Autism in preschoolers: Assessment, diagnostic and gender aspects

Abstract

Background: Very early assessment of young boys and girls with suspected autism spectrum disorders (ASD) is widely advocated, but knowledge is limited. Aims: Evaluate methods used in assessment of young children with suspected ASD, identify possible gender differences in clinical presentation, and examine parent/teacher experiences of the diagnostic process. Material and methods: Children (under age 4 years) were recruited after general population screening for ASD in Gothenburg. Different approaches - observation, formal testing, interview, and questionnaire - were used in four sub-studies (I-IV), each relating to 6-20 girls and 20-31 boys. Preschool free-field observation made by an education specialist was compared with structured clinic observation (I). Agreement across clinical first impressions and between such impressions and final comprehensive diagnosis was examined for independent members of a multidisciplinary team (II). Girls and boys were compared as regards diagnosis, developmental profiles and global functioning (III). Parent/teacher experience of assessment was examined (IV). Results: Agreement between observation in preschool and clinic was very good. Preschool observation and parent interview showed good agreement with final diagnosis. No clinical presentation gender differences were found, and correlations between results obtained in different developmental areas were strong. Parents and teachers were satisfied with the assessment and diagnostic process and did not regret that they had taken part in it. Conclusions: Girls and boys with ASD problems identified before 4 years of age are very similar. Preschool observation should be included in the diagnostic process, multidisciplinary assessments are crucial, and early diagnosis is considered important both by parents and preschool teachers.