Rural-Urban Differences in Age at Autism Diagnosis: A Multiple Model Analysis
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Abstract
Objective: Early recognition of autism is important, but diagnosis age varies among children. Recent studies have aimed to identify factors affecting age of diagnosis and several studies have attempted to explore geographic variation in age at diagnosis of autism. However, there is a lack of research examining geographic variations with multiple models to find whether geographic differences can be explained by risk factors such as socioeconomic status and differences in child characteristics. This study aimed to address this gap of knowledge by comparing age at diagnosis of autism between the group of people living in the center of the province and the group of people living in the rest of the province, considering potential medical and socioeconomic confounders.
Method: The study population consisted of 50 autistic children born in East Azerbaijan Province between 2004 and 2016. Initially, univariate testing by ANOVA was performed to identify family and individual factors contributing to differences in age at autism diagnosis. Following this, the association between living in the center of the province and age at diagnosis in univariate and multivariate analyses was examined.
Results: Results from the initial univariate analysis indicate a significant association between living in the center of province and early diagnosis. However, inclusion of possible confounders in multiple model illustrates that these geographical disparities in age at diagnosis can be explained by differences in socioeconomic and medical status.
Conclusion: Although geographic variation in age at diagnosis of autism was observed, analyses show that differences in individual and family-level factors may contribute to geographic differences. In this study, most of the observed variation was accounted for by family-level factors rather than geographic policies. Findings prove that multiple strategies are required to identify targeted interventions and strategies.
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28. Ghahari N, Hosseinali F, Cervantes de Blois CL, Alesheikh H. A space-time analysis of disparities in age at diagnosis of autism spectrum disorder: environmental and socioeconomic risk factors. J Environ Health Sci Eng. 2021;19(2):1941-50.
29. Spaan E, Mathijssen J, Tromp N, McBain F, ten Have A, Baltussen R. The impact of health insurance in Africa and Asia: a systematic review. Bull World Health Organ. 2012;90(9):685-92.
30. Skinner AC, Mayer ML. Effects of insurance status on children's access to specialty care: a systematic review of the literature. BMC Health Serv Res. 2007;7:194.
31. Kasper JD, Giovannini TA, Hoffman C. Gaining and losing health insurance: strengthening the evidence for effects on access to care and health outcomes. Med Care Res Rev. 2000;57(3):298-318; discussion 319-25.
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33. Bernstein J, Chollet D, Peterson S. How does insurance coverage improve health outcomes. Mathematica, Inc. 2010;1:1-10.
34. DeRigne L, Porterfield S, Metz S. The influence of health insurance on parent’s reports of children’s unmet mental health needs. Maternal and Child Health Journal. 2009;13(2):176-86.
35. Thomas P, Zahorodny W, Peng B, Kim S, Jani N, Halperin W, et al. The association of autism diagnosis with socioeconomic status. Autism. 2012;16(2):201-13.
36. Hrdlicka M, Vacova M, Oslejskova H, Gondzova V, Vadlejchova I, Kocourkova J, et al. Age at diagnosis of autism spectrum disorders: is there an association with socioeconomic status and family self-education about autism? Neuropsychiatr Dis Treat. 2016;12:1639-44.
37. Volkmar FR, Nelson DS. Seizure disorders in autism. JAACAP. 1990;29(1):127-9.
38. Saemundsen E, Ludvigsson P, Hilmarsdottir I, Rafnsson V. Autism spectrum disorders in children with seizures in the first year of life - a population-based study. Epilepsia. 2007;48(9):1724-30.
39. Saemundsen E, Ludvigsson P, Rafnsson V. Autism spectrum disorders in children with a history of infantile spasms: a population-based study. J Child Neurol. 2007;22(9):1102-7.
40. Gillberg C, Billstedt E. Autism and Asperger syndrome: coexistence with other clinical disorders. Acta Psychiatr Scand. 2000;102(5):321-30.
41. Cheung R, O'Donnell S, Madi N, Goldner E. Factors associated with delayed diagnosis of mood and/or anxiety disorders. Health Promot Chronic Dis Prev Can. 2017;37(5):137-48.
42. Bickel J, Bridgemohan C, Sideridis G, Huntington N. Child and family characteristics associated with age of diagnosis of an autism spectrum disorder in a tertiary care setting. J Dev Behav Pediatr. 2015;36(1):1-7.
43. Herlihy L, Knoch K, Vibert B, Fein D. Parents' first concerns about toddlers with autism spectrum disorder: effect of sibling status. Autism. 2015;19(1):20-8.
