Child's verbal ability and gender are associated with age at diagnosis in a sample of young children with ASD in Europe
Open accessAbstract
Background: Autism spectrum disorder can in some cases be reliably diagnosed by age 2 years, but in community settings, the mean age at diagnosis is often considerably higher. Later diagnosis has been found to be associated with lower symptom severity, lower parental socioeconomic status and fewer parental concerns. Gender differences in age at diagnosis have been examined, with mixed evidence. Methods: We examined the association of child's verbal ability and gender, and parental education, with age at diagnosis in a large sample of young children with autism spectrum disorder in 18 European countries (n = 1410). Results: There was considerable variation in age at diagnosis across countries. Children with better communication skills were diagnosed significantly later than non‐verbal and minimally verbal children. There was also a significant interaction of gender with verbal ability on age at diagnosis, in that female children with complex phrase speech were diagnosed later than male children with the same level of verbal ability. Conclusions: Our findings highlight the need to implement public awareness initiatives and training for professionals to promote early detection and, consequently, early intervention for autism spectrum disorder in Europe.
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For verbally able individuals with phrase speech in a population-based sample, girls had a significantly higher age of diagnosis than boys.
“Salomone et al. (2016) found that for verbally able individuals (i.e. those with phrase speech) in a population-based sample, girls had a significantly higher age of diagnosis than boys.”
From Barriers to Autism Spectrum Disorder Diagnosis for Young Women and Girls: a Systematic Review (2021) · cites this paper as Salomone et al. 2016
The Results report that, among children with complex phrase speech, girls had a significantly higher age at diagnosis than boys (p=.028). However, the Additional information section explicitly says the recruited sample cannot be considered representative of the general population of children with ASD, so calling it population-based is not supported. (LLM, conf=0.91)
Experimental — accuracy not yet measuredGirls with ASD may be missed in the diagnostic process and require additional verbal ability or behaviour problems to be noticed and to reach the diagnostic threshold, unlike boys.
“our results suggest that girls might be being missed within the diagnostic process, and that they require additional problems in verbal ability or behaviour, in order to be noticed and to push them over the diagnostic threshold, a finding which did not occur for boys (Duvekot et al. 2017; Dworzynski et al. 2012; Salomone et al. 2016).”
From Barriers to Autism Spectrum Disorder Diagnosis for Young Women and Girls: a Systematic Review (2021) · cites this paper as Salomone et al. 2016
The Results (page not specified) show that children with better verbal ability were diagnosed later, and that girls with complex phrase speech were diagnosed later than boys with the same verbal ability. The paper suggests a particular disadvantage for girls with better communication abilities, but it does not establish that girls must have additional verbal or behaviour problems to meet a diagnostic threshold. It also finds a verbal-ability association across children, not an effect absent in boys. (LLM, conf=0.87)
Experimental — accuracy not yet measuredASD diagnosis typically occurs later in Europe (3.5 years), the USA (4 years), and Canada (6 years).
“however, diagnosis typically occurs later in Europe (3.5 years), USA (4 years), and Canada (6 years), exposing an opportunity to decrease the age at diagnosis and accelerate access to specialized healthcare.”
From Tackling healthcare access barriers for individuals with autism from diagnosis to adulthood (2022) · cites this paper as [59]
The Results (page not provided) report a mean age at diagnosis of 42.16 months—approximately 3.5 years—in a sample from 18 European countries. The paper does not provide the claimed four-year figure for the USA or six-year figure for Canada, and cautions that its European sample is not representative of all children with ASD. (LLM, conf=0.88)
Experimental — accuracy not yet measuredThe gender difference in age of diagnosis was not seen for non-verbal or minimally verbal children.
“This gender difference was not seen for non-verbal or minimally verbal children.”
From Barriers to Autism Spectrum Disorder Diagnosis for Young Women and Girls: a Systematic Review (2021) · cites this paper as Salomone et al. 2016
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Barriers to Autism Spectrum Disorder Diagnosis for Young Women and Girls: a Systematic Review
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- Authors
- Salomone, E., Charman, T., McConachie, H., & Warreyn, P.
- Affiliations
- King's College London (GB)
- Newcastle University (GB)
- Ghent University (BE)
- Corresponding author
- Salomone, E.
- Venue
- Child: Care, Health and Development
- Publisher
- Wiley
- Published
- 2015-05-28
- Volume
- 42
- Issue
- 1
- Pages
- 141-145
- ISSN
- 0305-1862 (ISSN-L)
- 1365-2214
- OpenAlex
- W2112723012
- Cited by
- 62
- References
- 14
- Citations by year
- 2026: 3 · 2025: 3 · 2024: 2 · 2023: 8 · 2022: 10 · 2021: 12 · 2020: 7 · 2019: 5 · 2018: 4 · 2017: 5 · 2016: 2
- FWCI
- 2.21
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Child Care Health and Development (publishedVersion)
- PubMed (publishedVersion)
- Ghent University Academic Bibliography (Ghent University) (submittedVersion, other-oa)
- BOA (University of Milano-Bicocca) (submittedVersion)
- Institutional Research Information System University of Turin (University of Turin) (submittedVersion)
- Research Portal (King's College London) (submittedVersion, other-oa)
- Newcastle University ePrints (Newcastle Univesity)
- Funders
- European Science Foundation (COST Action BM1004)
- Innovative Medicines Initiative Joint Undertaking (115300)
- 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 › Clinical Psychology › Family and Disability Support Research
- Keywords
- autism spectrum disorder, age at diagnosis, verbal ability, gender differences, parental education, early detection, early intervention, communication skills, nonverbal children, cross-national variation
- MeSH terms
- Autism Spectrum Disorder, Age Factors, Child, Child, Preschool, Europe, Female, Humans, Language Development Disorders, Male, Parents, Severity of Illness Index, Sex Factors, Verbal Learning, Early Diagnosis
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