Relationship Between Advanced Maternal Age and Timing of First Developmental Evaluation in Children with Autism.

The analysis was limited to children already identified with ASD, so it cannot say how advanced maternal age affects screening or evaluation in the general population. The study used record review and could not fully determine why a child was evaluated, why a diagnosis was delayed, or whether the mother named on the birth certificate was the child's actual caregiver. Paternal age was missing for some records and was imputed, and the imputation relied on assumptions that may not have been fully met. Intellectual disability status was missing for some children, and the ID sub-analysis was restricted to sites with more complete ID data. Some children had no formal ASD diagnosis by age 8, so time-to-diagnosis analyses treated them as censored, which could bias results if diagnosis data were missing. Residual confounding from community-specific factors may have remained even after adjustment.

The study used ADDM surveillance data supported by NIH funding, and the authors reported no conflicts of interest.

Do not conclude that older maternal age itself causes earlier evaluation or faster diagnosis. The unadjusted differences became non-significant after adjustment for socioeconomic and demographic factors, so the apparent effect was confounded.