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.