2. Yousefian F, Mahvi AH, Yunesian M, Hassanvand MS, Kashani H, Amini H. Long-term exposure to ambient air pollution and autism spectrum disorder in children: A case-control study in Tehran, Iran. Sci Total Environ. 2018;643:1216-22.
3. Salar S, Daneshmandi H, Karimizadeh Ardakani M, Nazari Sharif H. The Relationship of Core Strength with Static and Dynamic Balance in Children with Autism. Ann. Appl. Sport Sci. 2014;2(4):33-42.
4. Baxter AJ, Brugha TS, Erskine HE, Scheurer RW, Vos T, Scott JG. The epidemiology and global burden of autism spectrum disorders. Psychol Med. 2015;45(3):601-13.
5. Fombonne E. Epidemiology of pervasive developmental disorders. Pediatr Res. 2009;65(6):591-8.
6. Gray DE. Accommodation, resistance and transcendence: three narratives of autism. Soc Sci Med. 2001;53(9):1247-57.
7. Karst JS, Van Hecke AV. Parent and family impact of autism spectrum disorders: a review and proposed model for intervention evaluation. Clin Child Fam Psychol Rev. 2012;15(3):247-77.
8. Mandell DS, Novak MM, Zubritsky CD. Factors associated with age of diagnosis among children with autism spectrum disorders. Pediatrics. 2005;116(6):1480-6.
9. Fernell E, Eriksson MA, Gillberg C. Early diagnosis of autism and impact on prognosis: a narrative review. Clin Epidemiol. 2013;5:33-43.
10. Estes A, Swain DM, MacDuffie KE. The effects of early autism intervention on parents and family adaptive functioning. Pediatr Med. 2019;2.
11. Dawson G. Early behavioral intervention, brain plasticity, and the prevention of autism spectrum disorder. Dev Psychopathol. 2008;20(3):775-803.
12. Bryson SE, Rogers SJ, Fombonne E. Autism spectrum disorders: early detection, intervention, education, and psychopharmacological management. Can J Psychiatry. 2003;48(8):506-16.
13. Rogers SJ. Brief report: early intervention in autism. J Autism Dev Disord. 1996;26(2):243-6.
14. Daniels AM, Mandell DS. Explaining differences in age at autism spectrum disorder diagnosis: a critical review. Autism. 2014;18(5):583-97.
15. Mandell DS, Wiggins LD, Carpenter LA, Daniels J, DiGuiseppi C, Durkin MS, et al. Racial/ethnic disparities in the identification of children with autism spectrum disorders. Am J Public Health. 2009;99(3):493-8.
16. Kelly B, Williams S, Collins S, Mushtaq F, Mon-Williams M, Wright B, et al. The association between socioeconomic status and autism diagnosis in the United Kingdom for children aged 5-8 years of age: Findings from the Born in Bradford cohort. Autism. 2019;23(1):131-40.
17. Rosenberg RE, Landa R, Law JK, Stuart EA, Law PA. Factors affecting age at initial autism spectrum disorder diagnosis in a national survey. Autism Res Treat. 2011;2011:874619.
18. Ouellette-Kuntz HM, Coo H, Lam M, Yu CT, Breitenbach MM, Hennessey PE, et al. Age at diagnosis of autism spectrum disorders in four regions of Canada. Can J Public Health. 2009;100(4):268-73.
19. Kalkbrenner AE, Daniels JL, Emch M, Morrissey J, Poole C, Chen JC. Geographic access to health services and diagnosis with an autism spectrum disorder. Ann Epidemiol. 2011;21(4):304-10.
20. Mandell DS, Palmer R. Differences among states in the identification of autistic spectrum disorders. Arch Pediatr Adolesc Med. 2005;159(3):266-9.
21. Hair JF, Black WC, Babin BJ, Anderson RE, Tatham RL. Multivariate data analysis. Upper Saddle River, NJ: Pearson/Prentice Hall. 2006 (Vol. 6).
22. Barbaro J, Halder S. Early identification of autism spectrum disorder: Current challenges and future global directions. Curr Dev Disord Rep. 2016;3(1):67-74.
23. Cooper K, Smith LGE, Russell AJ. Gender Identity in Autism: Sex Differences in Social Affiliation with Gender Groups. J Autism Dev Disord. 2018;48(12):3995-4006.
24. Geurts HM, Jansen MD. A retrospective chart study: the pathway to a diagnosis for adults referred for ASD assessment. Autism. 2012;16(3):299-305.
