Gender, assigned sex at birth, and gender diversity: Windows into diagnostic timing disparities in autism / Goldie A. MCQUAID in Autism, 28-11 (November 2024)  

Public ISBD [article]  inAutism > 28-11 (November 2024) . - p.2806 - 2820 Titre : Gender, assigned sex at birth, and gender diversity: Windows into diagnostic timing disparities in autism Type de document : Texte imprimé et/ou numérique Auteurs : Goldie A. MCQUAID, Auteur ; Allison B. RATTO, Auteur ; Allison JACK, Auteur ; Alexis KHUU, Auteur ; Jessica V. SMITH, Auteur ; Sean C. DUANE, Auteur ; Ann CLAWSON, Auteur ; Nancy Raitano LEE, Auteur ; Alyssa VERBALIS, Auteur ; Kevin A. PELPHREY, Auteur ; Lauren KENWORTHY, Auteur ; Gregory L. WALLACE, Auteur ; John F. STRANG, Auteur Article en page(s) : p.2806 - 2820 Langues : Anglais (eng) Mots-clés : age at diagnosis  autism  diagnosis  gender  sex Index. décimale : PER Périodiques Résumé : Later autism diagnosis is associated with increased mental health risks. Understanding disparities in diagnostic timing is important to reduce psychiatric burden for autistic people. One characteristic associated with later autism diagnosis is female sex assigned at birth. However, literature to date does not characterize, differentiate, or account for gender identity beyond assigned sex at birth. Gender diversity may be more common in autistic relative to neurotypical people, and autism is proportionally overrepresented in gender-diverse populations. We examined age at autism diagnosis by assigned sex at birth, gender identity, and gender diversity (gender-diverse vs cisgender) status, separately. Three independent cohorts representing different ascertainments were examined: a research-recruited academic medical center sample (N = 193; 8.0 - 18.0?years); a clinic-based sample (N = 1550; 1.3 - 25.4?years); and a community-enriched sample (N = 244, 18.2 - 30.0?years). The clinic-based and community-enriched samples revealed disparities in diagnostic timing: people assigned female at birth, people of female gender, and gender-diverse people were diagnosed with autism significantly later than persons assigned male at birth, persons of male gender, and cisgender persons, respectively. Birth-sex, gender identity, and gender diversity may each uniquely relate to disparities in autism diagnostic timing. The influence of ascertainment strategies, particularly in studies examining assigned sex at birth or gender identity, should be considered. Lay Abstract Later autism diagnosis is associated with risk for mental health problems. Understanding factors related to later autism diagnosis may help reduce mental health risks for autistic people. One characteristic associated with later autism diagnosis is female sex. However, studies often do not distinguish sex assigned at birth and gender identity. Gender diversity may be more common in autistic relative to neurotypical people, and autism is more common in gender-diverse populations. We studied age at autism diagnosis by sex assigned at birth, gender identity, and gender diversity (gender-diverse vs cisgender) status, separately. We studied three separate autistic samples, each of which differed in how they were diagnosed and how they were recruited. The samples included 193 persons (8.0 - 18.0?years) from a research-recruited academic medical center sample; 1,550 people (1.3 - 25.4?years) from a clinic-based sample; and 244 people (18.2 - 30.0?years) from a community-enriched sample. We found significant differences in the clinic-based and community-enriched samples. People assigned female sex at birth were diagnosed with autism significantly later than people assigned male at birth. People of female gender were diagnosed significantly later than people of male gender. Gender-diverse people were diagnosed significantly later than cisgender people. Sex assigned at birth, gender identity, and gender diversity may each show unique relationships with age of autism diagnosis. Differences in how autistic people are diagnosed and recruited are important to consider in studies that examine sex assigned at birth or gender identity. More research into autism diagnosis in adulthood is needed. En ligne : https://dx.doi.org/10.1177/13623613241243117 Permalink : https://www.cra-rhone-alpes.org/cid/opac_css/index.php?lvl=notice_display&id=537 [article] Gender, assigned sex at birth, and gender diversity: Windows into diagnostic timing disparities in autism [Texte imprimé et/ou numérique] / Goldie A. MCQUAID, Auteur ; Allison B. RATTO, Auteur ; Allison JACK, Auteur ; Alexis KHUU, Auteur ; Jessica V. SMITH, Auteur ; Sean C. DUANE, Auteur ; Ann CLAWSON, Auteur ; Nancy Raitano LEE, Auteur ; Alyssa VERBALIS, Auteur ; Kevin A. PELPHREY, Auteur ; Lauren KENWORTHY, Auteur ; Gregory