Autism From 2 to 9 Years of Age

TLDR

Autism represents an unusual pattern of development beginning in the infant and toddler years. The study examined the stability of autism spectrum diagnoses from ages 2 to 9 and identified features that predicted later diagnosis. The authors conducted a prospective cohort study of 192 autism referrals and 22 developmental‑delay controls, using ADI‑R, ADOS, and clinical diagnoses at ages 2 and 9, with consensus best‑estimate diagnoses at 9 years and a 67 % agreement (κ 0.72) with 2‑year diagnoses. Diagnostic stability was high for autism from age 2 to 9 (67 % agreement, κ 0.72), with most changes reflecting a shift from PDD‑NOS to autism; all age‑2 measures were strong predictors (OR 6.6–12.8), and after adjusting for verbal IQ, ADI‑R repetitive and ADOS social/repetitive domains remained significant, while experienced clinicians’ judgments consistently added predictive value.

Abstract

Autism represents an unusual pattern of development beginning in the infant and toddler years.To examine the stability of autism spectrum diagnoses made at ages 2 through 9 years and identify features that predicted later diagnosis.Prospective study of diagnostic classifications from standardized instruments including a parent interview (Autism Diagnostic Interview-Revised [ADI-R]), an observational scale (Pre-Linguistic Autism Diagnostic Observation Schedule/Autism Diagnostic Observation Schedule [ADOS]), and independent clinical diagnoses made at ages 2 and 9 years compared with a clinical research team's criterion standard diagnoses.Three inception cohorts: consecutive referrals for autism assessment to (1) state-funded community autism centers, (2) a private university autism clinic, and (3) case controls with developmental delay from community clinics.At 2 years of age, 192 autism referrals and 22 developmentally delayed case controls; 172 children seen at 9 years of age.Consensus best-estimate diagnoses at 9 years of age.Percentage agreement between best-estimate diagnoses at 2 and 9 years of age was 67, with a weighted kappa of 0.72. Diagnostic change was primarily accounted for by movement from pervasive developmental disorder not otherwise specified to autism. Each measure at age 2 years was strongly prognostic for autism at age 9 years, with odds ratios of 6.6 for parent interview, 6.8 for observation, and 12.8 for clinical judgment. Once verbal IQ (P = .001) was taken into account at age 2 years, the ADI-R repetitive domain (P = .02) and the ADOS social (P = .05) and repetitive domains (P = .005) significantly predicted autism at age 9 years.Diagnostic stability at age 9 years was very high for autism at age 2 years and less strong for pervasive developmental disorder not otherwise specified. Judgment of experienced clinicians, trained on standard instruments, consistently added to information available from parent interview and standardized observation.