Children currently diagnosed with an autism spectrum disorder are more likely to have coexisting psychiatric or neurodevelopmental conditions than are children with a past but not current diagnosis, and these conditions might lead to a change in ASD diagnosis, suggest the findings of a cross-sectional study in the February issue of Pediatrics.
An estimated 1% of 8-year-old children (typically the peak age of prevalence) have an ASD, such as autistic disorder; pervasive developmental disorder, not otherwise specified (PDD-NOS); or Asperger’s syndrome, according to the Centers for Disease Control and Prevention. Co-occurring conditions often include attention-deficit/hyperactivity disorder, learning disability, depression, anxiety, and seizures. Also, more than 10% of children diagnosed with an ASD at age 2 years no longer have the diagnosis by age 9 years.
To provide an appropriate diagnosis and opportunities for early intervention, clinicians must be able to differentiate between the core features of an ASD and any coexisting conditions.
Using cross-sectional data from the National Survey of Children’s Health 2007 (NSCH), Heather A. Close, of the Center for Autism and Developmental Disabilities Epidemiology at Johns Hopkins University, Baltimore, and her colleagues examined the relationship between co-occurring conditions and changes in diagnosis of an ASD (Pediatrics 2012;129:305-16 [doi:10.1542/peds.2011-1217]). This study consisted of 1,366 children from the NSCH with a parent-reported current or a past but not current (PBNC) diagnosis of an ASD.
The study authors found that the type of co-occurring conditions varied by age. For example, 3- to 5-year-old children currently diagnosed with an ASD were 11 times more likely to have a moderate or severe learning disability and 9 times more likely to have a moderate or severe developmental delay than children with a PBNC diagnosis. They were nearly 5 times more likely to have two or more current co-occurring conditions than children with a PBNC diagnosis of an ASD.
Meanwhile, children aged 6-11 years with a current ASD diagnosis were almost 4 times more likely to have had a past speech problem and 3.5 times more likely to have current moderate or severe anxiety than children with a PBNC diagnosis. And, they were more than 3 times as likely to have two or more current co-occurring conditions as those with a PBNC diagnosis.
Finally, adolescents aged 12-17 years with a current ASD diagnosis were almost 4 times more likely to have moderate or severe speech problems and 10 times more likely to have current mild seizures or epilepsy than children with a PBNC diagnosis of ASD.
Children and adolescents with a current ASD diagnosis were more likely to have two or more co-occurring conditions than those with a PBNC diagnosis.
The study results suggest that some co-occurring conditions might, in part, lead to a change in an ASD diagnosis, although the underlying mechanisms for this change are unclear. In this study, the researchers focused on the possible impact that neurodevelopmental and psychiatric conditions could have on the continuation of ASD diagnosis by comparing groups who currently have an ASD diagnosis to groups with a PBNC diagnosis.
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