The Role of Demographics in the Age of Autism Diagnosis in Jerusalem
Early diagnosis of autism spectrum disorder (ASD) in children enables earlier access to services and better ability to predict subsequent development. A vast body of literature consistently shows discrepancies in the age of diagnosis between children from varying socio-economic levels, cultural and ethnic backgrounds. The present study examines the effect of sociodemographic factors on age of ASD diagnosis among the three primary ethnic sectors in Jerusalem region: secular and modern religious Jews, ultra-Orthodox Jews and Arabs. Findings indicate minimal differences in age of diagnosis prior to the age of six, although Arab children of this age were largely minimally verbal. After age six, no Arab children were referred for an evaluation.
KeywordsAutism spectrum disorder Early diagnosis Socioeconomic Ethnic Jerusalem
We thank the children and families who made this study possible and the clinical staff of Leumit Healthcare Child Developmental Center.
JK and MB conceived of the study, and participated in its design and coordination along with RS; RS was responsible for data collection and organization; MB was responsible for all clinical characterization upon which the study is based; RS and TPG performed the statistical analyses; JK and RS drafted the manuscript with CS; All authors participated in manuscript preparation and approved the final manuscript.
Compliance with Ethical Standards
All procedures performed in studies involving human participants were in accordance with the ethical standards of the medical center’s research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The data analysis was conducted while separating the relevant data from identifying information, such as name and ID number, to maintain a proper lever of anonymity for the children and their families.
- American Psychiatric Association. (2013). Diagnostic and Statistical manual of mental disorders (DSM-5 ® ). Washington, DC: American Psychiatric Pub.Google Scholar
- Baio, J., Wiggins, L., Christensen, D. L., Maenner, M. J., Daniels, J., Warren, Z., … White, T. (2018). Prevalence of autism spectrum disorder among children aged 8 years—Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2014. MMWR Surveillance Summaries, 67(6), 1.Google Scholar
- Burstyn, I., Sithole, F., & Zwaigenbaum, L. (2010). Autism spectrum disorders, maternal characteristics and obstetric complications among singletons born in Alberta, Canada. Chronic Diseases in Canada, 30(4), 125–134.Google Scholar
- Calame, J., & Charlesworth, E. (2011). Divided cities: Belfast, Beirut, Jerusalem, Mostar, and Nicosia. Philadelphia: University of Pennsylvania Press.Google Scholar
- Clarfield, A. M., Manor, O., Nun, G. B., Shvarts, S., Azzam, Z. S., Afek, A., … Israeli, A. (2017). Health and health care in Israel: An introduction. The Lancet, 389(10088), 2503–2513.Google Scholar
- Donohue, M. R., Childs, A. W., Richards, M., & Robins, D. L. (2017). Race influences parent report of concerns about symptoms of autism spectrum disorder. Autism, 23, 1–12.Google Scholar
- Durkin, M. S., Maenner, M. J., Baio, J., Christensen, D., Daniels, J., Fitzgerald, R., … & Wingate, M. S. (2017). Autism spectrum disorder among US children (2002–2010): Socioeconomic, racial, and ethnic disparities. American Journal of Public Health, 107(11), 1818–1826.Google Scholar
- Durkin, M. S., Maenner, M. J., Meaney, F. J., Levy, S. E., DiGuiseppi, C., Nicholas, J. S., … & Schieve, L. A. (2010). Socioeconomic inequality in the prevalence of autism spectrum disorder: Evidence from a US cross-sectional study. PLoS ONE, 5(7), e11551.Google Scholar
- Fonbonne, E. (2005). Epidemiology of autistic disorder and other pervasive developmental disorders. Journal of Clinical Psychiatry, 66(10), 3–8.Google Scholar
- Green, J., Charman, T., McConachie, H., Aldred, C., Slonims, V., Howlin, P., … Byford, S. (2010). Parent-mediated communication-focused treatment in children with autism (PACT): A randomised controlled trial. The Lancet, 375(9732), 2152–2160.Google Scholar
- Korach, M., & Choshen, M. (2018). Jerusalem Facts and Trends: The state of the city and changing trends. Retrieved from http://en.jerusaleminstitute.org.il/.upload/jerusalem/%D7%A2%D7%9C%20%D7%A0%D7%AA%D7%95%D7%A0%D7%99%D7%99%D7%9A%20%D7%90%D7%A0%D7%92%D7%9C%D7%99%D7%AA%202018%20-%20%D7%93%D7%99%D7%92%D7%99%D7%98%D7%9C%20-%20%D7%A1%D7%95%D7%A4%D7%99%20.pdf.
