2016 Gatlinburg Conference Poster
PS-51
Title: Caregiver Concerns Prior To a Diagnostic Evaluation: Differences between Children with and Without Autism Spectrum
Disorder
Authors: Anna Wallisch, Brenda Salley, Lauren Little
Introduction: Research suggests that parental concerns precede an Autism Spectrum Disorder (ASD) diagnosis; it is unclear if
specific types of concerns may be specific to children with ASD versus another developmental condition. While previous studies
have gathered parent-report data from high-risk samples (Ozonoff et al., 2009) or used retrospective reports, caregiver concerns
preceding a diagnosis of ASD in a large community based sample remain unexamined. Therefore, this study examined the extent
to which parent concerns differentiate children with an eventual diagnosis of ASD versus those without in a community based
sample aged 12 months-9 years.
Methods: This secondary data analysis of caregiver report data gathered prior to a child's diagnostic evaluation resulting in a
diagnosis of ASD (n=271) or non-ASD (including global developmental delay; n=314). We examined 3 groups of participants: (ages
0-3yrs; 3-6yrs; 6-9yrs) with a total of n=585 children. Concerns were coded from an intake form prior to diagnostic evaluations.
Coding was adapted from Ozonoff et al. (2009), and included: 1) Externalizing; 2) Cognitive development; 3) Medical; 4) Motor;
5) Speech/communication; 6) Social interaction; 7) Stereotyped behavior; 8) Sensory aversions/preferences; 9) Unspecified
autism; 10) Internalizing. We used binary logistic regression to determine the extent to which categories of caregiver concerns
predicted diagnostic group (ASD/non-ASD) in 3 age groups of children. In the youngest group, increased Externalizing (p<.05;
OR=.334) and Cognitive development (p<.05; OR=.221) differentiated children in the non-ASD group. In children 3-6 yrs,
increased Speech (p<.05; OR=1.640) and Social concerns (p<.01; OR=2.156) differentiated children with ASD. In the oldest group,
increased Social concerns differentiated children with ASD (p<.05; OR=2.433). These four concerns correctly classified 74.5% of
children 0-3yrs; 62.5% 3-6yrs; and 73.1% of children 6-9yrs.
Discussion: Results suggest that parental concerns may help predict a diagnosis of ASD, but distinct concerns differentiate ASD
across age groups. Children that do not receive an ASD diagnosis in the 0-3yr group have a higher likelihood of Cognitive
development and Externalizing concerns potentially due to the emphasis of reaching developmental milestones at this age.
Among children aged 3-6 years that received an ASD diagnosis, the likelihood of Speech and Social concerns was increased. This
may be due to the changing social demands on the child (e.g., preschool). At 3 years, many children are increasingly
demonstrating complex language and social play, and this may be a potential differentiating factor and concern for parents of
children with ASD. In children with a diagnosis of ASD aged 6-9 years, speech concerns diminish, and the likelihood of Social
concerns is very high. The social demands for children further increase, as children are expected to cooperatively play and
interact when entering kindergarten. Children in the 0-3yr group do not yet have this social press and parallel play is acceptable.
The study results indicate that the contextual demands on children based on age may assist in better cognizance of potential
parental concerns predicting a diagnosis of ASD. By understanding the parental concerns that best differentiate those with an
eventual ASD diagnosis, we can better monitor children at risk of a diagnosis and identify children earlier.
References/Citations:
• Ozonoff, S., Young, G. S., Steinfeld, M. B., Hill, M. M., Cook, I., Hutman, T., & Sigman, M. (2009). How early do parent
concerns predict later autism diagnosis?. Journal of developmental and behavioral pediatrics: JDBP, 30(5), 367.