Early identification in autism: Subtypes based on child, family, and community characteristics

Abstract

Background. Disparities exist in the early identification of underserved children with ASD. Research suggests early parent concerns may be predictive of eventual child diagnosis and may aid in earlier identification of children with ASD. Our study used a large medical university sample to examine latent subtypes of children with an eventual ASD diagnosis based on parent concerns and socio-demographics. Methods. Prior to a diagnostic evaluation, parents reported their top three concerns on intake paperwork for 712 children 12 months- 12 years of age. Parent concerns were coded into eight concern categories. We performed a latent class analysis to examine subtypes based on parent concerns, child (i.e., age and gender), family (i.e., socioeconomic status), and community characteristics (i.e., access to service providers). We used a MANOVA to examine latent class differences by age at the diagnostic evaluation and age of a parent’s first concern. Results. Parent concerns and socio-demographics distinguished five latent classes. Two subtypes were identified younger (i.e., 3.5 years of age) and were differentiated by two parent concerns: communication and medical concerns. One of the younger subtypes included non-white, Hispanic children utilizing Medicaid. One subtype was identified around kindergarten and was differentiated by stereotyped and by developmental parent concerns. Lastly, two subtypes were identified at an older age (i.e., 9 years of age) with either developmental concerns, or social and behavior concerns. One of the oldest subtypes was characterized by females with ASD. Conclusion. Our study suggests that children with communication concerns are most likely identified by parents earlier, regardless of race, ethnicity, or SES. However, our findings point to the difficulty in identifying females with ASD, as well as children with social, behavior, and stereotyped parent concerns.