- Leonard, H., Glasson, E., Nassar, N., Whitehouse, A., Bebbington, A., Bourke, J., … Bower, C. (2011). Autism and intellectual disability are differentially related to sociodemographic background at birth. PLoS ONE, 6(3), e17875.Google Scholar
- Lord, C., Risi, S., Lambrecht, L., Cook, E. H., Leventhal, B. L., DiLavore, P. C., … Rutter, M. (2000). The Autism Diagnostic Observation Schedule—Generic: A standard measure of social and communication deficits associated with the spectrum of autism. Journal of Autism and Developmental Disorders, 30(3), 205–223.Google Scholar
- Lord, C., Rutter, M., DiLavore, P. C., Risi, S., Gotham, K., & Bishop, S. (2012). Autism diagnostic observation schedule–Second edition (ADOS-2). Los Angeles: Western Psychological Services.Google Scholar
- Mazurek, M. O., Handen, B. L., Wodka, E. L., Nowinski, L., Butter, E., & Engelhardt, C. R. (2014). Age at first autism spectrum disorder diagnosis: The role of birth cohort, demographic factors, and clinical features. Journal of Developmental and Behavioral Pediatrics, 35(9), 561–569.CrossRefGoogle Scholar
- Ng, M., de Montigny, J. G., Ofner, M., & Do, M. T. (2017). Environmental factors associated with autism spectrum disorder: A scoping review for the years 2003–2013. Chronic Diseases and Injuries in Canada, 37(1), 1.Google Scholar
- Ozonoff, S., Young, G. S., Landa, R. J., Brian, J., Bryson, S., Charman, T., … Stone, W. L. (2015). Diagnostic stability in young children at risk for autism spectrum disorder: A baby siblings research consortium study. Journal of Child Psychology and Psychiatry, 56(9), 988–998.Google Scholar
- Perryman, T. Y. (2009). Investigating disparities in the age of diagnosis of autism spectrum disorders. Chapel Hill: The University of North Carolina at Chapel Hill.Google Scholar
- Rai, D., Lewis, G., Lundberg, M., Araya, R., Svensson, A., Dalman, C., … Magnusson, C. (2012). Parental socioeconomic status and risk of offspring autism spectrum disorders in a Swedish population-based study. Journal of the American Academy of Child & Adolescent Psychiatry, 51(5), 467–476.Google Scholar
- Rosen, B., Waitzberg, R., & Merkur, S. (2015). Israel: Health system review. Health Systems in Transition, 17(6), 1–212.Google Scholar
- Rutter, M., Bailey, A., & Lord, C. (2003). SCQ. The Social Communication Questionnaire. Torrance, CA: Western Psychological Services.Google Scholar
- Salomone, E., Charman, T., McConachie, H., & Warreyn, P. (2016). Child’s verbal ability and gender are associated with age at diagnosis in a sample of young children with ASD in Europe. Child: Care, Health and Development, 42(1), 141–145.Google Scholar
- Shattuck, P. T., Durkin, M., Maenner, M., Newschaffer, C., Mandell, D. S., Wiggins, L., … Kirby, R. (2009). Timing of identification among children with an autism spectrum disorder: Findings from a population-based surveillance study. Journal of the American Academy of Child & Adolescent Psychiatry, 48(5), 474–483.Google Scholar
- The Association for Civil Rights in Israel. (2014). East Jerusalem by the Numbers. Retrieved from https://law.acri.org.il/en/2014/05/24/ej-numbers-14/.
- Wiggins, L. D., Barger, B., Moody, E., Soke, G., Pandey, J., & Levy, S. (2017). Brief report: The ADOS calibrated severity score best measures autism diagnostic symptom severity in pre-school children. Journal of Autism and Developmental Disorders. https://doi.org/10.1007/s10803-017-3072-x.Google Scholar
- Zwaigenbaum, L., Bauman, M. L., Choueiri, R., Fein, D., Kasari, C., Pierce, K., … Hansen, R. L. (2015). Early identification and interventions for autism spectrum disorder: Executive summary. Pediatrics, 136(Supplement 1), S1–S9.Google Scholar