Retention of autism spectrum disorder diagnosis: The role of co-occurring conditions in males and females

Authors

Yen-Tzu Wu, National Taiwan University College of Medicine
Matthew J. Maenner, Centers for Disease Control and Prevention
Lisa D. Wiggins, Centers for Disease Control and Prevention
Catherine E. Rice, Emory University School of Medicine
Catherine C. Bradley, Medical University of South Carolina
Maya L. Lopez, Emory University School of Medicine
Russell S. Kirby, University of South Florida
Li-Ching Lee, Johns Hopkins Bloomberg School of Public Health

Date of this Version

2016

Citation

Research in Autism Spectrum Disorders 25 (2016) 76-86

Comments

U.S. Government Work

Abstract

This study examined aSSOCiatIOns between ASD diagnosis retention and non-ASD cooccurring conditions (CoCs) by child sex. The sample included 7077 males and 1487 females who had an ASD diagnosis documented in their school or health records in a populationbased ASD surveillance system for 8-year-old children. ASD diagnosis retention status was determined when an initial ASD diagnosis was not later ruled out by a community professional. We found that ASD diagnosis remains fairly stable, with only 9% of children who had an initial documented ASD diagnosis later being ruled-out. Although most of the associations between the ASD diagnosis retention status and CoCs are similar in both sexes, the co-occurrence of developmental diagnoses (e.g., intellectual disability or sensory integration disorder) was predictive of ASD diagnostic changes in males, whereas the cooccurrence of specific developmental (e.g., personal/social delay) and neurological diagnosis (e.g., epilepsy) was associated with ASD diagnostic change in females. More ASD-related evaluations and less ASD-related impairment were associated with later ASD rule outs in both sexes. Our findings highlight that CoCs can complicate the diagnostic picture and lead to an increased likelihood of ambiguity in ASD diagnosis. Using sensitive and appropriate measures in clinical practice is necessary for differential diagnosis, particularly when there are co-occurring developmental conditions.