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Mapping the diagnosis of autism spectrum disorders in children aged under 7 years in Australia, 2010–2012

Catherine A Bent, Cheryl Dissanayake and Josephine Barbaro
Med J Aust 2015; 202 (6): 317-320. || doi: 10.5694/mja14.00328

Summary

Objectives: To investigate the frequency and age at diagnosis of autism spectrum disorder (ASD) in children aged under 7 years living in Australia.

Design and participants: Analysis of de-identified data on 15 074 children aged under 7 years registered with the Helping Children with Autism Package (HCWAP; a program that provides funding for access to early intervention and support services throughout Australia) between 1 July 2010 and 30 June 2012.

Main outcome measures: Age at diagnosis of ASD as confirmed by a paediatrician, psychiatrist and/or multidisciplinary team assessment.

Results: The average age at diagnosis of ASD in children registered with the HCWAP is currently 49 months, with the most frequently reported age being 71 months. Differences were evident in age at diagnosis across states, with children in Western Australia and New South Wales being diagnosed at a younger age. Across Australia, 0.74% of the population of children aged under 7 years are currently diagnosed with ASD and registered with the HCWAP. A higher proportion of children were registered with the HCWAP in Victoria compared with other states. There was no difference in age at diagnosis between Indigenous and non-Indigenous Australians, but children from a culturally and linguistically diverse background were diagnosed 5 months earlier than other children.

Conclusions: There may be a substantial gap between the age at which a reliable and accurate diagnosis of ASD is possible and the average age that children are currently diagnosed. The frequency of ASD diagnoses in Australia has increased substantially from previously published estimates.

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  • Catherine A Bent
  • Cheryl Dissanayake
  • Josephine Barbaro

  • La Trobe University, Melbourne, VIC.


Acknowledgements: 

Catherine Bent is supported by a La Trobe University Postgraduate Research Scholarship.

Competing interests:

No relevant disclosures

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access_time 07:41, 19 April 2015
Klaus Martin Beckmann

I congratulate the authors on their work. However I miss explicit mentioning of the effects of child abuse in the context of ASD. The article's referenced papers highlight the importance of differential diagnosis to an ASD diagnosis in children below the age of 7. This is notwithstanding the early work of John Bowlby (1) nor the work on Romanian orphans (2). The former is quintessential for attachment theory and the latter for the effects of trauma presenting as a triad of difficulties with social interaction, communication and behaviors, in other words complex developmental trauma. Substantiated childhood abuse in Australia is prevalent at 53666 in 2012- 2013 (3) and a not insignificant number of children will present as if ASD.

References:
1.) J Bowlby The making and breaking of affectional bonds. I. Aetiology and psychopathology in the light of attachment theory. An expanded version of the Fiftieth Maudsley Lecture, delivered before the Royal College of Psychiatrists, 19 November 1976. The British Journal of Psychiatry Mar 1977, 130 (3) 201-210; DOI: 10.1192/bjp.130.3.201

2.)MICHAEL L. RUTTER , JANA M. KREPPNER , THOMAS G. O'CONNOR Specificity and heterogeneity in children's responses to profound institutional privation. The British Journal of Psychiatry Aug 2001, 179 (2) 97-103; DOI: 10.1192/bjp.179.2.97

3.) Website accessed on 19/04/15 https://www3.aifs.gov.au/cfca/publications/child-abuse-and-neglect-statistics

Competing Interests: No relevant disclosures

Assoc Prof Klaus Martin Beckmann
School of Medicine, Griffith University

access_time 09:07, 20 April 2015
Cheryl Dissanayake

In response to Dr Beckmann's comment: "I miss explicit mentioning of the effects of child abuse in the context of ASD". The paper was not set up to address this issue, but rather used HCWA data to map the age of ASD diagnoses in Australia.

Prof. Rutter's and others work in on the Romanian orphans showed that despite some initial similarities with ASD features, the children who suffered neglet/abuse did not meet criteria for ASD, and the ASD features present mostly resolved once the children were placed in enriched environments.

With respect to attachment and John Bowlby, much work, including my own, has shown that children with ASD are attached to their caregivers/parents, and these attachments are functionally similar to those in children without ASD.

Competing Interests:

Prof Cheryl Dissanayake
La Trobe University

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