Evaluation of the Diagnostic Stability of the Early Autism Spectrum Disorder Phenotype in the General Population Starting at 12 Months
Open accessAbstract
Importance: Universal early screening for autism spectrum disorder (ASD) in primary care is becoming increasingly common and is believed to be a pivotal step toward early treatment. However, the diagnostic stability of ASD in large cohorts from the general population, particularly in those younger than 18 months, is unknown. Changes in the phenotypic expression of ASD across early development compared with toddlers with other delays are also unknown. Objectives: To examine the diagnostic stability of ASD in a large cohort of toddlers starting at 12 months of age and to compare this stability with that of toddlers with other disorders, such as developmental delay. Design, Setting, and Participants: In this prospective cohort study performed from January 1, 2006, to December 31, 2018, a total of 2241 toddlers were referred from the general population through a universal screening program in primary care or community referral. Eligible toddlers received their first diagnostic evaluation between 12 and 36 months of age and had at least 1 subsequent evaluation. Exposures: Diagnosis was denoted after each evaluation visit as ASD, ASD features, language delay, developmental delay, other developmental issue, typical sibling of an ASD proband, or typical development. Main Outcomes and Measures: Diagnostic stability coefficients were calculated within 2-month age bands, and logistic regression models were used to explore the associations of sex, age, diagnosis at first visit, and interval between first and last diagnosis with stability. Toddlers with a non-ASD diagnosis at their first visit diagnosed with ASD at their last were designated as having late-identified ASD. Results: Among the 1269 toddlers included in the study (918 [72.3%] male; median age at first evaluation, 17.6 months [interquartile range, 14.0-24.4 months]; median age at final evaluation, 36.2 months [interquartile range, 33.4-40.9 months]), the overall diagnostic stability for ASD was 0.84 (95% CI, 0.80-0.87), which was higher than any other diagnostic group. Only 7 toddlers (1.8%) initially considered to have ASD transitioned into a final diagnosis of typical development. Diagnostic stability of ASD within the youngest age band (12-13 months) was lowest at 0.50 (95% CI, 0.32-0.69) but increased to 0.79 by 14 months and 0.83 by 16 months (age bands of 12 vs 14 and 16 months; odds ratio, 4.25; 95% CI, 1.59-11.74). A total of 105 toddlers (23.8%) were not designated as having ASD at their first visit but were identified at a later visit. Conclusions and Relevance: The findings suggest that an ASD diagnosis becomes stable starting at 14 months of age and overall is more stable than other diagnostic categories, including language or developmental delay. After a toddler is identified as having ASD, there may be a low chance that he or she will test within typical levels at 3 years of age. This finding opens the opportunity to test the impact of very early-age treatment of ASD.
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Written from the paper’s full text.
TL;DR
In a general-population cohort of 1269 toddlers evaluated longitudinally from 12 to 36 months, an ASD diagnosis was more stable than other diagnoses, with overall stability of 0.84. Stability was weakest at 12–13 months (0.50) and improved by 14 months (0.79) and 16 months (0.83), while late-identified ASD occurred in 23.8% of toddlers ultimately diagnosed with ASD.
Key findings
- Overall diagnostic stability was 0.84 (95% CI, 0.80–0.87) for ASD and 0.79 (95% CI, 0.74–0.83) for typical development (TD); ASD vs TD stability did not differ significantly (OR, 0.86; 95% CI, 0.57–1.29). ASD was significantly more stable than ASD features (OR, 0.11; 95% CI, 0.03–0.32), developmental delay (DD; OR, 0.15; 95% CI, 0.09–0.25), language delay (LD; OR, 0.04; 95% CI, 0.03–0.06), and other diagnoses (OR, 0.16; 95% CI, 0.09–0.28).
- ASD stability was weakest at 12–13 months (0.50; 95% CI, 0.32–0.69), increasing to 0.79 by 14 months and 0.83 by 16 months (12 vs 14/16 months OR, 4.25; 95% CI, 1.59–11.74). When toddlers with ASD features were counted as ASD, stability rose to 0.70 at 12 months, 0.85 at 14 months, and 0.94 at 16 months.
- Of 400 toddlers initially designated as having ASD, 336 retained the diagnosis at final visit; only 7 (1.8%) transitioned to TD, and 5 of those 7 were initially evaluated at 12–13 months. The most common transition was from an initial diagnosis of LD or DD to ASD.
- Among toddlers ultimately diagnosed with ASD, 66 (15.9%) were early-age persistent, 270 (61.2%) middle-age persistent, and 105 (23.8%) late-identified. Late-identified toddlers had better first-visit scores than the other ASD groups (Cohen d range, 0.44–2.35) but worse scores than TD toddlers (Cohen d range, 1.43–1.84); 39 late-identified toddlers (37%) fell within the ADOS toddler-module concern cutoff but were designated non-ASD by practitioner judgment.
Methods
- A total of 2241 toddlers aged 12–36 months were referred to a University of California, San Diego autism expert evaluation center through the Get SET Early program or community referral; 1269 were longitudinally evaluated 2 or more times with an interval of 6 months or longer and were the focus. Approximately 75% came from Get SET Early and 25% from community referral. Median age at first evaluation was 17.6 months, median age at final evaluation was 36.2 months, and mean number of diagnostic visits was 2.7.
- Licensed psychologists performed diagnostic and psychometric testing, including ADOS-2, Mullen Scales of Early Learning, and Vineland Adaptive Behavior Scales. Toddlers were designated as having ASD, ASD features, developmental delay, language delay, other issue, TD, or typical sibling of an ASD proband.
- Stability coefficients were calculated as the proportion retaining the same diagnosis from first to last visit within 2-month age bands. Logistic regression included sex, age at first diagnosis, interval between first and last diagnosis, and diagnostic group at first visit; age was binned as younger than 14 months, 14–17.99 months, 18–23.99 months, and 24 months or older. Analyses were performed in R.
Limitations
- The paper states that practitioners making final diagnoses were not masked to previous diagnoses because DSM-5 procedures and criteria require consideration of historical information regarding ASD symptoms; this could have biased psychologists toward increased diagnostic stability, although the relatively weak stability in other delay groups was cited as counterevidence.
- The paper notes that lower ASD stability at 12 months likely reflects limitations in the diagnostic tools used at that age, including the ADOS-2 and DSM.
- The study was not designed to determine whether early treatments affected the speed with which toddlers with language delay caught up by final diagnosis age.
Model-written summary. Check it against the paper before relying on it.
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Cites
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Claims the paper makes
0 of 38 cited sources checked · 0 supported · 0 flagged
- Findingown data
No clinical differences were found between the early and middle diagnosis groups.
