Autistic young people diagnosed later had more psychiatric visits, small Canadian study finds

Autistic young people who were diagnosed later in childhood or adolescence used more psychiatric healthcare services than those diagnosed earlier, according to a new study published in Frontiers in Child and Adolescent Psychiatry.

What the researchers wanted to know

The authors note that more autistic children in Canada are being diagnosed later, and that a diagnosis after age six has already been linked with co-occurring mental health conditions. What has been less clear is whether the timing of a diagnosis is connected to how often young people end up using healthcare services, particularly mental health care.

Who took part and how

The study included 147 autistic young people who had been seen at a public diagnostic clinic linked to a major children’s hospital in Canada. Around a quarter (24.49%) were female. Just over half (54%) were in the early-diagnosed group, and the two groups had a similar mix of boys and girls.

Rather than asking young people or families directly, the researchers used records from a national Canadian healthcare reporting system to count different kinds of healthcare visits. They then used statistical modelling to see whether the timing of diagnosis predicted the number of visits, and whether sex changed that relationship.

What they found

After taking age into account, being diagnosed later in adolescence was linked with about 59% more psychiatric visits. When the researchers added sex into the model, the link became a little weaker and was no longer statistically significant.

The authors conclude that later-diagnosed autistic young people used more psychiatric services, and that this highlights a need for targeted support after a later autism diagnosis.

Things to bear in mind

This is useful early evidence, but it has clear limits:

• Small sample. With 147 young people, the authors themselves say the study was underpowered, meaning it was too small to reliably detect sex-related differences.
• One clinic. Everyone came from a single public clinic in Canada, so the results may not apply elsewhere, including in the UK.
• Correlation, not cause. The study shows a link, not that a later diagnosis causes more mental health needs. More psychiatric visits could reflect unmet needs before diagnosis, more distress, or simply that some young people were finally connected to services.
• Mostly male. Only about a quarter of participants were female, and the abstract does not mention gender identity, ethnicity or family income, all of which may affect when people are diagnosed.
• Records only. Healthcare records count visits, but they can’t tell us how young people felt, whether the care helped, or what support they needed and didn’t get.
• Some details unclear. The abstract gives a median age at assessment of five, which sits a little awkwardly with the “later in adolescence” wording. The full paper should explain exactly how the early and later groups were defined.
• Autistic involvement. The abstract does not say whether autistic people helped shape or carry out the research.

Why it matters

Many autistic people, especially girls and those who mask, are diagnosed later. This study adds to concerns that going years without a diagnosis, and the understanding and support that can come with it, may be tied to greater mental health strain. It supports calls for good, autism-informed support to be available after diagnosis, whatever a person’s age.

This piece summarises the paper’s abstract. Read the paper for the full methods and findings.