“Examination of the Time Between First Evaluation and First Autism Spectrum Diagnosis in a Population-Based Sample,” by Lisa D. Wiggins, Jon Baio and Catherine Rice, was a 2006 study undertaken because of the earlier findings that the earlier that young children who have an autism spectrum disorder, or ASD, are identified, the earlier it is possible to move them into the sort of interventions that will lead to better outcomes in development over time. Specifically, this study was designed to look at the patterns of identifying and diagnosing ASD children in major metropolitan areas. Based on a group of 115 eight-year-old children who had been diagnosed using a system at the Centers for Disease Control and Prevention, this study undertook several research questions. The main variables of interest were: the earliest age of identified diagnosis; the earliest age of evaluation; the particular variety of ASD that each child was found to have; the source that provided each evaluation; the traits of the professionals who rendered each first ASD diagnosis; and the specific tools that were used to arrive at that diagnosis.
The outcomes were fairly significant, according to the researchers. The majority of children were identified outside the school setting – typically this took place in a clinic or hospital. Just about one in four (24 percent) of ASD diagnosed children did not receive their initial diagnosis until they entered school, though. Seventy percent of the practitioners who arrived at an ASD diagnosis used no diagnostic instruments of any kind. When a diagnostic tool was used, though, the CARS test was the most common, with the ABC being the second most common. The advantage of both of these tools is that they do not take much time to administer, which means that hospital or clinic professionals can give them relatively quickly, while balancing a significant workload. Because these tools are so commonly used, it is important to make sure that tools that are easy to use are also accurate and well refined. The tools that take more time to administer are more effective in a professional setting, as students who have already been identified as belonging to the ASD spectrum can be more accurately placed on that spectrum with more sophisticated metrics.
In general, this article confirmed many of the findings of prior research, particularly the notion that diagnosis of ASD can often be unnecessarily delayed – for example, on average, ASD children do not receive a diagnosis, on average, until 13 months have passed since their first evaluation by a professional qualified to diagnose the condition. Gender and ethnicity did not impact the delay in diagnosis significantly; however, children who belong on the less severe end of the spectrum had more of a delay between first visit and diagnosis than those with more severe symptoms, as one might expect. The most troubling finding for the researchers was that so many practitioners (70 percent) do not use any diagnostic tools at all in making their findings of ASD for their patients.
The implications of this study include a need to provide more education to both clinical professionals and parents regarding the importance of diagnosing ASD as early as possible and of providing interventions as soon after the diagnosis as possible. The earlier these interventions begin, the more likely the patients are to be functionally normal.
The only criticism that I had about this study was that I wondered why the bias was toward students living in a major metropolitan center. This differentiation’s value was not made clear at any point in the paper, and I wondered why diagnosing ASD would differ at all, just on the basis of the size of one’s town.
Wiggins, L., Baio, J. and Rice, C. (2006). Examination of the time between first evaluation and
first autism spectrum diagnosis in a population-based sample. Developmental and
Behavioral Pediatrics Vol. 27 (2): S79-S87.