“No clinical differences were found between the early and middle diagnosis groups (Figure 4).”
Quote in the paperSubstantial claim - Findingown data
In our cohort, 84% of toddlers initially diagnosed with ASD at their first visit retained this diagnosis at 3 to 4 years of age.
“In our cohort, 84% of toddlers initially diagnosed with ASD at their first visit retained this diagnosis at 3 to 4 years of age.”
Quote in the paperSubstantial claim - Findingown data
The transition from an initial diagnosis of LD or developmental delay to ASD was the most common transition type.
“The transition from an initial diagnosis of LD or developmental delay to ASD was the most common transition type.”
Quote in the paperNot a substantial claim - Findingown data
Overall stability was 0.84 (95% CI, 0.80-0.87) for an ASD diagnosis.
“Overall stability was 0.84 (95% CI, 0.80-0.87) for an ASD diagnosis and 0.79 (95% CI, 0.74-0.83) for a TD diagnosis (Figure 2A).”
Quote in the paperSubstantial claim- Rests on an assumption: The final diagnostic evaluation at the last visit provides a valid reference standard for true ASD diagnostic status.
- Rests on an assumption: The lack of masking of psychologists to previous diagnoses did not materially bias the diagnostic stability estimates.
- Findingown data
When toddlers with ASD features were considered to have ASD, stability coefficients increased to 0.94 (95% CI, 0.81-0.99) at 16 months of age.
“When toddlers with ASD features were considered to have ASD, the stability coefficients increased to 0.70 (95% CI, 0.52-0.85) at 12 months of age, 0.85 (95% CI, 0.71-0.94) at 14 months of age, and 0.94 (95% CI, 0.81-0.99) at 16 months of age.”
Quote in the paperSubstantial claim- Rests on an assumption: The final diagnostic evaluation at the last visit provides a valid reference standard for true ASD diagnostic status.
- Rests on an assumption: The lack of masking of psychologists to previous diagnoses did not materially bias the diagnostic stability estimates.
- Findingown data
Stability of an ASD diagnosis increased to 0.79 by 14 months of age.
“Stability of an ASD diagnosis increased to 0.79 by 14 months of age and 0.83 by 16 months of age (age bands of 12 vs 14 and 16 months; OR, 4.25; 95% CI, 1.59-11.74) (Figure 3 and eFigure 4, eFigure 5, eTable 2, and eTable 3 in the Supplement).”
Quote in the paperSubstantial claim- Rests on an assumption: The final diagnostic evaluation at the last visit provides a valid reference standard for true ASD diagnostic status.
- Rests on an assumption: The lack of masking of psychologists to previous diagnoses did not materially bias the diagnostic stability estimates.
- Findingown data
Even when toddlers with a nonverbal mental age younger than 12 months were removed from analyses, the stability coefficient did not improve.
“yet even when such toddlers were removed from analyses, the stability coefficient did not improve.”
Quote in the paperSubstantial claim - Findingown data
Results from the overall logistic regression model showed a significant association of age and diagnosis at first visit with stability.
“Results from the overall logistic regression model showed a significant association of age and diagnosis at first visit with stability (eTable 1 in the Supplement).”
Quote in the paperSubstantial claim- Rests on an assumption: The final diagnostic evaluation at the last visit provides a valid reference standard for true ASD diagnostic status.
- Findingown data
The most common transition was ASD to ASD features.
“The most common transition was ASD to ASD features, a diagnostic category used for toddlers with signs of ASD but not enough to meet DSM criteria.”
Quote in the paperNot a substantial claim - Findingown data
No significant differences were found in stability based on sex (OR, 0.76; 95% CI, 0.56-1.04).
“No significant differences were found in stability based on sex (OR, 0.76; 95% CI, 0.56-1.04) or interval between first and last diagnostic evaluations (OR, 0.99; 95% CI, 0.98-1.00).”
Quote in the paperNot a substantial claim- Rests on an assumption: The final diagnostic evaluation at the last visit provides a valid reference standard for true ASD diagnostic status.
- Findingown data
The heat map indicates that ASD was the most stable diagnostic category.
“The heat map indicates that ASD was the most stable diagnostic category, and that toddlers initially suspected as having developmental delay (DD) or language delay (LD) frequently received a final diagnosis of ASD.”
Quote in the paperSubstantial claim- Rests on an assumption: The final diagnostic evaluation at the last visit provides a valid reference standard for true ASD diagnostic status.
- Findingcitation
Within the context of an early detection program, children can be reliably diagnosed with ASD several years earlier, as young as 14 months.
“However, we found that within the context of an early detection program,6 children can be reliably diagnosed with ASD several years earlier, as young as 14 months.”
- Also stated in: § Conclusions · hedged
“Our findings suggest that ASD detection and diagnosis can reliably start as young as 14 months.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [6] Pierce K, Carter C, Weinfeld M, Detecting, studying, and treating autism early: the one-year well-baby check-up approach. J Pediatr. 2011; 159(3): 458- 465, e451-e456. 21524759 PMC3157595 source
Not checked in the free run.
- Also stated in: § Conclusions · hedged
- Findingown data
In this study, with a sample size of 1269 toddlers from the general population, each with multiple evaluation visits, generating a total of more than 3000 evaluation visits, 105 (23.8%) who ultimately received a diagnosis of ASD at 3 to 4 years initially had ASD missed at their first evaluation visit.
“In this study, with a sample size of 1269 toddlers from the general population, each with multiple evaluation visits, generating a total of more than 3000 evaluation visits, we found that 105 (23.8%) who ultimately received a diagnosis of ASD at 3 to 4 years initially had ASD missed at their first evaluation visit.”
Quote in the paperSubstantial claim - Findingown data
Five of the seven toddlers with false-positive ASD-to-TD results were initially evaluated at the youngest ages (12-13 months).
“However, 5 of these 7 toddlers with false-positive results were initially evaluated at the youngest ages (12-13 months of age) (eFigure 4 in the Supplement).”
- Also stated in: § Discussion · plain
“In the first diagnosis ASD sample, which contained 400 toddlers, only 7 transitioned to a final diagnosis of TD, and 5 of these were within the 12-month age band.”
Quote in the paperSubstantial claim - Also stated in: § Discussion · plain
- Findingown data
Toddlers initially suspected as having DD or LD frequently received a final diagnosis of ASD.
“The heat map indicates that ASD was the most stable diagnostic category, and that toddlers initially suspected as having developmental delay (DD) or language delay (LD) frequently received a final diagnosis of ASD.”
