Factors associated with age of diagnosis in children with autism spectrum disorders: Report from a French cohort.
Free health care helps, but kids with mild autism still wait until after age 5 unless you actively screen.
01Research in Context
What this study did
Rattaz et al. (2022) tracked 4-year-olds in France who were later diagnosed with autism.
They looked at what made some kids get the label before age 3 and others wait until after age 5.
France gives every child free health care, so money should not slow families down.
What they found
Kids who also had intellectual disability or very clear autism signs were spotted before age 3.
Children with milder traits waited until after age 5.
Family income and parent jobs did not change the timing.
How this fits with other research
van 't Hof et al. (2021) pooled 40 countries and still found the world average sits at age 5.
The French number matches that global picture, showing universal care alone does not move the needle.
Fernell et al. (2010) saw the same early-ID pattern in Sweden: kids with ASD plus ID get flagged sooner.
Koller et al. (2021) looked at Jerusalem and saw ethnic gaps after age 6; France shows no SES gap, hinting that universal coverage may erase income effects but not severity effects.
Why it matters
Even when families pay nothing, mild autism still hides in plain sight until school age.
Screen preschoolers with subtle language or peer-play delays; do not wait for red-flag behaviors.
A quick social-communication check at every well-child visit can pull these kids into early intervention before the average 4.9-year mark.
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02At a glance
03Original abstract
Autism spectrum disorder is an early onset neurodevelopmental disorder and diagnosis can be made as early as 18 months of age. Early diagnosis of autism spectrum disorder is critical as it leads to early intervention. Age of autism spectrum disorder diagnosis has been linked to the child profile as autism spectrum disorder is characterized by strong heterogeneity, but is also influenced by socio-economic factors. There is paucity of data on age of diagnosis of autism spectrum disorder in France. We therefore examined the age of autism spectrum disorder diagnosis in 554 children and adolescents enrolled in the ELENA cohort study with respect to the influences of child profile, family antecedents, and socio-economic factors. The mean age of diagnosis was 4.9 years (±2.8 years). Early diagnosis, before 3 years of age, was related to the co-occurrence of intellectual disability, higher autism spectrum disorder symptom severity, and lower communicative abilities. Children in low socio-economic status families tended to have an earlier diagnosis, but these children also had greater degree of intellectual impairment compared to children in high socio-economic status families. The age of autism spectrum disorder diagnosis was not associated with the presence of an older sibling with autism spectrum disorder. The observed current trend of an inverse relationship between socio-economic status and age of diagnosis of autism spectrum disorder suggests equitable access to autism spectrum disorder services in France where health coverage is universal and free. Better screening of more subtle/less severe forms of autism spectrum disorder is needed, as well as further assessment of the link between the co-occurrence of autism spectrum disorder and intellectual impairment in children in lower socio-economic status families.
Autism : the international journal of research and practice, 2022 · doi:10.1177/13623613221077724