L. WALLACE, Auteur ; John F. STRANG, Auteur . - p.2806 - 2820. Langues : Anglais (eng) in Autism > 28-11 (November 2024) . - p.2806 - 2820 Mots-clés : age at diagnosis  autism  diagnosis  gender  sex Index. décimale : PER Périodiques Résumé : Later autism diagnosis is associated with increased mental health risks. Understanding disparities in diagnostic timing is important to reduce psychiatric burden for autistic people. One characteristic associated with later autism diagnosis is female sex assigned at birth. However, literature to date does not characterize, differentiate, or account for gender identity beyond assigned sex at birth. Gender diversity may be more common in autistic relative to neurotypical people, and autism is proportionally overrepresented in gender-diverse populations. We examined age at autism diagnosis by assigned sex at birth, gender identity, and gender diversity (gender-diverse vs cisgender) status, separately. Three independent cohorts representing different ascertainments were examined: a research-recruited academic medical center sample (N = 193; 8.0 - 18.0?years); a clinic-based sample (N = 1550; 1.3 - 25.4?years); and a community-enriched sample (N = 244, 18.2 - 30.0?years). The clinic-based and community-enriched samples revealed disparities in diagnostic timing: people assigned female at birth, people of female gender, and gender-diverse people were diagnosed with autism significantly later than persons assigned male at birth, persons of male gender, and cisgender persons, respectively. Birth-sex, gender identity, and gender diversity may each uniquely relate to disparities in autism diagnostic timing. The influence of ascertainment strategies, particularly in studies examining assigned sex at birth or gender identity, should be considered. Lay Abstract Later autism diagnosis is associated with risk for mental health problems. Understanding factors related to later autism diagnosis may help reduce mental health risks for autistic people. One characteristic associated with later autism diagnosis is female sex. However, studies often do not distinguish sex assigned at birth and gender identity. Gender diversity may be more common in autistic relative to neurotypical people, and autism is more common in gender-diverse populations. We studied age at autism diagnosis by sex assigned at birth, gender identity, and gender diversity (gender-diverse vs cisgender) status, separately. We studied three separate autistic samples, each of which differed in how they were diagnosed and how they were recruited. The samples included 193 persons (8.0 - 18.0?years) from a research-recruited academic medical center sample; 1,550 people (1.3 - 25.4?years) from a clinic-based sample; and 244 people (18.2 - 30.0?years) from a community-enriched sample. We found significant differences in the clinic-based and community-enriched samples. People assigned female sex at birth were diagnosed with autism significantly later than people assigned male at birth. People of female gender were diagnosed significantly later than people of male gender. Gender-diverse people were diagnosed significantly later than cisgender people. Sex assigned at birth, gender identity, and gender diversity may each show unique relationships with age of autism diagnosis. Differences in how autistic people are diagnosed and recruited are important to consider in studies that examine sex assigned at birth or gender identity. More research into autism diagnosis in adulthood is needed. En ligne : https://dx.doi.org/10.1177/13623613241243117 Permalink : https://www.cra-rhone-alpes.org/cid/opac_css/index.php?lvl=notice_display&id=537

Short report: Integrated evaluations for autism spectrum disorder in pediatric primary care clinics / Serene HABAYEB in Autism, 29-1 (January 2025)  

Public ISBD [article]  inAutism > 29-1 (January 2025) . - p.259-264 Titre : Short report: Integrated evaluations for autism spectrum disorder in pediatric primary care clinics Type de document : Texte imprimé et/ou numérique Auteurs : Serene HABAYEB, Auteur ; Anne INGE, Auteur ; Erica EISENMAN, Auteur ; Sheina GODOVICH, Auteur ; Maria LAUER, Auteur ; Amanda HASTINGS, Auteur ; Vanessa FUENTES, Auteur ; Melissa LONG, Auteur ; Xavier MARSHALL, Auteur ; Alexis KHUU, Auteur ; Leandra GODOY, Auteur Article en page(s) : p.259-264 Langues : Anglais (eng) Mots-clés : autism  integrated primary care Index. décimale : PER Périodiques Résumé : Primary care providers are often the first to identify concerns for autism through routine screening in the first 2 years of life. However, most children do not receive a diagnosis until years later resulting in delays accessing appropriate intervention. Delays in diagnosis disproportionately impact those who are