Support for a dimensional view of autism spectrum disorders in toddlers.
Kids sent for autism testing look similar on skills whether they get the diagnosis or not, but only the ASD group wins strong school help.
01Research in Context
What this study did
Lerner et al. (2012) looked at toddlers sent to an autism clinic. They compared kids who later got an ASD label with kids who did not.
All children took the same developmental tests. The team asked: do test scores match the final yes-or-no diagnosis?
What they found
The two groups scored almost the same on language, play, and cognitive tests. The kids without ASD were only a hair ahead.
Both groups still lagged far behind typically developing peers. Yet only the ASD-labeled group received strong school supports.
How this fits with other research
Latham et al. (2014) extends this view. They followed 80 children diagnosed before age three. One in five lost the ASD label by school age, but most still needed help.
Ilan et al. (2021) conceptually replicate the mismatch. Preschoolers with ASD showed the same test scores whether they sat in special-ed or mainstream rooms.
Keen et al. (2004) saw the same problem years earlier. Cognitive scores rarely lined up with classroom placement in the UK. The 2012 study shows the gap still exists.
Why it matters
Binary diagnosis should not gate services. If a toddler shows delays, write goals for those delays, not for the label. Push for IEP teams to look at test scores and daily function, not just the ASD checkbox.
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02At a glance
03Original abstract
Functional abilities in children with autism spectrum disorder (ASD) are highly heterogenous, and impairments can overlap with non-ASD neurodevelopmental disorders. We compared the profiles of children assessed for ASD with and without an ASD diagnosis using a retrospective cohort study of 101,739 children born in British Columbia (2000-2008). The children were grouped into the following five comparison groups: (1) ASD- (n = 1131), (2) ASD+ (n = 1583), (3) Ministry of Education designated ASD+ (n = 654), (4) special need other than ASD (n = 11,663), and (5) typically developing (n = 86,708). Five developmental domains were assessed using the Early Development Instrument. ANCOVA was used to control for covariates, Tukey's HSD test for multiple comparisons, and Cohen's d for effect size. The ASD- group had slightly higher scores than the ASD+ group with small to medium effect sizes in all domains (d = 0.20-0.48). The ASD- group had slightly higher scores than the Ministry of Education ASD+ group in only three domains with small effect sizes (d = 0.21-0.25). The ASD- group had lower scores in all domains compared to the typically developing group with large effect sizes in all domains (d = 1.12-1.77). The ASD- group received less education funding at school entry than both ASD+ groups. Overall, only small to medium differences in development were detected between the ASD- and ASD+ groups. While these children differ diagnostically, they share similar functional profiles and have substantially more difficulties than typically developing children. Therefore, differences in levels of support at school entry raise critical questions of equity. LAY SUMMARY: Comparison of children in British Columbia who have been referred for an autism assessment, with or without a diagnosis, shows similarities in their functional and developmental profiles in kindergarten. Furthermore, both groups of children have more difficulties than typically developing children. However, children who have been referred for assessment without an autism diagnosis receive less financial support at school entry, raising important questions on equity.
Journal of autism and developmental disorders, 2012 · doi:10.1007/s10803-011-1230-0