25. Wiggins LD, Baio J, Rice C. Examination of the time between first evaluation and first autism spectrum diagnosis in a population-based sample. J Dev Behav Pediatr. 2006;27(2 Suppl):S79-87.
26. Crick NR, Zahn-Waxler C. The development of psychopathology in females and males: current progress and future challenges. Dev Psychopathol. 2003;15(3):719-42.
27. Holtmann M, Bölte S, Poustka F. Autism spectrum disorders: sex differences in autistic behaviour domains and coexisting psychopathology. Dev Med Child Neurol. 2007;49(5):361-6.
28. Ghahari N, Hosseinali F, Cervantes de Blois CL, Alesheikh H. A space-time analysis of disparities in age at diagnosis of autism spectrum disorder: environmental and socioeconomic risk factors. J Environ Health Sci Eng. 2021;19(2):1941-50.
29. Spaan E, Mathijssen J, Tromp N, McBain F, ten Have A, Baltussen R. The impact of health insurance in Africa and Asia: a systematic review. Bull World Health Organ. 2012;90(9):685-92.
30. Skinner AC, Mayer ML. Effects of insurance status on children's access to specialty care: a systematic review of the literature. BMC Health Serv Res. 2007;7:194.
31. Kasper JD, Giovannini TA, Hoffman C. Gaining and losing health insurance: strengthening the evidence for effects on access to care and health outcomes. Med Care Res Rev. 2000;57(3):298-318; discussion 319-25.
32. Freeman JD, Kadiyala S, Bell JF, Martin DP. The causal effect of health insurance on utilization and outcomes in adults: a systematic review of US studies. Med Care. 2008;46(10):1023-32.
33. Bernstein J, Chollet D, Peterson S. How does insurance coverage improve health outcomes. Mathematica, Inc. 2010;1:1-10.
34. DeRigne L, Porterfield S, Metz S. The influence of health insurance on parent’s reports of children’s unmet mental health needs. Maternal and Child Health Journal. 2009;13(2):176-86.
35. Thomas P, Zahorodny W, Peng B, Kim S, Jani N, Halperin W, et al. The association of autism diagnosis with socioeconomic status. Autism. 2012;16(2):201-13.
36. Hrdlicka M, Vacova M, Oslejskova H, Gondzova V, Vadlejchova I, Kocourkova J, et al. Age at diagnosis of autism spectrum disorders: is there an association with socioeconomic status and family self-education about autism? Neuropsychiatr Dis Treat. 2016;12:1639-44.
37. Volkmar FR, Nelson DS. Seizure disorders in autism. JAACAP. 1990;29(1):127-9.
38. Saemundsen E, Ludvigsson P, Hilmarsdottir I, Rafnsson V. Autism spectrum disorders in children with seizures in the first year of life - a population-based study. Epilepsia. 2007;48(9):1724-30.
39. Saemundsen E, Ludvigsson P, Rafnsson V. Autism spectrum disorders in children with a history of infantile spasms: a population-based study. J Child Neurol. 2007;22(9):1102-7.
40. Gillberg C, Billstedt E. Autism and Asperger syndrome: coexistence with other clinical disorders. Acta Psychiatr Scand. 2000;102(5):321-30.
41. Cheung R, O'Donnell S, Madi N, Goldner E. Factors associated with delayed diagnosis of mood and/or anxiety disorders. Health Promot Chronic Dis Prev Can. 2017;37(5):137-48.
42. Bickel J, Bridgemohan C, Sideridis G, Huntington N. Child and family characteristics associated with age of diagnosis of an autism spectrum disorder in a tertiary care setting. J Dev Behav Pediatr. 2015;36(1):1-7.
43. Herlihy L, Knoch K, Vibert B, Fein D. Parents' first concerns about toddlers with autism spectrum disorder: effect of sibling status. Autism. 2015;19(1):20-8.
| Files | ||
| Issue | Vol 17 No 3 (2022) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/ijps.v17i3.9729 | |
| Keywords | ||
| Autism Spectrum Disorder Early Diagnosis Health Services Accessibility Health Status Disparities Multivariate Analysis Symptom Assessment Socioeconomic Factors | ||
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How to Cite
1.
Ghahari N, Yousefian F, Behzadi S, Jalilzadeh A. Rural-Urban Differences in Age at Autism Diagnosis: A Multiple Model Analysis. Iran J Psychiatry. 2022;17(3):294-303.
