Autism From 2 to 9 Years of Age | Autism Spectrum Disorders | JAMA Psychiatry | JAMA Network
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Original Article
June 2006

Autism From 2 to 9 Years of Age

Author Affiliations

Author Affiliations: University of Michigan, Ann Arbor (Drs Lord and Risi); University of North Carolina, Chapel Hill (Dr DiLavore); Hebrew University, Jerusalem, Israel (Dr Shulman); National Institute of Mental Health, Bethesda, Md (Dr Thurm); University of Manchester, Manchester, England (Dr Pickles).

Arch Gen Psychiatry. 2006;63(6):694-701. doi:10.1001/archpsyc.63.6.694

Context  Autism represents an unusual pattern of development beginning in the infant and toddler years.

Objectives  To examine the stability of autism spectrum diagnoses made at ages 2 through 9 years and identify features that predicted later diagnosis.

Design  Prospective study of diagnostic classifications from standardized instruments including a parent interview (Autism Diagnostic Interview–Revised [ADI-R]), an observational scale (Pre-Linguistic Autism Diagnostic Observation Schedule/Autism Diagnostic Observation Schedule [ADOS]), and independent clinical diagnoses made at ages 2 and 9 years compared with a clinical research team's criterion standard diagnoses.

Setting  Three inception cohorts: consecutive referrals for autism assessment to (1) state-funded community autism centers, (2) a private university autism clinic, and (3) case controls with developmental delay from community clinics.

Participants  At 2 years of age, 192 autism referrals and 22 developmentally delayed case controls; 172 children seen at 9 years of age.

Main Outcome Measures  Consensus best-estimate diagnoses at 9 years of age.

Results  Percentage agreement between best-estimate diagnoses at 2 and 9 years of age was 67, with a weighted κ of 0.72. Diagnostic change was primarily accounted for by movement from pervasive developmental disorder not otherwise specified to autism. Each measure at age 2 years was strongly prognostic for autism at age 9 years, with odds ratios of 6.6 for parent interview, 6.8 for observation, and 12.8 for clinical judgment. Once verbal IQ (P = .001) was taken into account at age 2 years, the ADI-R repetitive domain (P = .02) and the ADOS social (P = .05) and repetitive domains (P = .005) significantly predicted autism at age 9 years.

Conclusions  Diagnostic stability at age 9 years was very high for autism at age 2 years and less strong for pervasive developmental disorder not otherwise specified. Judgment of experienced clinicians, trained on standard instruments, consistently added to information available from parent interview and standardized observation.