Clinical Profile of First-Time Diagnosis of Autism Spectrum Disorder in School-Aged Youth

Abstract

Highlights What are the main findings? ASD Level 1 in school-aged children presents a distinct clinical profile marked by high rates of co-occurring conditions (ADHD and anxiety), a discrepancy between cognitive and adaptive behavioral functioning, and informant-dependent symptom severity—all of which may contribute to diagnostic overshadowing and delay, especially in females. Caregivers consistently rated internalizing symptoms and externalizing behaviors higher than teachers, which may be explained, in part, by the majority of children currently receiving academic accommodations/modifications, possibly minimizing symptoms in the school setting. Both caregivers and teachers rated social communication/motivation deficits as more impairing in females than males. What are the implications of the main findings? Referrals were primarily physician-driven, with approximately one-fourth receiving current medication management. Receiving routine symptom management may inadvertently contribute to diagnostic delay. Effective identification and support for school-aged children with ASD Level 1 requires looking beyond core autism symptoms alone toward a broader, multi-informant, multidomain clinical picture for earlier identification and to ensure that the full scope of co-occurring needs are met. Abstract Background/Objectives: There is limited research on clinical profiles of school-aged children receiving a first-time diagnosis of autism spectrum disorder (ASD) Level 1 and mixed findings related to sex differences in phenotype. This study aimed to describe the clinical profile of school-aged children receiving a first-time diagnosis of ASD Level 1, explore sex differences in phenotype by symptom severity and symptom domain profiles, and compare parent and teacher ratings on standardized measures of social, emotional, and behavioral functioning. Methods: A retrospective chart review of an ASD assessment clinic was completed. Eighty-one school-aged children were diagnosed with ASD Level 1. Measures of social, emotional, adaptive, and behavioral functioning were completed. Results: Females were significantly older at the time of diagnosis (M = 9.7 years) in comparison to males (M = 8.5 years). Additionally, over half of children diagnosed with ASD Level 1 presented with ADHD and over a third presented with an anxiety disorder. Approximately one-fourth of those diagnosed were currently taking psychotropic medication, and a substantial proportion had reported speech or language delay. Approximately half presented with food selectivity and sleep problems, with only 38% currently receiving behavioral health therapy services. Caregivers reported significantly higher internalizing symptoms and externalizing behavior on all Achenbach scales in comparison to teachers. Caregivers also reported significantly greater autism-specific social concerns. No statistically significant sex differences were found in parent or teacher ratings of domain scores. Based on caregiver reports, males demonstrated greater severity of aggressive behavior. Females displayed greater deficits in social communication and motivation based on both parent and teacher reports. Overall cognitive ability fell in the average range, while adaptive behavioral functioning was in the moderately low range. Conclusions: ASD Level 1 in school-aged children presents a distinct clinical profile marked by high rates of co-occurring conditions (ADHD and anxiety), existing academic accommodations/modifications, physician referral for evaluation, and varied symptom severity by informant type, all of which may contribute to diagnostic overshadowing and delay, especially in females.