Abstract
Background: Diagnostic stability in Autistic Disorder (AD) remains a relevant and underexplored topic, particularly in public health systems of middle-income countries.
Objective: To investigate whether diagnostic transience of AD, according to DSM-IV criteria, is associated with origin of care within the public, Brazilian Public Health System versus private service (out of pocket, Non-SUS), and gender/sex.
Methods: Retrospective analysis of medical records from children evaluated between 2009 and 2020 at a tertiary public pediatric hospital and a private psychiatric office in Minas Gerais, Brazil. Inclusion required a DSM-IV diagnosis of AD for at least 36 months. Statistical analyses included Chi-square, Fisher’s Exact, Mann–Whitney, and Kaplan–Meier survival estimates.
Results: Among 906 records analyzed, 186 were excluded, 68 had a transience diagnosis (average 9%): 1F:14M in the BPHS group versus 6F:47M in the non-BPHS group. No statistically significant association was found between diagnostic outcome and BPHS/non-BPHS origin or gender/sex (p > 0.05). Diagnostic transience was associated with a greater number of consultations (older age).
Discussion: Some results were consistent with the literature, such as the higher prevalence of male gender/sex (82.34%), the high frequency of environmental disorders and the median transience percentage (9%) by the 5-year-old median age. The new one is the lack of outcome differences between sex/gender and healthcare systems: BPHS, private, and international literature. The absence of difference in these outcomes is one of the most striking findings, as they differ substantially in access pathways, frequency and intensity of non-medical interventions, and professional specialization in ASD.
Conclusion: Diagnostic transience of AD occurred at similar rates regardless of healthcare origin or gender/sex. These findings raise questions about the importance of all biological markers that can complement clinical assessment and identify the most effective therapeutic methods for each individual affected by ASD. Further longitudinal and biologically integrated studies are necessary to clarify predictors of diagnostic stability and long-term outcomes