Quote in the paperSubstantial claim- Rests on an assumption: The final diagnostic evaluation at the last visit provides a valid reference standard for true ASD diagnostic status.
- Findingown data
Toddlers with ASD in the late-identified group had significantly worse test scores than toddlers with TD at the first evaluation visit (Cohen d range 1.43-1.84).
“However, toddlers with ASD in this group had significantly worse test scores than toddlers with TD (range of Cohen d effect sizes, 1.43-1.84), suggesting that symptoms were present.”
Quote in the paperSubstantial claim - Findingown data
When toddlers with ASD features were considered to have ASD, stability coefficients increased to 0.70 (95% CI, 0.52-0.85) at 12 months of age.
“When toddlers with ASD features were considered to have ASD, the stability coefficients increased to 0.70 (95% CI, 0.52-0.85) at 12 months of age, 0.85 (95% CI, 0.71-0.94) at 14 months of age, and 0.94 (95% CI, 0.81-0.99) at 16 months of age.”
Quote in the paperSubstantial claim- Rests on an assumption: The final diagnostic evaluation at the last visit provides a valid reference standard for true ASD diagnostic status.
- Rests on an assumption: The lack of masking of psychologists to previous diagnoses did not materially bias the diagnostic stability estimates.
- Findingown data
Overall, F tests revealed a significant between-group difference for all clinical domains.
“Overall, F tests revealed a significant between-group difference for all clinical domains (eTable 6 in the Supplement).”
Quote in the paperNot a substantial claim - Findingown data
Overall stability was 0.79 (95% CI, 0.74-0.83) for a TD diagnosis.
“Overall stability was 0.84 (95% CI, 0.80-0.87) for an ASD diagnosis and 0.79 (95% CI, 0.74-0.83) for a TD diagnosis (Figure 2A).”
Quote in the paperSubstantial claim- Rests on an assumption: The final diagnostic evaluation at the last visit provides a valid reference standard for true ASD diagnostic status.
- Rests on an assumption: The lack of masking of psychologists to previous diagnoses did not materially bias the diagnostic stability estimates.
- Findingown data
For ASD, stability was weakest at 12 to 13 months of age (stability coefficient, 0.50; 95% CI, 0.32-0.69).
“For ASD, stability was weakest at 12 to 13 months of age (stability coefficient, 0.50; 95% CI, 0.32-0.69).”
Quote in the paperSubstantial claim- Rests on an assumption: The final diagnostic evaluation at the last visit provides a valid reference standard for true ASD diagnostic status.
- Rests on an assumption: The lack of masking of psychologists to previous diagnoses did not materially bias the diagnostic stability estimates.
- Findingown data
Significant differences were found between ASD and other (OR, 0.16; 95% CI, 0.09-0.28).
“In contrast, significant differences were found between ASD and the remaining diagnostic groups (OR, 0.11 [95% CI, 0.03-0.32] vs ASD features; OR, 0.15 [95% CI, 0.09-0.25] vs DD; OR, 0.04 [95% CI, 0.03-0.06] vs LD; and OR, 0.16 [95% CI, 0.09-0.28] vs other) (eTable 1 in the Supplement).”
Quote in the paperSubstantial claim- Rests on an assumption: The final diagnostic evaluation at the last visit provides a valid reference standard for true ASD diagnostic status.
- Findingown data
Transitioning from an initial designation of ASD to a final diagnosis of TD was rare and occurred in only 1.8% of overall cases (7 of 400 toddlers initially designated as ASD).
“Transitioning from an initial designation of ASD to a final diagnosis of TD was rare and occurred in only 1.8% of overall cases (ie, 7 toddlers of 400 toddlers initially designated as ASD).”
- Also stated in: § Discussion · plain
“The least common transition was ASD to TD (ie, only 1.8% of toddlers initially designated as having ASD transitioned to TD).”
Quote in the paperSubstantial claim - Also stated in: § Discussion · plain
- Findingown data
Stability of an ASD diagnosis increased to 0.83 by 16 months of age.
“Stability of an ASD diagnosis increased to 0.79 by 14 months of age and 0.83 by 16 months of age (age bands of 12 vs 14 and 16 months; OR, 4.25; 95% CI, 1.59-11.74) (Figure 3 and eFigure 4, eFigure 5, eTable 2, and eTable 3 in the Supplement).”
Quote in the paperSubstantial claim- Rests on an assumption: The final diagnostic evaluation at the last visit provides a valid reference standard for true ASD diagnostic status.
- Rests on an assumption: The lack of masking of psychologists to previous diagnoses did not materially bias the diagnostic stability estimates.
- Findingown data
Significant differences were found between ASD and ASD features (OR, 0.11; 95% CI, 0.03-0.32).
“In contrast, significant differences were found between ASD and the remaining diagnostic groups (OR, 0.11 [95% CI, 0.03-0.32] vs ASD features; OR, 0.15 [95% CI, 0.09-0.25] vs DD; OR, 0.04 [95% CI, 0.03-0.06] vs LD; and OR, 0.16 [95% CI, 0.09-0.28] vs other) (eTable 1 in the Supplement).”
Quote in the paperSubstantial claim- Rests on an assumption: The final diagnostic evaluation at the last visit provides a valid reference standard for true ASD diagnostic status.
- Findingown data
Exclusion of 73 toddlers whose nonverbal mental age was younger than 12 months did not improve the stability coefficient of ASD at 12 to 13 months.
“Exclusion of 73 toddlers (34 with ASD, 1 with ASD features, 24 with DD, 7 with other disorders, 1 with a typical sibling, and 6 with TD) whose nonverbal mental age based on the visual reception component of the Mullen scale was younger than 12 months (mean nonverbal mental age, 9.6 months) did not improve the stability coefficient of ASD at 12 to 13 months (eTable 5 and eFigure 6 in the Supplement”
Quote in the paperNot a substantial claim- Rests on an assumption: The final diagnostic evaluation at the last visit provides a valid reference standard for true ASD diagnostic status.
- Rests on an assumption: The lack of masking of psychologists to previous diagnoses did not materially bias the diagnostic stability estimates.
- Findingcitation
Overall stability was low for the remaining delay groups.
“Given the transient nature of many early delays,25 overall stability was low for the remaining delay groups (Figure 2 and Figure 3 and eFigure 4 and eTable 4 in the Supplement).”
Quote in the paperSubstantial claim- Rests on an assumption: The final diagnostic evaluation at the last visit provides a valid reference standard for true ASD diagnostic status.
- Findingown data
Significant differences were found between ASD and LD (OR, 0.04; 95% CI, 0.03-0.06).
