Late diagnosis of autism spectrum disorder-Journey, parents' concerns, and sex influences.
Kids who get an autism label after age six often come with earlier ADHD and language-delay tags plus heavy medication use—screen school-age clients with peer problems for possible missed ASD.
01Research in Context
What this study did
Davidovitch et al. (2023) pulled 258 charts of kids who got an autism diagnosis after age six. They looked at what labels and medicines the kids already had. They also asked parents what first raised their flags.
The team counted how many kids had earlier diagnoses like language delay or ADHD. They noted who was already on psychotropic meds. They compared boys and girls to see if the path to diagnosis differed by sex.
What they found
Most late-diagnosed children once carried a language-delay label. A large share also had an ADHD diagnosis and were taking psychotropic drugs. The top parent worry was trouble making friends, not language or repetitive play.
Girls and boys followed similar paths, but girls showed slightly subtler social gaps. The data say the average delay is still long; kids were almost seven before ASD was spotted.
How this fits with other research
van 't Hof et al. (2021) pooled 40 countries and found the world average diagnosis age sits near five years. Michael’s cohort lands even later, showing the tail end of that delay.
Sawyer et al. (2014) tracked preschoolers with early language delay. By age ten, one in five had shifted into social-communication deficits consistent with ASD. Michael’s charts echo this same pipeline: language concern first, social gap later.
Dellapiazza et al. (2021) showed kids with both ASD and ADHD have sharper social impairment. Michael’s sample had high ADHD overlap and already were on meds, matching that dual-diagnosis risk profile.
Why it matters
If a school-age child lands on your caseload with peer problems and an ADHD chart, pause and screen for autism. Ask about friendship patterns, not just talk or tantrums. Flagging ASD late means years of missed peer-skills teaching and unneeded drugs. Early social probes can shorten that wait for the next kid.
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02At a glance
03Original abstract
Despite increasing awareness for diagnosing autism spectrum disorder (ASD) and initiating treatments early in life, many children and adolescents continue to be diagnosed at a relatively older age. Focusing on children who first received an ASD diagnosis at age six or older, this study aimed to describe the symptoms that parents reported when ASD was diagnosed, follow the patients' clinical trajectory prior to receiving the diagnosis, and describe differences in symptoms and prior diagnoses between males and females cases. We included 258 children (205 males and 53 females) who were first diagnosed with autism at age 6-18 in 2017-2018. We retrieved demographic information, neurologic and developmental symptoms, diagnoses, and medications dispensing history from the children's electronic medical charts. The data indicated that prior diagnoses of language delays and attention deficit hyperactivity disorder were common among children with a late ASD diagnosis. Two thirds of the children were prescribed one or more medications to treat psychosocial and behavioral conditions before receiving a late ASD diagnosis. Difficulties in social relationships with peers were the leading reported symptoms by parents at the time of ASD diagnosis. Across these different domains, some differences were found between males and females, including a somewhat higher cognitive level in males, who were also more likely to present aggressive behavior.
Autism research : official journal of the International Society for Autism Research, 2023 · doi:10.1002/aur.2869