Child and Family Characteristics Associated With Age of Autism Spectrum Disorder Diagnosis in a Primary Care Population.

Abstract

Objective: To compare a sample of pediatric primary care patients diagnosed with autism spectrum disorder (ASD) with the general clinic population, as well as associations of child and caregiver characteristics with age of diagnosis.

Method: Cross-sectional data for patients from 2 large, urban primary care practices diagnosed with ASD between March 1, 2018, and February 28, 2022, were collected from the medical record through extraction and chart review. The sample was compared with the total primary care population using χ2 analysis. Unadjusted bivariate linear regression and multivariate linear regression were used to evaluate associations of each variable with age of diagnosis.

Results: Patients diagnosed with ASD were more likely to be male, Hispanic, publicly insured and medically complex than the general clinic population. There was also a higher maternal education level in the autism group. In unadjusted linear regression analyses, language delay, connection with Early Intervention (EI), earlier age of parental concern, earlier age of referral, having an M-CHAT completed, higher M-CHAT scores, and having a first-degree relative with ASD were associated with earlier age of diagnosis. In multivariate linear regression analysis, connection with EI, better continuity of care, higher M-CHAT scores and having commercial insurance were associated with earlier diagnosis. Race/ethnicity, language, and Social Vulnerability Index ≥ 90%ile were not significantly associated with age of ASD diagnosis.

Conclusion: This study reflects shifting prevalence patterns of ASD, but a persistent disparity in age of diagnosis among publicly insured children. It highlights the importance of developmental monitoring, continuity of care, and navigation support to help families obtain ASD diagnoses promptly.