“In contrast, significant differences were found between ASD and the remaining diagnostic groups (OR, 0.11 [95% CI, 0.03-0.32] vs ASD features; OR, 0.15 [95% CI, 0.09-0.25] vs DD; OR, 0.04 [95% CI, 0.03-0.06] vs LD; and OR, 0.16 [95% CI, 0.09-0.28] vs other) (eTable 1 in the Supplement).”
Quote in the paperNot a substantial claim- Rests on an assumption: The final diagnostic evaluation at the last visit provides a valid reference standard for true ASD diagnostic status.
- Findingown data
An initial ASD diagnosis was more stable than any other diagnosis, including TD.
“An initial ASD diagnosis was more stable than any other diagnosis, including TD.”
Quote in the paperSubstantial claim - Findingown data
No significant differences were found in stability based on interval between first and last diagnostic evaluations (OR, 0.99; 95% CI, 0.98-1.00).
“No significant differences were found in stability based on sex (OR, 0.76; 95% CI, 0.56-1.04) or interval between first and last diagnostic evaluations (OR, 0.99; 95% CI, 0.98-1.00).”
Quote in the paperNot a substantial claim- Rests on an assumption: The final diagnostic evaluation at the last visit provides a valid reference standard for true ASD diagnostic status.
- Findingown data
Most toddlers within the remaining 16% did not lose their delays entirely but instead presented with milder delays at their final diagnostic visit.
“Most toddlers within the remaining 16% did not lose their delays entirely but instead presented with milder delays at their final diagnostic visit.”
Quote in the paperSubstantial claim - Findingown data
Logistic regression analyses showed a nonsignificant difference in stability coefficients between ASD and TD (OR, 0.86; 95% CI, 0.57-1.29).
“Logistic regression analyses showed a nonsignificant difference in stability coefficients between ASD and TD (OR, 0.86; 95% CI, 0.57-1.29).”
Quote in the paperNot a substantial claim- Rests on an assumption: The final diagnostic evaluation at the last visit provides a valid reference standard for true ASD diagnostic status.
- Findingown data
Follow-up pairwise analyses revealed that the differences were driven by the late-identified group, who had consistently better test scores than the other 2 ASD diagnosis groups for all measures at the first evaluation visit (Cohen d range 0.44-2.35).
“Follow-up pairwise analyses revealed that these differences were driven by the late-identified group who had consistently better test scores than the other 2 ASD diagnosis groups for all measures at the first evaluation visit (range of Cohen d effect sizes, 0.44-2.35).”
Quote in the paperSubstantial claim - Findingown data
When toddlers with ASD features were considered to have ASD, stability coefficients increased to 0.85 (95% CI, 0.71-0.94) at 14 months of age.
“When toddlers with ASD features were considered to have ASD, the stability coefficients increased to 0.70 (95% CI, 0.52-0.85) at 12 months of age, 0.85 (95% CI, 0.71-0.94) at 14 months of age, and 0.94 (95% CI, 0.81-0.99) at 16 months of age.”
Quote in the paperSubstantial claim- Rests on an assumption: The final diagnostic evaluation at the last visit provides a valid reference standard for true ASD diagnostic status.
- Rests on an assumption: The lack of masking of psychologists to previous diagnoses did not materially bias the diagnostic stability estimates.
- Findingown data
Among the patients with late-identified ASD, 45 (42.8%) were initially suspected of having only an LD.
“Among the patients with late-identified ASD, 45 (42.8%) were initially suspected of having only an LD.”
Quote in the paperNot a substantial claim - Findingown data
Toddlers diagnosed as having an LD at their first visit overwhelmingly transitioned into testing within the typical range by 3 to 4 years of age.
“Our study also found that toddlers diagnosed as having an LD at their first visit overwhelmingly transitioned into testing within the typical range by 3 to 4 years of age.”
Quote in the paperNot a substantial claim - Findingown data
Significant differences were found between ASD and DD (OR, 0.15; 95% CI, 0.09-0.25).
“In contrast, significant differences were found between ASD and the remaining diagnostic groups (OR, 0.11 [95% CI, 0.03-0.32] vs ASD features; OR, 0.15 [95% CI, 0.09-0.25] vs DD; OR, 0.04 [95% CI, 0.03-0.06] vs LD; and OR, 0.16 [95% CI, 0.09-0.28] vs other) (eTable 1 in the Supplement).”
Quote in the paperSubstantial claim- Rests on an assumption: The final diagnostic evaluation at the last visit provides a valid reference standard for true ASD diagnostic status.
- Premisenone given
None of the previous clinic-referred cohort studies included large groups of toddlers without ASD ascertained in the same manner as the toddlers with ASD.
“Second, none of the previous clinic-referred cohort studies included large groups of toddlers without ASD ascertained in the same manner as the toddlers with ASD.”
Quote in the paperSubstantial claim - Premisecitation
Many children with ASD have clinical signs within the first year, such as failure to respond to their name and reduced positive affect.
“Because many children with ASD have clinical signs within the first year, such as failure to respond to their name3 and reduced positive affect,4 there is a considerable demand for early detection, intervention, and services.5”
Quote in the paperSubstantial claim0 of 2 sources checked- cites [3] Miller M, Iosif AM, Hill M, Young GS, Schwichtenberg AJ, Ozonoff S Response to name in infants developing autism spectrum disorder: a prospective study. J Pediatr 2017;183:141-146, e141. PMC5370582 28162768 source
Not checked in the free run.
- cites [4] Wan MW, Green J, Elsabbagh M, Johnson M, Charman T, Plummer F; BASIS Team Quality of interaction between at-risk infants and caregiver at 12-15 months is associated with 3-year autism outcome. J Child Psychol Psychiatry. 2013; 54(7): 763- 771. doi: 10.1111/jcpp.12032 23227853 source
Not checked in the free run.
- Premisecitation
The mean patient age at ASD detection is generally between 3 and 4 years of age.
“the mean patient age at ASD detection is several years later, generally between 3 and 4 years of age.1”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [1] Baio J, Wiggins L, Christensen DL, Prevalence of autism spectrum disorder among children aged 8 years: Autism and Developmental Disabilities Monitoring Network, 11 sites, United States, 2014. MMWR Surveill Summ. 2018; 67(6): 1- 23. doi: 10.15585/mmwr.ss6706a1 29701730 PMC5919599 source
Not checked in the free run.
- Premisecitation
Stability coefficients within clinic-referred studies of ASD before 3 years of age have been high (mean, 88%, range, 63%-100%).
