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Background: The age at which children are diagnosed with autism spectrum disorder (ASD) has not significantly decreased in the past 20 years. Adverse childhood events (ACEs) experienced by caregivers of autistic children may predict delays in caregivers attending ASD diagnostic evaluations, negatively impacting the age at which the child is diagnosed with ASD. The purpose of this study was to further explore the caregiver delay response by analyzing recurring events common in caregivers of children at risk for ASD., Methods: We used a quantitative research design with convenience sampling to categorize caregivers of children referred for an ASD diagnostic evaluation into three groups based on their ACEs score and medical history., Findings: A higher percentage of caregivers with four or more ACEs compared to the national average was noted. Parental separation or divorce, verbal aggression, emotional abuse, and parental alcohol or substance abuse occurred most frequently, and the latter predicted a prolonged time in attending the diagnostic evaluation., Discussion: ACEs experienced by caregivers of children with ASD may delay the age of ASD diagnosis. Further investigation into the effect of ACEs on caregivers' mental health status and executive functioning is warranted to develop best practice for assisting caregivers in ASD recognition, diagnosis, and care management., Application to Practice: Clinicians should consider caregiver ACEs score when referring a child for a diagnostic developmental evaluation. Resources to address caregiver mental health needs should be provided at the onset of the referral process to increase the likelihood of caregiver adherence., Competing Interests: Declaration of Competing Interest The authors declared that there are no conflicts of interest., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Autism Spectrum Disorder (ASD), with the current prevalence at one in 44 children, is the most rapidly escalating neurodevelopmental disorder in the United States. While the 2000 to 2018 Autism and Developmental Disabilities Monitoring (ADDM) Network reports indicate progress toward identifying children with ASD by age 24 months, the actual age at which most children receive a diagnosis, ranging between age 51 to 53 months, has not significantly changed since 2000. Racial and gender disparities further complicate ASD identification. This article explores past ADDM findings to highlight ASD identification practices and provide relevant care management recommendations for primary care clinicians. Armed with this information, clinicians can improve ASD identification in their practice and advocate for beneficial, evidence-based health policies that decrease known disparities and enhance ASD care management for all., Competing Interests: Declaration of Competing Interest The authors declare that there is no conflict of interest. The authors would like to thank Mrs. Liliana Barrientos-Figueroa for her support in examining the 2014 ADDM report and Mr. Clay Kilmer for editing., (Copyright © 2022 Elsevier Inc. All rights reserved.)