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Cited by 360Autism Spectrum Disorder ResearchFamily and Disability Support ResearchChild Nutrition and Feeding Issues

Age of diagnosis for autism: individual and community factors across 10 birth cohorts

Open access
Fountain, Christine, King, Marissa D, Bearman, Peter S·2011·Journal of Epidemiology and Community Health
DOI 10.1136/jech.2009.104588PMC PMC3039707
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Abstract

Background: The incidence of autism rose dramatically between 1992 and 2001, while the age at which children were first diagnosed declined. During this period the size and composition of the autism caseload has changed, but little is known about whether the factors associated with the timing of diagnosis may also have shifted. Using a multilevel analysis strategy, the individual and community-level factors associated with age of diagnosis were modelled across 10 birth cohorts of California children. Methods: Linked birth and administrative records on 17 185 children with diagnoses of autistic disorder born in California between 1992 and 2001 and enrolled with the California Department of Developmental Services (DDS) were analysed. Information on cases, their parents and their residential location were extracted from birth and DDS records. Zip codes of residence were matched to census data to create community-level measures. Multilevel linear models were estimated for each birth cohort, with individual-level effects for sex, race, parental characteristics, poverty status, birth order and symptom expression. At the community level measures of educational and economic composition, local autism prevalence and the presence of a child psychiatrist were included. Results: Children with highly educated parents are diagnosed earlier, and this effect has strengthened over time. There is a persistent gap in the age of diagnosis between high and low socioeconomic status (SES) children that has shrunk but not disappeared over time. Conclusion: Routine screening for autism in early childhood for all children, particularly those of low SES, is necessary to eliminate disparities in early intervention.

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  • Disparities in timely receipt of developmental support services have persisted for many decades and may contribute to differences in developmental outcomes and school readiness by levels of social risk.

    “Unfortunately, disparities in timely receipt of developmental support services have persisted for many decades and may contribute to differences in developmental outcomes and school readiness by levels of social risk.3–7”

    From Sustained Effectiveness of a 211 Call Center With Early Childhood Care Coordination (2025) · cites this paper as [7]

    The Results (Socioeconomic status; page unavailable) show that lower-SES California children with autism were diagnosed later across the 1992–2001 birth cohorts. The Discussion (Policy implications; page unavailable) says this delay may amplify later socioeconomic differences in outcomes. The paper does not establish disparities over many decades, directly measure timely receipt of developmental support services, or address school readiness. (LLM, conf=0.87)

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  • For Asperger's disorder, median age at diagnosis across studies ranged from 89 to 116 months.

    “Among studies reporting age at diagnosis for Asperger’s disorder (n = 16), mean and median ages ranged from 45 [11] to 134 months [3] and 89 [26] to 116 months [22], respectively.”

    From Explaining differences in age at autism spectrum disorder diagnosis: A critical review (2014) · cites this paper as [22]

  • Median age at diagnosis for combined all ASDs ranged from 36 to 82 months.

    “from 36 [25] to 82 months [22]”

    From Explaining differences in age at autism spectrum disorder diagnosis: A critical review (2014) · cites this paper as [22]

  • Six studies found no association between SES measures and age at ASD diagnosis.

    “Six studies found no association between SES measures and age at diagnosis, including three studies using samples from outside of the United States [22, 27, 29, 30, 34, and 42].”

    From Explaining differences in age at autism spectrum disorder diagnosis: A critical review (2014) · cites this paper as [22]

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Authors
Fountain, C., King, M. D., & Bearman, P. S.
Affiliations
Columbia University (US)
Corresponding author
Bearman, Peter S
ORCID
Venue
Journal of Epidemiology and Community Health
Publisher
BMJ
Published
2010-10-25
Volume
65
Issue
6
Pages
503-510
ISSN
  • 0141-7681 (ISSN-L)
  • 0143-005X
  • 1470-2738
DOI
10.1136/jech.2009.104588
PMC
PMC3039707
OpenAlex
W2110150914
Cited by
359
References
14
Citations by year
2026: 14 · 2025: 12 · 2024: 12 · 2023: 21 · 2022: 31 · 2021: 39 · 2020: 39 · 2019: 33 · 2018: 33 · 2017: 20 · 2016: 25 · 2015: 23 · 2014: 21 · 2013: 18 · 2012: 14
FWCI
6.79
Type
journal article
Language
en
Open access
Locations
  • Journal of Epidemiology & Community Health (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
  • Columbia Academic Commons (Columbia University)
Funders
National Institutes of Health (DP1OD003635)
Topics
  • Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
  • Social Sciences › Psychology › Clinical Psychology › Family and Disability Support Research
  • Health Sciences › Medicine › Psychiatry and Mental health › Child Nutrition and Feeding Issues
Keywords
autism spectrum disorder, age at diagnosis, birth cohort, autism incidence, parental education, socioeconomic status, autism screening, early intervention, autism prevalence, child psychiatrists
MeSH terms
Age Factors, Autistic Disorder, California, Child, Child, Preschool, Educational Status, Female, Health Policy, Humans, Male, Parents, Regression Analysis, Social Class, Cohort Studies, Age of Onset

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