Rethinking the idea of late autism spectrum disorder onset.
Open accessAbstract
A common theory of autism spectrum disorder (ASD) symptom onset includes toddlers who do not display symptoms until well after age 2, which are termed late-onset ASD cases. Objectives were to analyze differences in clinical phenotype between toddlers identified as ASD at initial evaluations (early diagnosed) versus those initially considered nonspectrum, then later identified as ASD (late diagnosed). Two hundred seventy-three toddlers recruited from the general population based on a failed developmental screening form or parent or physician concerns were followed longitudinally from 12 months and identified as early- and late-diagnosed cases of ASD, language delayed, or typically developing. Toddlers completed common standardized assessments and experimental eye-tracking and observational measures every 9-12 months until age 3. Longitudinal performance on standardized assessments and experimental tests from initial evaluations were compared. Delay in social communication skills was seen in both ASD groups at early-age initial assessment, including increased preference for nonsocial stimuli, increased stereotypic play, reduced exploration, and use of gestures. On standardized psychometric assessments, early-diagnosed toddlers showed more impairment initially while late-diagnosed toddlers showed a slowing in language acquisition. Similar social communication impairments were present at very early ages in both early-detected ASD and so-called late-onset ASD. Data indicate ASD is present whether detected or not by current methods, and development of more sensitive tools is needed.
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Late-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.”
From Evaluation of the Diagnostic Stability of the Early Autism Spectrum Disorder Phenotype in the General Population Starting at 12 Months (2019) · cites this paper as [20]
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”
From Evaluation of the Diagnostic Stability of the Early Autism Spectrum Disorder Phenotype in the General Population Starting at 12 Months (2019) · cites this paper as [20]
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- Authors
- Bacon, E. C., Courchesne, E., Barnes, C. C., Cha, D., Pence, S., Schreibman, L., Stahmer, A. C., & Pierce, K.
- Affiliations
- University of California San Diego (US)
- University of California, Davis (US)
- Corresponding author
- Bacon, Elizabeth C.
- Venue
- Development and Psychopathology
- Publisher
- Cambridge University Press (CUP)
- Published
- 2017-08-14
- Volume
- 30
- Issue
- 2
- Pages
- 553-569
- ISSN
- 0954-5794 (ISSN-L)
- 1469-2198
- PMC
- PMC10515446
- OpenAlex
- W2743643029
- Cited by
- 52
- References
- 51
- Citations by year
- 2026: 4 · 2025: 3 · 2024: 6 · 2023: 5 · 2022: 6 · 2021: 13 · 2020: 3 · 2019: 3 · 2018: 8 · 2017: 1
- FWCI
- 2.35
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Development and Psychopathology (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- National Institutes of Health (5r01mh110558-05)
- University of California, San Diego
- National Institute of Mental Health (R01-MH110558, R01MH080134, P50MH081755)
- 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 › Child and Animal Learning Development
- Keywords
- autism spectrum disorder, toddlers, early diagnosis, developmental screening, social communication deficits, language delay, eye tracking, longitudinal development
- MeSH terms
- Autism Spectrum Disorder, Child, Preschool, Humans, Infant, Language Development, Longitudinal Studies, Male, Age of Onset, Early Diagnosis, Social Skills
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