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Russell AS, McFayden TC, McAllister M, Liles K, Bittner S, Strang JF, Harrop C. Who, when, where, and why: A systematic review of "late diagnosis" in autism. Autism Res 2024. [PMID: 39579014 DOI: 10.1002/aur.3278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2024] [Accepted: 11/13/2024] [Indexed: 11/25/2024]
Abstract
An autism diagnosis can be a critical milestone toward effective and affirming support. Despite the sharp increase in the number of studies focused on late diagnosis over the last 15 years, there remains no consensus as to what constitutes a late diagnosis of autism, with cutoffs ranging from infancy to middle adulthood. This preregistered systematic review evaluated (a) the field's current quantification of late diagnosis in autism, (b) how the threshold for late diagnosis varies as a function of demographic and population factors, and (c) trends over time. Of the 11,697 records retrieved, N = 420 articles met inclusion criteria and were extracted. Articles spanned 35 years (1989-2024) and included participants from every continent except Antarctica. Only 34.7% of included studies provided a clear threshold for "late diagnosis" (n = 146/420). Late diagnosis cutoffs averaged 11.53 years (range = 2-55 years; median = 6.5 years) with a bimodal distribution (3 and 18 years). The threshold for late diagnosis varied by participant location, F(5,140) = 10.4, p < 0.0001, and sample age, F(5,140) = 20.1, p < 0.0001. Several key rationales for age determinations emerged, including access to services, considerations for adult diagnoses, and data driven approaches. What authors consider to be a "late" diagnosis of autism varies greatly according to research context. Justifications for a specific late-diagnosis age cutoff varied, underscoring the need for authors to contextualize their conceptualizations.
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Affiliation(s)
- Alison S Russell
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Tyler C McFayden
- Carolina Institute for Developmental Disabilities, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Margaret McAllister
- Department of Health Sciences, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Kimberly Liles
- Department of Health Sciences, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Sophie Bittner
- Department of Health Sciences, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - John F Strang
- Gender and Autism Program, Children's National Hospital, Washington, District of Columbia, USA
| | - Clare Harrop
- Department of Health Sciences, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- UNC TEACCH Autism Program, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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de Medeiros AM, Lobo MF, Vieira MDT, Duarte L, Carvalho JPM, Teodoro AC, Claro RM, Gomes NR, Freitas A. Social Vulnerability of Brazilian Metropolitan Schools and Teachers' Absence from Work Due to Vocal and Psychological Symptoms: A Multilevel Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2972. [PMID: 36833667 PMCID: PMC9966546 DOI: 10.3390/ijerph20042972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 01/23/2023] [Accepted: 01/24/2023] [Indexed: 06/18/2023]
Abstract
Teachers' voices and psychological symptoms are the main reasons for absence from work. The objectives of this study were: (i) to spatially represent, through a webGIS, the standardized rates of teachers' absences due to voice (outcome 1) and psychological symptoms (outcome 2) in each Brazilian Federative Unit (FU = 26 states plus Federal District) and (ii) to analyze the relationship between each national outcome rate and the Social Vulnerability Index (SVI) of the municipality where urban schools are located, adjusted for sex, age, and working conditions. This cross-sectional study comprised 4979 randomly sampled teachers working in basic education urban schools, of which 83.3% are women. The national absence rates were 17.25% for voice symptoms and 14.93% for psychological symptoms. The rates, SVI, and school locations in the 27 FUs are dynamically visualized in webGIS. The multilevel multivariate logistic regression model showed a positive association between voice outcome and high/very high SVI (OR = 1.05 [1.03; 1.07]), whereas psychological symptoms were negatively associated with high/very high SVI (OR = 0.86 [0.85 0.88]) and positively associated with intermediate SVI (OR = 1.15 [1.13; 1.16]), in contrast with low/very low SVI. Being a woman (voice: OR = 1.36 [1.35; 1.38]; psychological: 1.22 [1.21; 1.24]) and working in schools with various precarious conditions (17 variables) increased the odds of being absent due to voice and psychological symptoms. The results confirm the need for investments to improve working conditions in schools.
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Affiliation(s)
- Adriane Mesquita de Medeiros
- Postgraduate Program in Speech-Language Sciences, Federal University of Minas Gerais, Belo Horizonte 30130-100, Brazil
- Postgraduate Program in Public Health, Federal University of Minas Gerais, Belo Horizonte 30130-100, Brazil
| | - Mariana Fernandes Lobo
- CINTESIS@RISE, MEDCIDS, Faculty of Medicine of the University of Porto, 4200-450 Porto, Portugal
| | - Marcel de Toledo Vieira
- Department of Statistics and Graduate Program in Economics, Federal University of Juiz de Fora, Juiz de Fora 36036-900, Brazil
| | - Lia Duarte
- Institute of Earth Sciences, FCUP Pole, Rua do Campo Alegre, 4169-007 Porto, Portugal
- Department of Geosciences, Environment and Spatial Planning, Faculty of Sciences of the University of Porto (FCUP), Rua do Campo Alegre, 4169-007 Porto, Portugal
| | - João Paulo Monteiro Carvalho
- Department of Geosciences, Environment and Spatial Planning, Faculty of Sciences of the University of Porto (FCUP), Rua do Campo Alegre, 4169-007 Porto, Portugal
| | - Ana Cláudia Teodoro
- Institute of Earth Sciences, FCUP Pole, Rua do Campo Alegre, 4169-007 Porto, Portugal
- Department of Geosciences, Environment and Spatial Planning, Faculty of Sciences of the University of Porto (FCUP), Rua do Campo Alegre, 4169-007 Porto, Portugal
| | - Rafael Moreira Claro
- Postgraduate Program in Public Health, Federal University of Minas Gerais, Belo Horizonte 30130-100, Brazil
| | - Nayara Ribeiro Gomes
- Postgraduate Program in Speech-Language Sciences, Federal University of Minas Gerais, Belo Horizonte 30130-100, Brazil
| | - Alberto Freitas
- CINTESIS@RISE, MEDCIDS, Faculty of Medicine of the University of Porto, 4200-450 Porto, Portugal
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