Diagnosis of Autism in School Age and Adolescence in an Ethnically Diverse Population.

Despite policy emphasis on early identification, many children with Autism are diagnosed late, with some being diagnosed as late as adolescence. The objective of this study was to examine the demographics and clinical characteristics of school-age children and adolescents initially diagnosed with Autism age 7 and older, in an urban, university-affiliated multidisciplinary center that evaluates/treats youth with developmental disabilities. A chart review of all school-age children and adolescents referred for evaluation to determine if the child has developmental disabilities from January 2019 to May 2023 was performed. Of all children evaluated in that period (n = 825), 164 (19.8%) were diagnosed with Autism, 123 (75%) had a previous diagnosis, and 41 (25%) were newly diagnosed with Autism. Patients newly diagnosed with Autism age ≥7 were more likely to be diagnosed with Language Disorder (100% vs. 82%, p = 0.001) and Anxiety Disorder (27% vs. 13%, p = 0.04), be prescribed with an antidepressant (10% vs. 1%, p = 0.03), and less likely to be diagnosed with Intellectual Disabilities (13% vs. 34%, p = 0.001) than those who had a previous diagnosis of Autism, with no other differences in demographics or developmental diagnosis between the groups. Of the 136 patients referred for evaluation with a previous diagnosis of Autism, 13 (9.5%) did not meet the criteria for Autism any longer after multidisciplinary evaluations but continued to present developmental disorders, including Language Disorder (100%), attention-deficit/hyperactivity disorder (46%), and Speech Sound Disorder (38%). Of the 87 families who were concerned about Autism (without a previous diagnosis), 32 (36.8%) confirmed the diagnosis of Autism, 9 (1.5%) patients were newly diagnosed with Autism, and there were no parental concerns. In conclusion, in this ethnically diverse group of school-age children and adolescents with developmental disabilities, 25% received an initial diagnosis of Autism after age 7. Similar to previous reports, children who received a later diagnosis were more likely to present a language impairment, anxiety, and higher cognitive skills. Longitudinal studies, in ethnically diverse populations, are necessary to understand the trajectory and clinical profile of Autism.

Remote Learning Experience for Children With Developmental Disabilities During COVID-19 Pandemic in an Ethnically Diverse Community.

Owing to the COVID-19 pandemic, K-12 education in New York City quickly transitioned to remote learning. We performed a structured interview with 50 consecutive families of children with developmental disabilities about their experience with remote learning 2 months after COVID-19 lockdown. We observed that setting up the remote learning system was challenging for families who were born outside of the United States, spoke limited English, or had a lower level of education. Though some special education supports were in place, remote learning for children with developmental disabilities led to gaps in their therapeutic services. Children with more severe developmental disabilities joined less than 2 hours of remote learning per day and had a decrease in their therapeutic services. Most children (80%) relied on their parents for education. Additionally, for low-income communities, with families who spoke languages other than English, remote learning revealed a new barrier to access: technology.

Screening for Depression in Adolescents with Developmental Disabilities: Brief Report.

Objectives: (1) To examine adherence of universal screening for adolescent depression at initial visits by using an established screening instrument (Patient Health Questionnaire 9 [PHQ-9]) in a university-affiliated urban developmental center that serves children with developmental disabilities (DDs); (2) to study the frequency of positive screening for depression in adolescents with DD. Methods: Review of all adolescents referred for multidisciplinary evaluation in a developmental center in 2019. Data included demographics, DD diagnoses, and use of and scores on the PHQ-9 at initial visit. Statistics included chi-square and non-parametrics. Results: Of all the children evaluated in 2019 (n = 240), 52 were adolescents, 35 boys (63%)/17 girls (37%), age 14 ± 2 years old, and 27 (54%) belonging to a bilingual English-Spanish household. DD: Developmental Language Disorder (88%), Learning Disabilities (54%), attention-deficit/hyperactivity disorder (44%), Autism Spectrum Disorder (25%), Intellectual Disabilities (12%), and Phonological Disorder (8%). The PHQ-9 was administered to 30 (58%) individuals. Scores varied from minimal depression for 17 (57%), mild for 10 (33%), and moderate and severe for 3 (10%); 3 patients endorsed suicidality. Females were more likely to obtain higher scores on the PHQ-9 than males. Adolescents diagnosed with Autism Spectrum Disorder, Intellectual Disabilities, and Phonological Disorder were less likely to be screened. Conclusion: More than half of the sample of urban adolescents with DD were screened for depression at initial visit, and 10% screened positive for moderate to severe depression. Efforts to follow the U.S. Preventive Services Task Force recommendation of universal screening of adolescent depression should continue. However, given challenges with reading and verbal abilities, screening modifications (reading to them) should be considered.

Social Differences Between Monolingual English and Bilingual English-Spanish Children With Autism Spectrum Disorders.