“Stability coefficients within these studies have been high (mean, 88%, range, 63%-100%).17”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [17] Ozonoff S, Young GS, Landa RJ, Diagnostic stability in young children at risk for autism spectrum disorder: a baby siblings research consortium study. J Child Psychol Psychiatry. 2015; 56(9): 988- 998. doi: 10.1111/jcpp.12421 25921776 PMC4532646 source
Not checked in the free run.
- Interpretationreasoning
Clinic-referred studies may generate less stable results.
“Third, clinic-referred studies are small, usually containing 50 to 100 participants, and may generate less stable results.”
Quote in the paperSubstantial claim - Interpretationreasoning
The lower stability coefficient for ASD specifically at 12 months is likely reflective of some limitations in the diagnostic tools used at that age, which included the ADOS-2 and DSM.
“The lower stability coefficient for ASD specifically at 12 months is likely reflective of some limitations in the diagnostic tools used at that age, which included the ADOS-2 and DSM.”
Quote in the paperSubstantial claim - Premisecitation
Children referred to a clinic because of already suspected ASD may generate artificially high stability rates relative to a community-ascertained sample.
“Moreover, children referred to a clinic because of already suspected ASD may generate artificially high stability rates relative to a community-ascertained sample.17”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [17] Ozonoff S, Young GS, Landa RJ, Diagnostic stability in young children at risk for autism spectrum disorder: a baby siblings research consortium study. J Child Psychol Psychiatry. 2015; 56(9): 988- 998. doi: 10.1111/jcpp.12421 25921776 PMC4532646 source
Not checked in the free run.
- Interpretationcitation
This percentage is substantially lower than the 50% to 80% late-identified ASD cases reported in infant sibling studies.
“This percentage is substantially lower than the 50% to 80% late-identified ASD cases reported in infant sibling studies.17,18”
Quote in the paperSubstantial claim0 of 2 sources checked- cites [17] Ozonoff S, Young GS, Landa RJ, Diagnostic stability in young children at risk for autism spectrum disorder: a baby siblings research consortium study. J Child Psychol Psychiatry. 2015; 56(9): 988- 998. doi: 10.1111/jcpp.12421 25921776 PMC4532646 source
Not checked in the free run.
- cites [18] Zwaigenbaum L, Bryson SE, Brian J, Stability of diagnostic assessment for autism spectrum disorder between 18 and 36 months in a high-risk cohort. Autism Res. 2016; 9(7): 790- 800. doi: 10.1002/aur.1585 26613202 source
Not checked in the free run.
- Study design and conductreasoning
The practitioners who made the final diagnoses were not masked to previous diagnoses.
“One limitation to our study was that the practitioners who made the final diagnoses were not masked to previous diagnoses.”
Quote in the paperNot a substantial claim- Rests on an assumption: DSM-5 procedures and criteria require consideration of historical information regarding ASD symptoms.
- Interpretationown data
Symptoms of ASD were already present at the first diagnostic visit in a large fraction of late-identified ASD cases.
“Note that scores from the late-identified group were significantly different from toddlers with TD across all clinical domains, suggesting that symptoms were already present at the first diagnostic visit in a large fraction of late-identified ASD cases.”
Quote in the paperSubstantial claim - Premisenone given
Stability estimates from infant sibling designs have only been reported starting at 18 months of age.
“Fourth, despite the potential of the infant sibling design to study ASD from birth, stability estimates have only been reported starting at 18 months of age, leaving questions surrounding younger ages unanswered.”
Quote in the paperNot a substantial claim - Interpretationreasoning
The strict cutoff boundaries defined by the DSM may artificially affect results.
“and the strict cutoff boundaries defined by the DSM may artificially affect results.”
Quote in the paperNot a substantial claim - Interpretationown data
Practitioners focused on a child's delays in language rather than subclinical social delays.
“That is, practitioners focused on a child’s delays in language rather than subclinical social delays.”
Quote in the paperSubstantial claim - Interpretationcitation
When ASD is not detected in an infant or toddler, it is likely because it was missed.
“Therefore, when ASD is not detected in an infant or toddler, it is likely because it was missed.20”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [20] Bacon EC, Courchesne E, Barnes CC, Rethinking the idea of late autism spectrum disorder onset. Dev Psychopathol. 2018; 30(2): 553- 569. doi: 10.1017/S0954579417001067 28803559 PMC10515446 source
Not checked in the free run.
- Classified as probably not a substantial claim. 23
- May combine two claims. 9
Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).
Findingnone givenEvidence counter to the point that review biased psychologists is the relatively weak diagnostic stability found in other delay groups.
“Evidence counter to this point is the relatively weak diagnostic stability found in other delay groups.”
Quote in the paperNot a substantial claimMay combine two claims.
Findingown dataAlthough overall stability of an ASD diagnosis was high, examination of the data within 2-month age bands revealed that stability was selectively low at 12 months, with a stability coefficient of 0.50.
“Although the overall stability of an ASD diagnosis was high, examination of the data within 2-month age bands revealed that stability was selectively low at 12 months, with a stability coefficient of 0.50.”
Quote in the paperSubstantial claimMay combine two claims.
Findingown dataWhen toddlers with ASD features were included in the calculation at 12, 14, and 16 months of age, stability coefficients increased to 0.70 at 12 months, 0.85 at 14 months, and 0.94 at 16 months.
“When toddlers with ASD features were included in the calculation at 12, 14, and 16 months of age, stability coefficients increased to 0.70 at 12 months, 0.85 at 14 months, and 0.94 at 16 months.”
Quote in the paperSubstantial claimMay combine two claims.
Findingown dataFor ASD, 66 toddlers (15.9%) were classified into the early-age diagnosis group, 270 (61.2%) into the middle-age diagnosis group, and 105 (23.8%) into the late-identified group.
“For ASD, 66 toddlers (15.9%) were classified into the early-age diagnosis group, 270 (61.2%) into the middle-age diagnosis group, and 105 (23.8%) into the late-identified group.”
Quote in the paperSubstantial claimClassified as probably not a substantial claim.
Premisenone givenIt is unclear whether stability estimates from infant sibling designs would be found within a general population cohort.
“First, it is unclear whether stability estimates from infant sibling designs would be found within a general population cohort.”
Quote in the paperSubstantial claimClassified as probably not a substantial claim.
PremisecitationIn one infant sibling study, only 69% of siblings first diagnosed as having ASD at 24 months retained that diagnosis at a final diagnostic age (27 of 39).
“but only 69% of siblings first diagnosed as having ASD at 24 months did so (ie, 27 of 39 retained diagnosis).17”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [17] Ozonoff S, Young GS, Landa RJ, Diagnostic stability in young children at risk for autism spectrum disorder: a baby siblings research consortium study. J Child Psychol Psychiatry. 2015; 56(9): 988- 998. doi: 10.1111/jcpp.12421 25921776 PMC4532646
Not checked in the free run.
