Autism Diagnostic Timeline: No Disparities between Hispanic and Non-Hispanic White Populations in Western New York

Background: Early autism spectrum disorder (ASD) diagnosis and treatment improves developmental outcomes. National data describes disparities between Hispanic and non-Hispanic white (NHW) children regarding access to early intervention (EI) and diagnostic services - Hispanic children are less often evaluated for ASD by age 36 months, and more likely to be diagnosed after age 4 years, than are NHW children. New York State has the fourth largest Hispanic population in the country, yet the northeastern U.S. is underrepresented in national data.

Objectives: Describe ages of entry to EI services, referral, initial evaluation, and first ASD diagnosis according to child’s ethnicity/race (Hispanic, NHW) and primary language (English, bilingual English-Spanish, or Spanish) in a northeastern U.S. tertiary care clinic sample. This clinic is the primary source for ASD diagnosis in the western New York region.

Methods: We reviewed 493 medical records of children ages 24-60 months with an ASD diagnosis seen in clinic between September 1, 2015-February 28, 2017. Subjects were selected on the basis of receiving an ASD diagnosis during that time and self-identified ethnicity and race. Exclusion criteria were non-Hispanic race other than white, gestational age <37 weeks, genetic diagnosis with known increased ASD risk, primary language other than English or Spanish, and missing data on variables of interest.

Results: Of 493 patients reviewed, 177 (36%) met criteria and were included in the analyses. Fifteen percent (n=27) identified as Hispanic, 85% (n=150) as NHW. Of Hispanic patients, 63% (n=17) were English-speaking (Hisp-E), 15% (n=4) were bilingual (Hisp-B), and 22% (n=6) were Spanish-speaking (Hisp-S).

Significantly more Hispanic children had public health insurance compared to NHW (70 v. 45%, respectively, p=0.017). Hispanic children were referred for evaluation earlier than NHW (Hispanic 28.62±7.21 v. NHW 32.66±9.77, p=0.045). EI participation rate was similar between groups (Hispanic 85 v. NHW 80%, p=0.549), with no difference by age at entry to EI services (Hispanic 22.23±4.88 v. NHW 22.64±5.84, p=0.756). No differences existed by ages at initial evaluation (Hispanic 36.07±8.22 v. NHW 38.57±9.96, p=0.221) or first ASD diagnosis (Hispanic 36.81±8.53 v. NHW 39.60±10.14, p=0.181). Ages reported in months.

Considering Hispanic language subgroups, there were no statistically significant differences between these and NHW on all outcomes of interest. Although not significant, Hisp-S had highest EI participation (100%), compared to Hisp-E (82%), NHW (80%), and Hisp-B (75%). Hisp-S also had earliest mean ages of referral, evaluation, and diagnosis.

Conclusions: Contrasting with published literature, Hispanic children in this sample participated in EI services at similar rates as NHW patients. They also were evaluated for and diagnosed with ASD on average by age 36 months, comparable to NHW counterparts. Variation from the literature may be due to regional differences in screening, referral, and availability of services, as well as differences in the Hispanic population sampled. Reasons for differences between this sample and national data should be further explored. Higher utilization of public health insurance among Hispanics may have resulted in earlier age of referral for patients in this sample because of mandated developmental screening; barriers preventing their timely evaluation must be considered.