Predictors of Autism Spectrum Disorder Among Children With Diagnostic Uncertainty After Initial...

To examine demographic and child/family factors predictive of autism spectrum disorder (ASD) in children with diagnostic uncertainty after initial assessment by experienced Developmental Behavioral Pediatric (DBP) clinicians.

A retrospective cohort of 87 consecutive children was seen for Interdisciplinary Autism Diagnostic Team (IADT) assessment between January 2022 and March 2023 because of initial DBP clinician diagnostic uncertainty. Sociodemographic and child/family characteristics including IADT results were analyzed using Mann-Whitney U tests, χ 2 tests, and logistic regression to determine predictors of ASD diagnosis.

Mean age of referred children was 6.9 (SD 3.02) years, 74% were male, and 78% did not exhibit cognitive delays. Demographic factors did not significantly differ between ASD and non-ASD diagnostic groups. The ASD group had lower rates of prenatal substance exposure ( p < 0.001), physical aggression ( p = 0.033), family history of non-ASD mental health conditions ( p = 0.002), and adverse childhood events ( p = 0.016). Autism spectrum disorder diagnostic testing best predicted an ASD diagnosis. The ASD group had significantly higher Autism Diagnostic Observation Schedule (ADOS) Total ( p < 0.001) and Comparison scores ( p < 0.001) than the non-ASD group.

Children with ASD diagnostic uncertainty often share similar demographic and clinical features. This study found that family history of non-ASD conditions and child experiences of early adversity are significant factors in differentiating ASD and non-ASD. Child and family factors at point-of-referral may help discern need for an ASD team evaluation including structured observational tools (e.g., ADOS-2) and improve efficiency of assessment planning.