Illustration by Laurène Boglio

How accurately do general pediatricians assess children for autism?

This question was at the heart of a new study that caught autism researchers’ attention on Twitter this week.

Compared with an expert team of clinicians using the Autism Diagnostic Observation Schedule and the Mullen Scales of Early Learning, pediatricians correctly identify autistic children “almost 90% of the time,” tweeted study investigator Melanie Penner, senior clinical scientist and developmental pediatrician at Holland Bloorview Kids Rehabilitation Hospital in Toronto, Canada.

But when pediatricians suspect a child does not have autism, they agree with the experts “only 60% of the time,” Penner continued. “More caution is needed for these children.”

What else did we find? Diagnosing a child as ‘non-autistic’ is more challenging. The team agreed with pediatricians only 60% of the time when they ‘ruled out’ autism. More caution is needed for these children, particularly if parents/teachers are wondering about autism

— Dr. Melanie Penner (@drmelpenner) January 25, 2023

The results, which Penner and her colleagues published last month in JAMA Network Open, show that some children can receive an accurate autism diagnosis from a pediatrician, Penner concluded.

And such diagnoses could “minimize time families will wait to confirm diagnosis and access support,” tweeted Justine Cohen-Silver, assistant professor of pediatrics at University of Toronto.

Great work @drmelpenner this is an important finding , general paediatricians are equally able to diagnose autism compared to developmental sub specialists. Hoping to minimize time families will wait to confirm diagnosis and access support https://t.co/Z2lZUXucb2

— Dr. Justine Cohen-Silver (@silver_justine) January 29, 2023

The work “highlights the importance of maximizing the excellent skillsets of well-trained generalists,” tweeted Eyal Cohen, professor of pediatrics and health policy, management and evaluation at the University of Toronto.

Great study @drmelpenner. We have so many long waitlists to see specialized teams in autism (& other conditions too). Your work really highlights the importance of maximizing the excellent skillsets of well-trained generalists to meet the needs of those with complex needs. https://t.co/Iq6XpqD4Gi

— Eyal Cohen (@dreyalcohen) January 28, 2023

“For those interested in both excellence and equity in clinical services for autistic children, this paper … is the early clubhouse leader for the most important paper of the year,” tweeted Andrew Whitehouse, professor of autism research at the Telethon Kids Institute and the University of Western Australia in Perth.

**Important paper**
For those interested in both excellence and equity in clinical services for autistic children, this paper by @drmelpenner and colleagues is the early clubhouse leader for the most important paper of the year. ???? /1 https://t.co/wThbTTrkIt

— Andrew Whitehouse (@AJOWhitehouse) January 26, 2023

Long waitlists for an autism diagnosis mean that a more flexible diagnostic process is needed, which is the direction they “have gone in Australia,” Whitehouse added.

As Mel writes, the key conclusion is that we should adopt flexible Dx processes. The ethical implications of the long waitlists demand this. This research provides more evidence to move in that direction.
And that is where we have gone in Australiahttps://t.co/BGFswiFesY /5

— Andrew Whitehouse (@AJOWhitehouse) January 26, 2023

The Australian diagnostic guidelines that Whitehouse and his colleagues adopted in 2019 “were a guiding light in thinking how we can approach diagnosis more equitably,” Penner responded.

Andrew! Thank you for these kindest of words, which I have surely screenshotted and will come back to on a tough day. The Aussie guidelines were a guiding light in thinking how we can approach diagnosis more equitably.

— Dr. Melanie Penner (@drmelpenner) January 26, 2023

Research about a different age cohort also cropped up on Twitter this week: a longitudinal study on cognitive aging in adults with autism, published in January in Psychiatry Research.

Beginning in 2011, the researchers followed 128 autistic and 112 non-autistic adults, aged 24 to 85, and tested them on 15 different cognitive measures at different times over 10 years. They found “no evidence for accelerated cognitive aging for autistic adults,” and age-related changes in cognition were similar for autistic and non-autistic adults, tweeted Hilde Geurts, professor of clinical neuropsychology at the University of Amsterdam in the Netherlands.

2. Performance gets worse with increasing age on a group level, but this is true whether you are autistic or not. This is what we call parallel aging 4/n

— Dr. Hilde M. Geurts ([email protected]) (@dutcharc) January 27, 2023

“Longitudinal research on autistic people in later life is so rare,” tweeted Rebecca Charlton, senior lecturer in psychology at Goldsmiths, University of London in the United Kingdom.

Longitudinal research on autistic people in later life is so rare. Fantastic that @dutcharc and team are working on this. https://t.co/SnVkdABxW5

— Dr Rebecca Charlton (@GoldAgeLabUK) January 27, 2023

Lucy Livingston, lecturer in psychology at King’s College London in the U.K., called the research “really important” in a separate tweet.

Really important #longitudinal research on #aging in #autism by @dutcharc @CTorenvliet
Key take home: “autistic individuals diagnosed in adulthood, without intellectual disability, do not seem at risk for accelerated cognitive decline” https://t.co/mTJjyxjN8f

— Dr Lucy Livingston (@Lucy_Livingston) January 30, 2023

Lastly, Elizabeth Weir, research associate at the Autism Research Centre at the University of Cambridge in the U.K., tweeted a link to her editorial “about an important new meta-analysis on the #cardiometabolic #health of #autistic people.”

New editorial out today in @JAMAPediatrics about an important new meta-analysis on the #cardiometabolic #health of #autistic people.

Both the editorial & meta-analysis can be found here: https://t.co/jDk2q5jXUW pic.twitter.com/I3HxYDEyck

— Elizabeth Weir (@Eweir21) January 30, 2023

The meta-analysis found that autistic people have an increased risk of developing diabetes, dyslipidemia and heart disease. In the editorial, Weir wrote that this study fills an important gap in research on physical health problems among autistic people.

Weir also wrote that several studies suggest autistic people are dying younger than expected. Bernadette Grosjean, a psychiatrist, tweeted that “more research and more support” is urgently needed.

“Overall, autistic people are dying much younger than expected, with several studies now suggesting that autistic people are, on average, dying 12 to 30 years younger than others.” Where we need more research and more support…it is urgent https://t.co/g95tDFdITx

— Dr Bernadette Grosjean (@bernaharbor) January 31, 2023

That’s it for this week’s Community Newsletter! If you have any suggestions for interesting social posts you saw in the autism research sphere, feel free to send an email to [email protected].

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Cite this article: https://doi.org/10.53053/YIME4862