Although autism spectrum disorder (ASD) can be identified in children as young as 18 months, the median ages for diagnosis are 48 months for autism and 75 months for Asperger syndrome. That time gap can make a big difference.
“Children can get developmental therapy, physical therapy or occupational therapy,” said Kristen Berg, an assistant professor in the Department of Rehabilitation Sciences. “When they’re younger, their health trajectories are more malleable. You can make more of an impact the earlier you intervene.”
In a new study, Berg, along with Associate Professor of Rehabilitation Sciences Beth Pfeiffer and other researchers, explore the role of adverse childhood experiences (ACEs) in delaying an ASD diagnosis and a child beginning treatment. These experiences range from economic hardship or community violence to the death or incarceration of a parent, or substance abuse or domestic violence in the child’s home.
Berg and her colleagues analyzed data on 1,624 children with ASD, measuring for the types of ACEs they experienced and their levels of exposure. Then, they compared this to their ages when they were diagnosed and began using therapy services.
The study showed that exposure to ACEs caused significant delays in children receiving diagnoses or services. Even just the presence of one or two ACEs of moderate severity is associated with a 22- to 27-percent increase in the median age of entry into treatment.
Berg's findings suggest that families of children with ASD may face barriers to service besides just the capacity to afford them. A family with insurance but many stressors in the home, for instance, may struggle to navigate the complex insurance system or even being able to arrange transportation to health service centers.
Meanwhile, ACEs are proven indicators of poor health outcomes later in life. Already, some pediatricians are screening for ACEs during visits. Then they’re addressing them by providing families with information on support and services that can help.
It’s a tactic that can facilitate earlier ASD diagnoses while providing an opportunity to reduce family stress and, potentially, improve children’s lifetime health trajectories.
“Right now, it’s a matter of figuring out what’s needed and connecting vulnerable families to those resources,” said Berg. “We can support these families by helping facilitate access to needed services.”