OBJECTIVE: Bilingualism is increasingly prevalent; however, research in bilingual children with autism is sparse. The purpose of this study was to compare social skills and autistic features in monolingual English and bilingual English-Spanish children with autism spectrum disorder. METHODS: We conducted a review of the multidisciplinary evaluations done in all children aged one to six years diagnosed with autism spectrum disorder in an inner city, university-affiliated clinic from 2003 to 2013. Collected information included demographics, developmental testing, and autistic characteristics. RESULTS: We identified 462 children; 165 were bilingual English-Spanish and 297 were monolingual English. Parents of bilingual children reported stereotyped or repetitive use of language more often (66% vs 48% P = 0.002) than monolinguals. Significant differences were not found in social interaction, use of nonverbal behaviors, peer relationships, sharing or social or emotional reciprocity, mannerisms, or autism severity. CONCLUSIONS: Bilingualism does not seem to confer an extra vulnerability on children with autism spectrum disorder; however, differences in qualitative use of language were observed.

When an Early Diagnosis of Autism Spectrum Disorder Resolves, What Remains?

A chart review was performed of 38 children diagnosed with autism spectrum disorder (ASD) by 3 years of age at an inner-city developmental program who subsequently experienced resolution of ASD symptomatology and no longer met diagnostic criteria for ASD at follow-up an average of 4 years later. Demographic, developmental/cognitive data, Childhood Autism Rating Scale, and Autism Diagnostic Observation Schedule data as available were reviewed from the initial diagnostic evaluation and at the time of follow-up. Services received by the children between the time of diagnosis and follow-up, educational setting at the time of follow-up, and emotional/behavioral and learning diagnoses made by the multidisciplinary team at follow-up were reviewed. The findings indicate that residual emotional/behavioral and learning problems were present at follow-up in the vast majority of children in this group and that the majority continued to require educational support.

Sleep Problems in Children With Autism and Other Developmental Disabilities: A Brief Report.

Sleep problems in children with autism and the association with child behavioral problems was studied in an ethnically diverse population, in a cross-sectional study with structured interview. Sample included 50 families of children with autism and 50 families of children with other developmental disabilities, matched by age/gender. Interview included Child Sleep Habits Questionnaire and Aberrant Behavior Checklist. In this ethnically diverse sample, at least 78% of families of children with autism reported significant sleep problems compared to 34% of families of children with other developmental disabilities. Specifically, children with autism reported more frequent bedtime resistance, sleep anxiety, and night wakings than children with other developmental disabilities. Across groups, sleep problems were related to child behavioral difficulties, including irritability and hyperactivity, although this association did not reach significance for the group with autism. Specifics in terms of the nature of sleep disorders will help our understanding and design of effective treatment options.

Parental Stress in Families of Children With Autism and Other Developmental Disabilities.

The level of parental stress in families of children with autism and other developmental disabilities and its association with child comorbid symptoms was studied in an ethnically diverse population, in a cross-sectional study with structured interview. The sample included 50 families of children with autism and 50 families of children with other developmental disabilities, matched by age/gender. Interview included Parenting Stress Index-Short Form, Gastrointestinal Questionnaire, Child Sleep Habits Questionnaire, and Aberrant Behavior Checklist. In this ethnically diverse sample, parental stress was significantly higher for the autism group and for non-Hispanic and US-born mothers. In both study groups, parental stress was related to child irritability. Parental stress was also related to gastrointestinal problems in the autism group and to sleep difficulties in the developmental disabilities group. Targeting child irritability may be particularly important in reducing parental stress for families of children with autism and other developmental disabilities.

Use of complementary and alternative medicine in children with autism and other developmental disabilities: associations with ethnicity, child comorbid symptoms, and parental stress.

The use of complementary and alternative medicine by children with autism and the association of its use with child comorbid symptoms and parental stress was studied in an ethnically diverse population, in a cross-sectional study with structured interviews. The sample included 50 families of children with autism and 50 families of children with other developmental disabilities, matched by age/gender. Interview included the Complementary and Alternative Medicine Questionnaire, Gastrointestinal Questionnaire, Children's Sleep Habits Questionnaire, Aberrant Behavior Checklist, and Parenting Stress Index. In this ethnically diverse sample, the use of complementary and alternative medicine was significantly higher for the autism group. In the autism group, use was significantly related to child's irritability, hyperactivity, food allergies, and parental stress; in the developmental disabilities group, there was no association with child comorbid symptoms or parental stress. The results contribute information to health care providers about families of children with autism who are more likely to use complementary and alternative medicine.

Language differences between monolingual English and bilingual English-Spanish young children with autism spectrum disorders.

Bilingualism is common worldwide and increasingly prevalent, but there is little information about bilingual children with autism spectrum disorder. The goal of the study was to compare expressive and receptive language skills in monolingual English and bilingual English-Spanish children with autism spectrum disorder. A review of the multidisciplinary evaluations done in toddlers who were diagnosed with autism spectrum disorder at a university-affiliated center between 2003 and 2010 was performed. Data included demographics, developmental testing, autistic characteristics, and expressive and receptive language skills, obtained from formal speech and language evaluation. A total of 80 toddlers were identified, 40 classified as bilingual English-Spanish. Compared with monolinguals, bilingual children were more likely to vocalize and utilize gestures, with no other differences in language skills. There were no differences in cognitive functioning and autistic features between the groups. In this study, bilingualism did not negatively affect language development in young children with autism spectrum disorder.

Age at diagnosis of autism spectrum disorders.

Early identification of autism has become a national priority but, despite efforts, there are children who are being identified at a later age. In this study, children of Hispanic and African American origin, foreign-born children, and children born to foreign mothers were more likely to be diagnosed later.