otherwise disadvantaged by society based on race or socioeconomic status. Embedding mental health clinicians into primary care clinics offers a promising opportunity to address barriers to accessing diagnostic and intervention services once primary care providers identify concerns. The goal of this study was to assess the Autism in Primary Care program through which embedded mental health professionals in an urban primary care setting, primarily serving Black and Latinx families with Medicaid, were trained to provide autism diagnostic evaluations. Two hundred and fifty children completed evaluations through Autism in Primary Care program. Wait times to access evaluations in primary care were found to be significantly shorter than through standard avenues of care (e.g. tertiary care clinics). Referring primary care providers and caregivers endorsed high levels of satisfaction with the program. Embedding autism evaluations into primary care settings offers a promising opportunity to improve earlier diagnosis and treatment access for families, reduce inequities in care, and increase caregiver and child well-being.Lay abstractPrimary care providers often screen for autism during well child visits in the first few years of life and refer children for diagnostic evaluations when needed. However, most children do not receive a diagnosis until years later which delays access to services. Racism, socioeconomic status, and other systemic inequalities that limit access to health care further delay diagnostic evaluations. Mental health clinicians who work in primary care clinics can help address barriers to accessing diagnostic evaluation services once they are recommended by their primary care provider. However, mental health clinicians who work in primary care typically do not have training in diagnosing autism. The goal of this study was to evaluate a program training mental health professionals working in an urban primary care setting, primarily serving Black and Latinx families insured by Medicaid, to provide autism diagnostic evaluations. Two hundred and fifty children completed evaluations through the Autism in Primary Care (APC) program. The wait time to access an evaluation through APC was significantly shorter than through standard avenues of care (e.g. referring to a separate autism clinic). Referring primary care providers and caregivers endorsed high levels of satisfaction with the program. Conducting autism evaluations in primary care settings offers a promising opportunity to improve earlier diagnosis and treatment access for families, reduce inequities in care, and increase caregiver and child well-being. En ligne : https://dx.doi.org/10.1177/13623613241260800 Permalink : https://www.cra-rhone-alpes.org/cid/opac_css/index.php?lvl=notice_display&id=544 [article] Short report: Integrated evaluations for autism spectrum disorder in pediatric primary care clinics [Texte imprimé et/ou numérique] / Serene HABAYEB, Auteur ; Anne INGE, Auteur ; Erica EISENMAN, Auteur ; Sheina GODOVICH, Auteur ; Maria LAUER, Auteur ; Amanda HASTINGS, Auteur ; Vanessa FUENTES, Auteur ; Melissa LONG, Auteur ; Xavier MARSHALL, Auteur ; Alexis KHUU, Auteur ; Leandra GODOY, Auteur . - p.259-264. Langues : Anglais (eng) in Autism > 29-1 (January 2025) . - p.259-264 Mots-clés : autism  integrated primary care Index. décimale : PER Périodiques Résumé : Primary care providers are often the first to identify concerns for autism through routine screening in the first 2 years of life. However, most children do not receive a diagnosis until years later resulting in delays accessing appropriate intervention. Delays in diagnosis disproportionately impact those who are otherwise disadvantaged by society based on race or socioeconomic status. Embedding mental health clinicians into primary care clinics offers a promising opportunity to address barriers to accessing diagnostic and intervention services once primary care providers identify concerns. The goal of this study was to assess the Autism in Primary Care program through which embedded mental health professionals in an urban primary care setting, primarily serving Black and Latinx families with Medicaid, were trained to provide autism diagnostic evaluations. Two hundred and fifty children completed evaluations through Autism in Primary Care program. Wait times to access evaluations in primary care were found to be significantly shorter than through standard avenues of care (e.g. tertiary care clinics). Referring primary care providers and caregivers endorsed high levels of satisfaction with the program. Embedding autism evaluations into primary care settings offers a promising opportunity to improve earlier diagnosis and treatment access for families, reduce inequities in