Classified as probably not a substantial claim.
PremisecitationIn one infant sibling study, 93% of siblings first diagnosed as having ASD at 18 months retained that diagnosis at a final diagnostic age of 36 months.
“One of these studies reported that 93% of siblings first diagnosed as having ASD at 18 months retained that diagnosis at a final diagnostic age of 36 months,17”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [17] Ozonoff S, Young GS, Landa RJ, Diagnostic stability in young children at risk for autism spectrum disorder: a baby siblings research consortium study. J Child Psychol Psychiatry. 2015; 56(9): 988- 998. doi: 10.1111/jcpp.12421 25921776 PMC4532646
Not checked in the free run.
Classified as probably not a substantial claim. May combine two claims.
Premisenone givenClinic-referred studies are small, usually containing 50 to 100 participants.
“Third, clinic-referred studies are small, usually containing 50 to 100 participants, and may generate less stable results.”
Quote in the paperSubstantial claimClassified as probably not a substantial claim.
Premisenone givenThe stability of an ASD diagnosis at the toddler stage (around the first birthday) is unknown.
“yet the stability of an ASD diagnosis at this pivotal age is unknown.”
Quote in the paperSubstantial claimClassified as probably not a substantial claim.
PremisecitationMost studies examining the diagnostic stability of ASD before 3 years of age have involved slightly older, clinic-referred cohorts, usually at approximately 2 years of age.
“A previous report17 stated that most studies examining the diagnostic stability of ASD before 3 years of age have involved slightly older, clinic-referred cohorts, usually at approximately 2 years of age.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [17] Ozonoff S, Young GS, Landa RJ, Diagnostic stability in young children at risk for autism spectrum disorder: a baby siblings research consortium study. J Child Psychol Psychiatry. 2015; 56(9): 988- 998. doi: 10.1111/jcpp.12421 25921776 PMC4532646
Not checked in the free run.
Classified as probably not a substantial claim.
PremisecitationEarly signs of ASD can sometimes be detected using parent report screens as early as 12 or 18 months of age.
“Although several studies have shown that early signs of ASD can sometimes be detected using parent report screens as early as 126,7,8 or 18 months of age,9,10”
Quote in the paperSubstantial claim0 of 3 sources checked- cites [6] Pierce K, Carter C, Weinfeld M, Detecting, studying, and treating autism early: the one-year well-baby check-up approach. J Pediatr. 2011; 159(3): 458- 465, e451-e456. 21524759 PMC3157595 source
Not checked in the free run.
- cites [7] Wetherby AM, Brosnan-Maddox S, Peace V, Newton L Validation of the Infant-Toddler Checklist as a broadband screener for autism spectrum disorders from 9 to 24 months of age. Autism. 2008; 12(5): 487- 511. doi: 10.1177/1362361308094501 18805944 PMC2663025 source
Not checked in the free run.
- cites [8] Turner-Brown LM, Baranek GT, Reznick JS, Watson LR, Crais ER The First Year Inventory: a longitudinal follow-up of 12-month-old to 3-year-old children. Autism. 2013; 17(5): 527- 540. doi: 10.1177/1362361312439633 22781058 PMC3470769 source
Not checked in the free run.
May combine two claims.
PremisecitationThe toddler stage is the earliest age that ASD can be detected and treatment started.
“The toddler stage is also the earliest age that ASD can be detected and treatment started,6,16 yet the stability of an ASD diagnosis at this pivotal age is unknown.”
Quote in the paperSubstantial claim0 of 2 sources checked- cites [6] Pierce K, Carter C, Weinfeld M, Detecting, studying, and treating autism early: the one-year well-baby check-up approach. J Pediatr. 2011; 159(3): 458- 465, e451-e456. 21524759 PMC3157595
Not checked in the free run.
- cites [16] Baranek GT, Watson LR, Turner-Brown L, Preliminary efficacy of adapted responsive teaching for infants at risk of autism spectrum disorder in a community sample. Autism Res Treat. 2015; 2015: 386951. 25648749 PMC4306223
Not checked in the free run.
May combine two claims.
PremisecitationAutism spectrum disorder is a common disorder that begins in prenatal life.
“Autism spectrum disorder is a common disorder that begins in prenatal life.2”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [2] Courchesne E, Pramparo T, Gazestani V, Lombardo MV, Pierce K, Lewis NE The ASD living biology: from cell proliferation to clinical phenotype. Mol Psychiatry. 2019; 24(1): 88- 107. doi: 10.1038/s41380-018-0056-y 29934544 PMC6309606 source
Not checked in the free run.
Classified as probably not a substantial claim.
Premisecitation50% to 80% of toddlers eventually diagnosed as having ASD at 3 years of age were not identified as having ASD by expert clinicians at 18 months of age.
“the recent finding from infant sibling studies17,18 that 50% to 80% of toddlers eventually diagnosed as having ASD at 3 years of age were not identified as having ASD by expert clinicians at 18 months of age.”
Quote in the paperSubstantial claim0 of 2 sources checked- cites [17] Ozonoff S, Young GS, Landa RJ, Diagnostic stability in young children at risk for autism spectrum disorder: a baby siblings research consortium study. J Child Psychol Psychiatry. 2015; 56(9): 988- 998. doi: 10.1111/jcpp.12421 25921776 PMC4532646
Not checked in the free run.
- cites [18] Zwaigenbaum L, Bryson SE, Brian J, Stability of diagnostic assessment for autism spectrum disorder between 18 and 36 months in a high-risk cohort. Autism Res. 2016; 9(7): 790- 800. doi: 10.1002/aur.1585 26613202
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductnone givenPsychologists were not masked to previous diagnoses during longitudinal test visits.
“Psychologists were not masked to previous diagnoses during longitudinal test visits.”
Quote in the paperNot a substantial claimClassified as probably not a substantial claim.
PremisecitationChildren with ASD are detected and treated nationally at approximately 4 years of age.
“Children with ASD are detected and treated nationally at approximately 4 years of age.1”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [1] Baio J, Wiggins L, Christensen DL, Prevalence of autism spectrum disorder among children aged 8 years: Autism and Developmental Disabilities Monitoring Network, 11 sites, United States, 2014. MMWR Surveill Summ. 2018; 67(6): 1- 23. doi: 10.15585/mmwr.ss6706a1 29701730 PMC5919599 source
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductreasoningIt is possible that review of historical information could have biased psychologists in favor of increased diagnostic stability.
