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Author Notes:

Corresponding author at: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, Suite E6032, Baltimore, MD 21205, United States. llee38@jhu.edu (L.-C. Lee)

Surveillance data used for this study were collected under multiple cooperative agreements from the Centers for Disease Control and Prevention.

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

Conflicts of interest The sponsor for the data collection of the Autism and Developmental Disabilities Monitoring (ADDM) Network is the US Centers for Disease Control and Prevention (CDC).

The sponsor had no involvement in (1) study design; (2) analysis, and interpretation of data; (3) the writing of the report; or (4) the decision to submit the paper for publication.

The authors do not have any potential conflict of interest, real or perceived.

The authors have no financial relationships relevant to this article to disclose.



  • Social Sciences
  • Science & Technology
  • Life Sciences & Biomedicine
  • Education, Special
  • Psychology, Developmental
  • Psychiatry
  • Rehabilitation
  • Education & Educational Research
  • Psychology
  • Autism spectrum disorder
  • Child sex
  • Diagnosis retention
  • Co-occurring conditions (CoCs)
  • AGE

Retention of autism spectrum disorder diagnosis: The role of co-occurring conditions in males and females


Journal Title:

Research in Autism Spectrum Disorders


Volume 25


, Pages 76-86

Type of Work:

Article | Post-print: After Peer Review


This study examined associations between ASD diagnosis retention and non-ASD co-occurring conditions (CoCs) by child sex. The sample included 7077 males and 1487 females who had an ASD diagnosis documented in their school or health records in a population-based ASD surveillance system for 8-year-old children. ASD diagnosis retention status was determined when an initial ASD diagnosis was not later ruled out by a community professional. We found that ASD diagnosis remains fairly stable, with only 9% of children who had an initial documented ASD diagnosis later being ruled-out. Although most of the associations between the ASD diagnosis retention status and CoCs are similar in both sexes, the co-occurrence of developmental diagnoses (e.g., intellectual disability or sensory integration disorder) was predic tive of ASD diagnostic changes in males, whereas the co-occurrence of specific developmental (e.g., personal/social delay) and neurological diagnosis (e.g., epilepsy) was associated with ASD diagnostic change in females. More ASD-related evaluations and less ASD-related impairment were associated with later ASD rule outs in both sexes. Our findings highlight that CoCs can complicate the diagnostic picture and lead to an increased likelihood of ambiguity in ASD diagnosis. Using sensitive and appropriate measures in clinical practice is necessary for differential diagnosis, particularly when there are co-occurring developmental conditions.

Copyright information:

© 2016 Elsevier Ltd. All rights reserved.

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