Initial diagnosis patterns of coexisting mental health and neurodevelopmental conditions in autistic children and youth: Evidence from a nationally representative sample in Canada

Background: Elevated prevalence of coexisting health conditions has been observed in autistic people, yet how the timing of their initial diagnoses varies by sex and age of autism diagnosis remains understudied. Using a person-centered approach, we examined the patterns of initial diagnosis for mental health and neurodevelopmental conditions among autistic children and youth identified from the general population. Methods: The sample was drawn from the 2019 Canadian Health Survey on Children and Youth (CHSCY) cohort (N = 47,781), consisting of 776 5–17-year-olds (82% assigned-male-at-birth) with a caregiver-reported diagnosis of autism. Multigroup latent class analysis was used to identify subgroups based on ages of initial diagnoses of autism, anxiety, mood, learning, and attention-deficit/hyperactivity disorders stratified by sex assigned at birth. Functional difficulties and multimorbidity status, including the number and types of coexisting conditions, were compared across the subgroups. Results: Four latent subgroups were identified for each sex group, primarily differentiated by the age of autism diagnosis. The most prevalent class (46%) was characterized by an initial autism diagnosis at ages 3–5 years. The remaining subgroups, with autism diagnosed primarily before age 3, at 6–8, and at 9–17 years, each comprised ~20% of the sample. Subgroups with autism diagnosed after age 6 tended to have more coexisting conditions, with females showing heightened probabilities of mental health diagnoses across age windows from birth to age 17 years. The temporal order of coexisting diagnoses relative to autism diagnosis varied across subgroups, with sex differences more evident for anxiety and attention-deficit/hyperactivity disorders. Conclusions: There were nuanced variations in the timing of initial diagnoses of coexisting conditions based on the age of autism diagnosis. The sex-varying patterns highlight the importance of continuous monitoring and evaluation of the neurodevelopmental and mental health needs of autistic children and youth, with supports tailored to sex and the timing of autism diagnosis.