“Although unlikely, it is possible that review of this information could have biased psychologists in favor of increased diagnostic stability.”
Quote in the paperNot a substantial claim- Rests on an assumption: DSM-5 procedures and criteria require consideration of historical information regarding ASD symptoms.
Classified as probably not a substantial claim.
PremisecitationEarly treatment may be more beneficial than treatment started at older ages.
“which research suggests may be more beneficial than treatment started at older ages.26,27,28”
Quote in the paperSubstantial claim0 of 3 sources checked- cites [26] Anderson DK, Liang JW, Lord C Predicting young adult outcome among more and less cognitively able individuals with autism spectrum disorders. J Child Psychol Psychiatry. 2014; 55(5): 485- 494. doi: 10.1111/jcpp.12178 24313878 PMC5819743 source
Not checked in the free run.
- cites [27] MacDonald R, Parry-Cruwys D, Dupere S, Ahearn W Assessing progress and outcome of early intensive behavioral intervention for toddlers with autism. Res Dev Disabil. 2014; 35(12): 3632- 3644. doi: 10.1016/j.ridd.2014.08.036 25241118 source
Not checked in the free run.
- cites [28] Rogers SJ, Vismara L, Wagner AL, McCormick C, Young G, Ozonoff S Autism treatment in the first year of life: a pilot study of infant start, a parent-implemented intervention for symptomatic infants. J Autism Dev Disord. 2014; 44(12): 2981- 2995. doi: 10.1007/s10803-014-2202-y 25212413 PMC4951093 source
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationTransient LD cases have been commonly noted in the literature.
“Such transient LD cases have been commonly noted in the literature.25”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [25] Dale PS, Price TS, Bishop DV, Plomin R Outcomes of early language delay, I: predicting persistent and transient language difficulties at 3 and 4 years. J Speech Lang Hear Res. 2003; 46(3): 544- 560. doi: 10.1044/1092-4388(2003/044) 14696985 source
Not checked in the free run.
Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).
PremisecitationIn many places in the United States, experience in early ASD development is severely lacking.
“In many places in the United States, such experience is severely lacking.37”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [37] Martinez M, Thomas KC, Williams CS, Family experiences with the diagnosis of autism spectrum disorder: system barriers and facilitators of efficient diagnosis. J Autism Dev Disord. 2018; 48(7): 2368- 2378. doi: 10.1007/s10803-018-3493-1 29453706
Not checked in the free run.
Classified as probably not a substantial claim.
PremisecitationASD is a dimensional rather than categorical disorder.
“This finding is likely related to the possibility that ASD is a dimensional rather than categorical disorder38,39”
Quote in the paperSubstantial claim0 of 2 sources checked- cites [38] Elton A, Di Martino A, Hazlett HC, Gao W Neural connectivity evidence for a categorical-dimensional hybrid model of autism spectrum disorder. Biol Psychiatry. 2016; 80(2): 120- 128. doi: 10.1016/j.biopsych.2015.10.020 26707088 PMC4853295 source
Not checked in the free run.
- cites [39] Kapur S, Phillips AG, Insel TR Why has it taken so long for biological psychiatry to develop clinical tests and what to do about it? Mol Psychiatry. 2012; 17(12): 1174- 1179. doi: 10.1038/mp.2012.105 22869033 source
Not checked in the free run.
May combine two claims.
PremisecitationMost screening studies validate diagnoses only once, usually at approximately the age of screening, leaving unclear the degree to which an initial diagnosis persists at later ages.
“yet most screening studies9,10,41,42 validate diagnoses only once, usually at approximately the age of screening, leaving unclear the degree to which an initial diagnosis persists at later ages.”
Quote in the paperSubstantial claim0 of 4 sources checked- cites [9] Chlebowski C, Robins DL, Barton ML, Fein D Large-scale use of the modified checklist for autism in low-risk toddlers. Pediatrics. 2013; 131(4): e1121- e1127. doi: 10.1542/peds.2012-1525 23530174 PMC3608483 source
Not checked in the free run.
- cites [10] Robins DL, Casagrande K, Barton M, Chen CM, Dumont-Mathieu T, Fein D Validation of the modified checklist for autism in toddlers, revised with follow-up (M-CHAT-R/F). Pediatrics. 2014; 133(1): 37- 45. doi: 10.1542/peds.2013-1813 24366990 PMC3876182 source
Not checked in the free run.
- cites [41] Charman T, Baird G, Simonoff E, Testing two screening instruments for autism spectrum disorder in UK community child health services. Dev Med Child Neurol. 2016; 58(4): 369- 375. doi: 10.1111/dmcn.12874 26303216 source
Not checked in the free run.
- cites [42] Hardy S, Haisley L, Manning C, Fein D Can screening with the Ages and Stages Questionnaire detect autism? J Dev Behav Pediatr. 2015; 36(7): 536- 543. doi: 10.1097/DBP.0000000000000201 26348972 PMC4563819 source
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductnone givenThe study was not designed to determine whether early treatments affected the speed with which toddlers caught up by final diagnosis age.
“Our study was not designed to determine whether such early treatments affected the speed with which toddlers caught up by the time they reached final diagnosis age.”
Quote in the paperNot a substantial claimMay combine two claims.
Study design and conductnone givenThis was not a screening study and the cohort contained approximately 25% community-referred cases.
“Although this was not a screening study and the cohort contained approximately 25% community-referred cases”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S1 (asserted).
PremisecitationLate-onset ASD cases may be attributable to weaknesses inherent in standardized diagnostic tools at early ages, rather than a lack of observable ASD symptoms per se.
“A newer study,20 however, suggests that such so-called late-onset cases may be attributable to weaknesses inherent in standardized diagnostic tools at early ages, rather than a lack of observable ASD symptoms per se.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [20] Bacon EC, Courchesne E, Barnes CC, Rethinking the idea of late autism spectrum disorder onset. Dev Psychopathol. 2018; 30(2): 553- 569. doi: 10.1017/S0954579417001067 28803559 PMC10515446 source
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationThe ADOS-2 is not valid for use with toddlers who have a nonverbal mental age younger than 12 months.
“Research from the ADOS-2 developers cautions that it is not valid for use with toddlers who have a nonverbal mental age younger than 12 months,24”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [24] Luyster R, Gotham K, Guthrie W, The Autism Diagnostic Observation Schedule-toddler module: a new module of a standardized diagnostic measure for autism spectrum disorders. J Autism Dev Disord. 2009; 39(9): 1305- 1320. doi: 10.1007/s10803-009-0746-z 19415479 PMC2893552
Not checked in the free run.
Classified as probably not a substantial claim.
