and Renner, 1988). Age at diagnosis was compared across sub types of ASD; residence; sex of the child; income and educational level of parents; and other medical diagnoses.  

Results:

The mean age at diagnosis was 4.54 years (SD= 2.36) for Autistic Disorder (AD), 5.47 years (SD= 2.53) for Pervasive Developmental Disorder-Not Otherwise Specified (PDDNOS), and 7.90 years (SD= 2.59) for Asperger disorder. Rural children were diagnosed at 5.19 years,   0.63 years later than urban children (t= 2.64, P= .008). Children from low income homes (incomes less than $50 per month) had significantly (t=2.23, P=.026) higher age at diagnosis (M= 5.45, SD= 2.97) than children from relatively higher income homes (M= 4.64, SD=2.38).  Children with a severe language deficit received a diagnosis 2.18 years earlier than other children. ASD children with poor eye contact also received a significantly earlier diagnosis (t= 4.02, P=.000). Children with a medical condition received a diagnosis 0.78 yrs later than children with no medical condition (t= 2.85, P=.004). ASD children with parents with low levels of education were more likely to be diagnosed at a later age. Education of the mother explained 5% of the variance in the age at diagnosis (F=31.78, P=.000).

Conclusions:

Place of residence, income, education of parents, sub type were major contributors of disparities in the age of diagnosis. ASD children from rural areas, poorer homes, and with parents with low levels of education are under served. There is an urgent need to educate pediatricians in the community regarding the early signs of autism for early referral and timely initiation of services in the developing countries.