Persistence of Autism Spectrum Disorder From Early Childhood Through School Age

作者：Elizabeth Harstad, MD, MPH; Ellen Hanson, PhD; Stephanie J. Brewster, MS, CGC; Rafael DePillis, BS; Anna L. Milliken, BA; Gabriella Aberbach, MSc; Georgios Sideridis, PhD; William J. Barbaresi, MD

摘要原文：IMPORTANCE While the prevalence of autism spectrum disorder (ASD) continues to increase and early diagnosis is emphasized, there is limited information on outcomes for children diagnosed with ASD in early childhood using contemporary diagnostic criteria.

OBJECTIVES To determine the frequency with which children who are clinically diagnosed with ASD at 12 to 36 months of age continue to meet diagnostic criteria for ASD at 5 to 7 years of age and to evaluate whether baseline child-specific and demographic characteristics and receipt of interventions are associated with ASD persistence.

DESIGN, SETTING, AND PARTICIPANTS In this natural history cohort study, children who received a clinical ASD diagnosis at 12 to 36 months of age underwent a research diagnostic assessment at 5 to 7 years of age. Research assessments occurred from August 14, 2018,to January 8, 2022.

INTERVENTION Children received community-based interventions, and parents provided details about interventions received.

MAIN OUTCOMES AND MEASURES The main outcome was persistence of ASD diagnosis based on current functioning. An experienced research psychologist assigned an ASD diagnosis (present or absent) according to criteria from the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) after the research assessment. The research assessment included administration of the Autism Diagnostic Observation Schedule–2, Autism Diagnostic Interview–Research, and a cognitive measure.

RESULTS Of the 213 participants diagnosed with ASD at initial clinical assessment (mean [SD] age, 24.6 [3.9] months; 177 boys [83.1%]), 79 (37.1%) did not continue to meet diagnostic criteria for ASD (nonpersistent ASD) at research assessment (mean [SD] age, 74.3 [7.1] months). All children with nonpersistent ASD had IQ of at least 70, while there was a bimodal distribution of IQ for those with persistent ASD (46 with IQ <70 and 88 with IQ 70).All children received some interventions, and 201 (94.4%) received ASD-specific intervention, mostly applied behavioral analysis. In a multilevel logistic regression model, the only variables associated with increased odds of being in the nonpersistent ASD group at 6 years of age were higher baseline adaptive skills (b coefficient = −0.287 [SE, 0.108]) and female sex (b = 0.239 [SE, 0.064]).

CONCLUSIONS AND RELEVANCE The findings of this cohort study suggest that among toddlers diagnosed with ASD, baseline adaptive function and sex may be associated with persistence of ASD.

摘要翻译：重要性  虽然自闭症谱系障碍 (ASD) 的患病率持续增加，并且早期诊断受到重视，但关于使用当代诊断标准在幼儿期诊断为 ASD 的儿童的结果信息有限。

目的  确定在 12 至 36 个月大时被临床诊断为 ASD 的儿童在 5 至 7 岁时继续满足 ASD 诊断标准的频率，并评估基线儿童特异性和人口特征以及是否接受干预措施与 ASD 持续存在相关。

设计、设置和参与者  在这项自然史队列研究中，在 12 至 36 个月大时接受临床 ASD 诊断的儿童在 5 至 7 岁时接受了研究诊断评估。研究评估于2018年8月14日至2022年1月8日进行。

干预  儿童接受基于社区的干预，家长提供有关所接受干预的详细信息。

主要结果和措施  主要结果是基于当前功能的 ASD 诊断的持续性。研究评估后，经验丰富的研究心理学家根据《精神障碍诊断和统计手册》（第五版）中的标准指定 ASD 诊断（存在或不存在）。研究评估包括自闭症诊断观察表 – 2 的管理、自闭症诊断访谈研究和认知测量。

结果  在初次临床评估时诊断为 ASD 的 213 名参与者中（平均 [SD] 年龄，24.6 [3.9] 个月；177 名男孩 [83.1%]），79 名 (37.1%) 没有继续满足 ASD 诊断标准（非持续性 ASD） ）在研究评估时（平均 [SD] 年龄，74.3 [7.1] 个月）。所有非持续性自闭症儿童的智商至少为 70，而持续性自闭症儿童的智商呈双峰分布（46 名智商<70 和 88 名智商≥70）。所有儿童都接受了一些干预措施，其中 201 名（94.4%）接受了针对 ASD 的干预措施，主要是应用行为分析。在多级逻辑回归模型中，与 6 岁时属于非持续性 ASD 组的几率增加相关的唯一变量是较高的基线适应技能（b 系数 = -0.287 [SE，0.108]）和女性（b = 0.239） [SE，0.064]）。

结论和相关性  这项队列研究的结果表明，在诊断患有自闭症谱系障碍 (ASD) 的幼儿中，基线适应功能和性别可能与自闭症谱系障碍 (ASD) 的持续存在相关。