Impact of Preterm Birth Subtype on Risk of Diagnosis of Autism Spectrum Disorders in the Offspring.
Females with ASD are diagnosed later than males on average, likely due to stronger language masking social deficits — warranting earlier and more proactive screening.
01Research in Context
What this study did
et al. built a large, population-based U.S. cohort of people with autism spectrum disorder in Rhode Island.
The Rhode Island Consortium for Autism Research and Treatment (RI-CART) brought together all major points of service for families affected by ASD across the state.
Diagnosis was based on direct behavioral observation using the Autism Diagnostic Observation Schedule, Second Edition.
The first 1,000 participants ranged in age from 21 months to 64 years, and the cohort was estimated to represent between 20% and 49% of pediatric-age persons in Rhode Island with ASD.
What they found
Females received a first diagnosis of ASD at a later age than males.
The researchers noted this gap may reflect more advanced language abilities in females with ASD, allowing them to go undetected longer.
A high rate of co-occurring medical and psychiatric conditions was observed across participants.
How this fits with other research
et al. (2017) saw limited boy-girl diagnostic differences at the point of early-intervention entry. The RI-CART data show the gap clearly when looking at a broad, representative cohort — the two papers are complementary, not contradictory.
Perales-Marín et al. (2021) highlighted that different ASD subgroups carry distinct risk profiles. The RI-CART cohort provides the large representative sample needed to examine such subgroup questions rigorously.
Maeva et al. (2019) documented that even borderline preterm birth affects developmental outcomes. The RI-CART study adds that females in this population may face additional delays in receiving a formal ASD diagnosis.
Why it matters
If you assess girls for ASD and something feels off but the first screen looks borderline, trust the pattern and look again.
Females may mask social deficits with stronger language skills, delaying diagnosis and thus delaying intervention.
Ask about co-occurring medical and psychiatric conditions at intake — the data show they are common and warrant attention as part of any treatment plan.
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02At a glance
03Original abstract
The objective of this study was to establish a large, densely sampled, U.S. population-based cohort of people with autism spectrum disorder (ASD). The Rhode Island Consortium for Autism Research and Treatment (RI-CART) represents a unique public-private-academic collaboration involving all major points of service for families in Rhode Island affected by ASD. Diagnosis was based on direct behavioral observation via the Autism Diagnostic Observation Schedule, Second Edition. For the first 1,000 participants, ages ranged from 21 months to 64 years. Using Geographic Information System and published prevalence rates, the overall cohort is estimated to represent between 20% and 49% of pediatric age persons in Rhode Island with ASD, with demographics representative of U.S. Census. We observed a high rate of co-occurring medical and psychiatric conditions in affected individuals. Among the most prominent findings of immediate clinical importance, we found that females received a first diagnosis of ASD at a later age than males, potentially due to more advanced language abilities in females with ASD. In summary, this is the first analysis of a large, population-based U.S. cohort with ASD. Given the depth of sampling, the RI-CART study reflects an important new resource for studying ASD in a representative U.S. population. Psychiatric and medical comorbidities in ASD constitute a substantial burden and warrant adequate attention as part of overall treatment. Our study also suggests that new strategies for earlier diagnosis of ASD in females may be warranted. Autism Res 2020, 13: 474-488. © 2020 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: The Rhode Island Consortium for Autism Research and Treatment (RI-CART) represents a unique public-private-academic collaboration involving all major points of service for families in Rhode Island affected by autism spectrum disorder (ASD). In this article, we provide results from the first 1,000 participants, estimated to represent >20% of affected families in the state. Importantly, we find a later age at first diagnosis of ASD in females, which potentially calls attention to the need for improved early diagnosis in girls. Also, we report a high rate of co-occurring medical and psychiatric conditions in affected individuals.
Journal of autism and developmental disorders, 2025 · doi:10.1007/s10803-013-2016-3