Disparities in Diagnoses Received Prior to a Diagnosis of Autism Spectrum Disorder

Center for Autism and Developmental Disabilities Research and Epidemiology, University of Pennsylvania, Philadelphia, PA, USA.
Journal of Autism and Developmental Disorders (Impact Factor: 3.34). 11/2007; 37(9):1795-802. DOI: 10.1007/s10803-006-0314-8
Source: PubMed

ABSTRACT This study estimated differences by ethnicity in the diagnoses assigned prior to the diagnosis of autism. In this sample of 406 Medicaid-eligible children, African-Americans were 2.6 times less likely than white children to receive an autism diagnosis on their first specialty care visit. Among children who did not receive an autism diagnosis on their first visit, ADHD was the most common diagnosis. African-American children were 5.1 times more likely than white children to receive a diagnosis of adjustment disorder than of ADHD, and 2.4 times more likely to receive a diagnosis of conduct disorder than of ADHD. Differences in diagnostic patterns by ethnicity suggest possible variations in parents' descriptions of symptoms, clinician interpretations and expectations, or symptom presentation.


Available from: Jennifer Pinto-Martin, Jan 20, 2014
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    ABSTRACT: Although problems with expressive language are very common in both the general population (15 to 20%) as well as in clinical settings (50 to 75%), detection of such problems remains insufficient. Language problems require attention, as they are often associated with severe developmental disorders, such as autism, Asperger’s syndrome, attention deficit hyperactivity disorder (ADHD) and mental retardation. In theory, the vocabulary associated with these psychiatric disorders could be identified with an instrument that measures expressive vocabulary. Objectives 1. To determine the incidence of language delay (LD) (LDS d»50 words) in a sample of children with development typical of the community. 2. To determine the vocabulary level for the following subgroups: autism, Asperger’s syndrome, ADHD and other psychiatric disorders (OPD), through the use of the Language Development Survey (LDS). 3. To analyze whether the LDS is able to differentiate between these clinical subgroups. Subjects and Method The sample was composed of: a community group with typical development (TDG) (n=302), and a clinical group (CG) (n=55), both with age range between 2 and 5 years. Four clinical subgroups were formed: autism, Asperger’s syndrome, ADHD, and an OPD group (enuresis, encopresis, separation anxiety). The LDS is made up of a list of words identified by the parent on the vocabulary of children with a Cronbach’s alpha coefficient of 0.99, a test-retest coefficient of .97 to .99 and sensitivity and specificity of 86-90%. The definition used for Language Delay (LD) was based on a cutoff of ≤50 words. Statistical Analysis. Categorical data was analyzed using the chi-squared test, while continuous measurements such as age, socioeconomic status and LDS score were analyzed using Student’s t-test. A Kruskal-Wallis test was applied for contrast analysis of the mean LDS scores between groups. Results The groups were similar for variables such as the child’s age, parents’ age and mean LDS score. The incidence of LD (≤50 words) was 21.2% for the TDG and 23.6% for the clinical population. Male children showed a higher incidence of language delay (TDG: 21.6% for males and 20.7% for females, (p<0.926), CG: 26.2% for males and 15.4% for females, (p<0.423). The vocabulary of the Autism group was the smallest of all subgroups (M=85, SD= 78.68) followed by the OPD group (M=149, SD=121.0), which demonstrated a performance level similar to that of the community group (TDG) (M=179, SD=105.0). The Asperger’s group (M=259, SD=127) had a similar score to that of the ADHD group (M=286, SD=100.25). The Kruskal-Wallis oneway analysis of variance in mean scores was significant (p<.002), but the only significant inter-group contrast was between the autism and ADHD groups (M=85 vs. M=286, p<.01). Discussion The incidence of LD for the TDG was 21.6% and for the CG was 23.6%. The LDS was sensitive to the detection of vocabulary level between the groups, and the results were consistent with expected performance, with certain exceptions. Children with ADHD expressed a higher number of words as compared to the TDG. The only significant contrast was between the ADHD group and the autism group. The vocabulary of the Asperger’s group was greater than that of the autism group, although this difference was not statistically significant. Conclusions The Mexican version of the LDS is a useful screening tool for identifying language delay in preschool-age children. This study demonstrates that language delay in a preschool-age child with ADHD may indicate the need to further an Autism diagnosis. That being said, other disorders that can accompany ADHD must also be considered, including specific language impairments (pronunciation, expression, comprehension). The LDS measures vocabulary, but does not identify the complex qualitative language impairments often associated with Asperger’s syndrome.