care, and increase caregiver and child well-being.Lay abstractPrimary care providers often screen for autism during well child visits in the first few years of life and refer children for diagnostic evaluations when needed. However, most children do not receive a diagnosis until years later which delays access to services. Racism, socioeconomic status, and other systemic inequalities that limit access to health care further delay diagnostic evaluations. Mental health clinicians who work in primary care clinics can help address barriers to accessing diagnostic evaluation services once they are recommended by their primary care provider. However, mental health clinicians who work in primary care typically do not have training in diagnosing autism. The goal of this study was to evaluate a program training mental health professionals working in an urban primary care setting, primarily serving Black and Latinx families insured by Medicaid, to provide autism diagnostic evaluations. Two hundred and fifty children completed evaluations through the Autism in Primary Care (APC) program. The wait time to access an evaluation through APC was significantly shorter than through standard avenues of care (e.g. referring to a separate autism clinic). Referring primary care providers and caregivers endorsed high levels of satisfaction with the program. Conducting autism evaluations in primary care settings offers a promising opportunity to improve earlier diagnosis and treatment access for families, reduce inequities in care, and increase caregiver and child well-being. En ligne : https://dx.doi.org/10.1177/13623613241260800 Permalink : https://www.cra-rhone-alpes.org/cid/opac_css/index.php?lvl=notice_display&id=544

Time is of the essence: Age at autism diagnosis, sex assigned at birth, and psychopathology / Jessica V. SMITH in Autism, 28-11 (November 2024)  

Public ISBD [article]  inAutism > 28-11 (November 2024) . - p.2909 - 2922 Titre : Time is of the essence: Age at autism diagnosis, sex assigned at birth, and psychopathology Type de document : Texte imprimé et/ou numérique Auteurs : Jessica V. SMITH, Auteur ; Goldie A. MCQUAID, Auteur ; Gregory L. WALLACE, Auteur ; Emily NEUHAUS, Auteur ; Andrea LOPEZ, Auteur ; Allison B. RATTO, Auteur ; Allison JACK, Auteur ; Alexis KHUU, Auteur ; Sara J. WEBB, Auteur ; Alyssa VERBALIS, Auteur ; Kevin A. PELPHREY, Auteur ; Lauren KENWORTHY, Auteur Article en page(s) : p.2909 - 2922 Langues : Anglais (eng) Mots-clés : autism  diagnostic delay  diagnostic timing  mental health outcomes Index. décimale : PER Périodiques Résumé : Age at autism diagnosis is associated with sex assigned at birth (hereafter, "sex"), such that girls/women are more likely to be delayed or "missed" entirely in the diagnostic process compared to boys/men. Later diagnosed individuals, especially girls/women, demonstrate increased anxious/depressive symptoms. Data on autistic youth from clinic-based (n = 1035; 22.9% assigned female) and sex-balanced research-based (n = 128; 43% assigned female) samples were probed via regression-based mediation models to understand relationships between diagnostic age, sex, and symptoms of anxiety/depression. We hypothesized diagnostic age would mediate the relationship between sex and anxious/depressive symptoms. In both samples, later diagnostic age predicted greater anxious and depressive symptoms, and sex did not directly predict anxious symptoms. In the clinic-based but not the research-based sample, individuals assigned female at birth were later diagnosed than those assigned male, and there was a significant indirect effect of sex on anxious and depressive symptoms through diagnostic age, such that those assigned female and later diagnosed experienced greater symptoms. Within the research-based sample only, sex predicted depressive symptoms. The present study provides an important impetus for further evaluating the implications of diagnostic timing, enhancing tools for recognizing autism in individuals assigned female at birth, and grounding research with real-world ascertainment strategies. Lay Abstract Previous research has shown that girls/women are diagnosed later than boys/men with autism. Individuals who are diagnosed later in life, especially girls/women, have greater anxious and depressive symptoms. Previous research has been limited due to narrow inclusionary criteria for enrollment in studies. The present study uses two samples-one clinic-based, large "real-world" sample and another research-based sample with strict criteria for autism diagnosis-to understand the relationships between diagnostic age, sex assigned at birth, and symptoms of anxiety/depression. In both samples, those who were diagnosed later had greater anxious/depressive symptoms, and