Child Age at Time of First Maternal Concern and Time to Services Among Children with Autism Spectrum Disorder.

Most timing data were collected retrospectively from maternal recall, so parents of children with more severe disability may have recalled concerns differently. The study did not collect age at ASD diagnosis for children with an existing community diagnosis, so it could not test whether diagnosis timing mediated the relationship between concern and services. Chronic condition onset dates were not collected, so a condition diagnosed after service start could have biased associations toward the null. ADOS-2 and MSEL scores measured current severity and development at the clinic visit, not severity or development when concern began or services started. Income was measured before pregnancy and insurance before the clinic visit, which may not represent the periods when concern and service initiation occurred. The sample consisted of families who consented to research participation, who may have had earlier or greater concerns than families who did not participate. For time-to-service analyses, 42 children were excluded because services began before reported first concern and 7 lacked service initiation age; excluded children had mean first concern age about 4 months later than included children. The non-Latino other race group was small and diverse, making confidence intervals wide in univariate analysis. The analysis reports associations, not causal effects, and service initiation was defined as any recommended ASD service, not a specific therapy.

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Do not conclude that parents of non-Latino Black or non-Latino other race children were slower to recognize developmental concerns. The study found no significant association between maternal race/ethnicity and age at first concern, and it cannot show why service initiation took longer.