: The Association between Race and Age of First Evaluation Among Children with Autism Spectrum Disorder.
Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder characterized by social communication impairments and restricted and/or repetitive behaviors. Impairments are evident early in childhood. Despite increasing ASD awareness and increasing prevalence of ASD, the age of ASD identification has not changed. A key public health goal is to identify children with ASD early and provide early intervention. Studies have shown the benefits of early interventions; however, studies have also shown race-based and SES disparities in access to healthcare services.
The aim of this study was to determine if there is an association between race/ethnicity and age of first evaluation among children with ASD. We predict race-based disparities in age of first evaluation among children with ASD.
Children with ASD born in 2010 and residing in New Jersey (NJ) in 2014 were identified from active surveillance, using a Centers for Disease Control and Prevention (CDC), ascertainment method, based on retrospective review and analysis of information contained in health and education records. Information on race/ethnicity, sex, SES (mother’s education level), impairment level, and age of first evaluation was analyzed. We examined the unadjusted and adjusted odds ratio for Black, non-Hispanic versus White, non-Hispanic children and Hispanic versus White, non-Hispanic children as the predictor variable, and if they did not receive a comprehensive evaluation by age 36 months as the outcome. Regression Models were adjusted for other covariates. Pearson Chi-Square Tests and multivariate logistic regression models were used for analysis.
Overall, 518 4-year-old children were identified with ASD in 2014. The prevalence estimate was 28.6 (95% CI 26.2,31.2). The sample was predominately male with a 4.4 (3.3,5.8) ratio. This sample was further restricted to children born in NJ (n=407). Overall, 67% of children received a comprehensive evaluation by age 36 months. There were no differences by sex, SES, or impairment level; however, there was a significant difference by race/ethnicity (p=.0012). Unadjusted and adjusted odds ratios were the same for Black, non-Hispanic compared to White, non-Hispanic Children. Unadjusted OR = 2.0 (95% CI 1.1,3.5) and adjusted OR=2.0 (95% CI1.2,3.6). For Hispanic compared to White, non-Hispanic children, the unadjusted and adjusted odds ratios were slightly different. Unadjusted OR = 1.9 (95% CI 1.1,3.5) and adjusted OR=1.7 (95% CI 1.0,3.0). The adjusted OR for Hispanic compared to White, non-Hispanic children was no longer significant. Females were more likely than males to receive evaluations early, adjusted OR = 0.8 (95%CI 0.5,1.4), and mild impairment vs severe impairment adjusted OR was 1.7 (95% CI 0.9,3.1); however, these findings were non-significant.
Overall, we found significant race-based disparities in access to services. Black, non-Hispanic children with ASD were half as likely to receive a comprehensive evaluation by 36 months compared to White, non-Hispanic children with ASD. When we adjusted the model for sex, mother’s education level, and degree of impairment, the findings did not change. Our findings are consistent with previous findings and underscore the importance of universal screening to enhance early identification and decrease race-based disparities.