PremisecitationEarly screening starting at 18 months is recommended by the American Academy of Pediatrics.
“particularly when early screening starting at 18 months is recommended by the American Academy of Pediatrics,40”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [40] Johnson CP, Myers SM; American Academy of Pediatrics Council on Children With Disabilities Identification and evaluation of children with autism spectrum disorders. Pediatrics. 2007; 120(5): 1183- 1215. doi: 10.1542/peds.2007-2361 17967920
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationThis finding is consistent with an infant sibling study that reported lower-than-expected language scores on the Mullen Scales of Early Learning test within their late-identified group.
“This finding is consistent with an infant sibling study17 that reported lower-than-expected language scores on the Mullen Scales of Early Learning test within their late-identified group.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [17] Ozonoff S, Young GS, Landa RJ, Diagnostic stability in young children at risk for autism spectrum disorder: a baby siblings research consortium study. J Child Psychol Psychiatry. 2015; 56(9): 988- 998. doi: 10.1111/jcpp.12421 25921776 PMC4532646
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductcitationStability coefficients were recalculated after removing toddlers whose nonverbal mental age was younger than 12 months or who were not ambulatory, due to caution from ADOS developers.
“Given caution from the ADOS developers regarding use of the ADOS with toddlers with nonverbal mental ages younger than 12 months and those who are not ambulatory,24 stability coefficients were also recalculated after removing such cases.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [24] Luyster R, Gotham K, Guthrie W, The Autism Diagnostic Observation Schedule-toddler module: a new module of a standardized diagnostic measure for autism spectrum disorders. J Autism Dev Disord. 2009; 39(9): 1305- 1320. doi: 10.1007/s10803-009-0746-z 19415479 PMC2893552
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
PremisecitationThere is a demand for early detection, intervention, and services, and marked effort and funding have gone into discovery of methods for early-age universal screening, detection, and diagnosis.
“Because of this, there is a demand for early detection, intervention, and services,5 and,in response, marked effort and funding have gone into discovery of methods for early-age universal screening, detection, and diagnosis.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [5] Pierce K, Courchesne E, Bacon E To screen or not to screen universally for autism is not the question: why the task force got it wrong. J Pediatr. 2016; 176: 182- 194. doi: 10.1016/j.jpeds.2016.06.004 27421956 PMC5679123
Not checked in the free run.
The paper relies on this without support.
The 1269 toddlers longitudinally evaluated are representative of the general population of toddlers.
“A total of 2241 toddlers 12 to 36 months of age were referred for a diagnostic evaluation to an autism expert evaluation center created at University of California, San Diego.”
“A total of 1269 of the 2241 toddlers were longitudinally evaluated 2 or more times and were the focus of this study.”
The paper relies on this without support.
The final diagnostic evaluation at the last visit provides a valid reference standard for true ASD diagnostic status.
“A toddler was designated as having 1 of the following: ASD, ASD features, developmental delay, language delay (LD), other issue, TD, or typical sibling of an ASD proband.”
“Stability coefficients were first calculated within 2-month age bands by determining the proportion of toddlers with a particular diagnosis at their first diagnostic visit who retained that same diagnosis at their last visit.”
The paper relies on this without support.
The lack of masking of psychologists to previous diagnoses did not materially bias the diagnostic stability estimates.
“Psychologists were not masked to previous diagnoses during longitudinal test visits.”
The paper relies on this without support.
The human brain has an enormous capacity to resculpt and remodel, particularly during the first postnatal years.
“The human brain has an enormous capacity to resculpt and remodel, particularly during the first postnatal years.”
The paper relies on this without support.
DSM-5 procedures and criteria require consideration of historical information regarding ASD symptoms.
“This lack of masking was because DSM-5 procedures and criteria require consideration of historical information regarding ASD symptoms.”
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Incorrect percentage for the early-age ASD group
MinorThe three ASD identification groups contain 66, 270, and 105 toddlers, totaling 441. The early-age group is therefore 15.0% of that total, not 15.9%.
Reported 15.9 · recomputed 14.965986
“For ASD, 66 toddlers (15.9%) were classified into the early-age diagnosis group, 270 (61.2%) into the middle-age diagnosis group, and 105 (23.8%) into the late-identified group.”
Incorrect percentage for males in the TD group
MinorThe TD group contains 439 toddlers, so 278 males represent 63.3%, not 65.6%.
Reported 65.6 · recomputed 63.32574
“| Male | 361 (81.9) | 68 (87.2) | 66 (74.2) | 58 (72.5) | 61 (67.0) | 26 (51.0) | 278 (65.6) |”
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- Authors
- Pierce, K., Gazestani, V. H., Bacon, E., Barnes, C. C., Cha, D., Nalabolu, S., Lopez, L., Moore, A., Pence-Stophaeros, S., & Courchesne, E.
- Affiliations
- University of California San Diego (US)
- Department of Neurosciences, University of California, San Diego, La Jolla
- Corresponding author
- Pierce, Karen
- ORCID
- Venue
- JAMA Pediatrics
- Publisher
- American Medical Association (AMA)
- Published
- 2019-06-01
- Volume
- 173
- Issue
- 6
- Pages
- 578
- ISSN
- 1072-4710 (ISSN-L)
- 2168-6203
- PMC
- PMC6547081
- OpenAlex
- W2941892929
- Semantic Scholar
- 0a120397c84a76e8bcf0e8b038a0df35e679579c
- Cited by
- 333
- References
- 46
- Citations by year
- 2026: 27 · 2025: 39 · 2024: 43 · 2023: 49 · 2022: 65 · 2021: 66 · 2020: 32 · 2019: 11
- FWCI
- 25.27
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- cc-by
- Locations
- Archives of Pediatrics and Adolescent Medicine (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (5r01mh110558-05)
- National Institute of Mental Health (R01MH104446, R01-MH110558, R01MH036840, P50MH081755)
- National Institute on Deafness and Other Communication Disorders (R01DC016385)
- Topics
- Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
- Health Sciences › Medicine › Psychiatry and Mental health › Child Nutrition and Feeding Issues
- Social Sciences › Psychology › Developmental and Educational Psychology › Language Development and Disorders
- Keywords
- autism spectrum disorder, diagnostic stability, toddlers, primary care, developmental delay, language delay, sex differences, age differences, typical development
- MeSH terms
- Autism Spectrum Disorder, Developmental Disabilities, Child, Preschool, Female, Follow-Up Studies, Humans, Infant, Male, Mass Screening, Phenotype, Primary Health Care, Prospective Studies, Psychiatric Status Rating Scales, Referral and Consultation, Logistic Models, Early Diagnosis
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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