anxiety was not predicted by sex. In the clinic-based but not research-based sample, those assigned female at birth were diagnosed later than those assigned male at birth. In the clinic-based sample only, individuals assigned female at birth and who were later diagnosed experienced greater symptoms of anxiety/depression compared to those assigned male who benefited from earlier diagnostic timing. Within the research-based sample, those assigned female at birth had greater depressive symptoms than those assigned male. These findings highlight the importance of timely identification of autism, especially for girls/women who are often diagnosed later. Community-based samples are needed to better understand real-world sex-based and diagnostic age-based disparities in mental health. En ligne : https://dx.doi.org/10.1177/13623613241249878 Permalink : https://www.cra-rhone-alpes.org/cid/opac_css/index.php?lvl=notice_display&id=537 [article] Time is of the essence: Age at autism diagnosis, sex assigned at birth, and psychopathology [Texte imprimé et/ou numérique] / Jessica V. SMITH, Auteur ; Goldie A. MCQUAID, Auteur ; Gregory L. WALLACE, Auteur ; Emily NEUHAUS, Auteur ; Andrea LOPEZ, Auteur ; Allison B. RATTO, Auteur ; Allison JACK, Auteur ; Alexis KHUU, Auteur ; Sara J. WEBB, Auteur ; Alyssa VERBALIS, Auteur ; Kevin A. PELPHREY, Auteur ; Lauren KENWORTHY, Auteur . - p.2909 - 2922. Langues : Anglais (eng) in Autism > 28-11 (November 2024) . - p.2909 - 2922 Mots-clés : autism  diagnostic delay  diagnostic timing  mental health outcomes Index. décimale : PER Périodiques Résumé : Age at autism diagnosis is associated with sex assigned at birth (hereafter, "sex"), such that girls/women are more likely to be delayed or "missed" entirely in the diagnostic process compared to boys/men. Later diagnosed individuals, especially girls/women, demonstrate increased anxious/depressive symptoms. Data on autistic youth from clinic-based (n = 1035; 22.9% assigned female) and sex-balanced research-based (n = 128; 43% assigned female) samples were probed via regression-based mediation models to understand relationships between diagnostic age, sex, and symptoms of anxiety/depression. We hypothesized diagnostic age would mediate the relationship between sex and anxious/depressive symptoms. In both samples, later diagnostic age predicted greater anxious and depressive symptoms, and sex did not directly predict anxious symptoms. In the clinic-based but not the research-based sample, individuals assigned female at birth were later diagnosed than those assigned male, and there was a significant indirect effect of sex on anxious and depressive symptoms through diagnostic age, such that those assigned female and later diagnosed experienced greater symptoms. Within the research-based sample only, sex predicted depressive symptoms. The present study provides an important impetus for further evaluating the implications of diagnostic timing, enhancing tools for recognizing autism in individuals assigned female at birth, and grounding research with real-world ascertainment strategies. Lay Abstract Previous research has shown that girls/women are diagnosed later than boys/men with autism. Individuals who are diagnosed later in life, especially girls/women, have greater anxious and depressive symptoms. Previous research has been limited due to narrow inclusionary criteria for enrollment in studies. The present study uses two samples-one clinic-based, large "real-world" sample and another research-based sample with strict criteria for autism diagnosis-to understand the relationships between diagnostic age, sex assigned at birth, and symptoms of anxiety/depression. In both samples, those who were diagnosed later had greater anxious/depressive symptoms, and anxiety was not predicted by sex. In the clinic-based but not research-based sample, those assigned female at birth were diagnosed later than those assigned male at birth. In the clinic-based sample only, individuals assigned female at birth and who were later diagnosed experienced greater symptoms of anxiety/depression compared to those assigned male who benefited from earlier diagnostic timing. Within the research-based sample, those assigned female at birth had greater depressive symptoms than those assigned male. These findings highlight the importance of timely identification of autism, especially for girls/women who are often diagnosed later. Community-based samples are needed to better understand real-world sex-based and diagnostic age-based disparities in mental health. En ligne : https://dx.doi.org/10.1177/13623613241249878 Permalink : https://www.cra-rhone-alpes.org/cid/opac_css/index.php?lvl=notice_display&id=537

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