Disparities in Diagnoses Received Prior to a Diagnosis of Autism Spectrum Disorder

Center for Autism and Developmental Disabilities Research and Epidemiology, University of Pennsylvania, Philadelphia, PA, USA.
Journal of Autism and Developmental Disorders (Impact Factor: 3.34). 11/2007; 37(9):1795-802. DOI: 10.1007/s10803-006-0314-8
Source: PubMed


This study estimated differences by ethnicity in the diagnoses assigned prior to the diagnosis of autism. In this sample of 406 Medicaid-eligible children, African-Americans were 2.6 times less likely than white children to receive an autism diagnosis on their first specialty care visit. Among children who did not receive an autism diagnosis on their first visit, ADHD was the most common diagnosis. African-American children were 5.1 times more likely than white children to receive a diagnosis of adjustment disorder than of ADHD, and 2.4 times more likely to receive a diagnosis of conduct disorder than of ADHD. Differences in diagnostic patterns by ethnicity suggest possible variations in parents' descriptions of symptoms, clinician interpretations and expectations, or symptom presentation.

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Available from: Jennifer Pinto-Martin, Jan 20, 2014
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    • "), how and when autism can be diagnosed (e.g., Lord et al. 1997; Luyster et al. 2009), the increasing prevalence of autism diagnoses and factors that may contribute to this (e.g., Blumberg et al. 2013; Kim et al. 2011), ethnic disparities in autism diagnoses in the United States and likely contributions of socioeconomic factors to these disparities (e.g., Durkin et al. 2010; Mandell et al. 2007), the higher prevalence of autism among males and the possibility that diagnostic measures may be less effective in detecting autism in females (e.g., Baron-Cohen et al. 2009), and how cultural factors including stigma may influence rates of diagnosis internationally (e.g., Elsabbagh et al. 2012; Kim et al. 2011). After introducing common traits observed among people with autism and emphasizing that each individual with autism is unique (e.g., Wing 1988), the training discussed associations between giftedness and autistic traits in the general population (e.g., Vital et al. 2009), and the heterogeneity of intelligence in autism (e.g., Bölte et al. 2009). "
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    ABSTRACT: College students with autism may be negatively impacted by lack of understanding about autism on college campuses. Thus, we developed an online training to improve knowledge and decrease stigma associated with autism among college students. Participants (N = 365) completed a pre-test, online training, and post-test. Women reported lower stigma towards autism than men. Participation in the training was associated with decreased stigma and increased knowledge about autism. Although participants exhibited relatively high baseline knowledge of autism, misconceptions were common, particularly in open-ended responses. Participants commonly confused autism with other disorders, such as learning disabilities. This study suggests that online training may be a cost-effective way to increase college students’ understanding and acceptance of their peers with autism.
    Full-text · Article · Nov 2015 · Journal of Autism and Developmental Disorders
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    • "Although screening for ASD during early intervention has been linked to earlier ASD diagnosis (Twyman et al. 2009), higher rates of screening amongst African Americans may not necessarily lead to higher rates of early diagnosis, as African American children have been found to require three times the number of visits to a specialist before receiving an ASD diagnosis (Mandell et al. 2002). African American children are also three times more likely than white children to receive a different diagnosis, such as conduct disorder or oppositional defiant disorder, prior to being diagnosed with ASD (Mandell et al. 2007). Children who were at younger ages at the time of assessment were more likely to have screening refused than older children. "
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    ABSTRACT: Emerging evidence of the efficacy of early intervention for autism spectrum disorder (ASD) has focused attention on the need for early identification of young children suspected of having ASD and thus on the implementation of routine ASD screenings. This study examined the refusal rates of ASD screening among infants and toddlers enrolled in EarlySteps, the State of Louisiana’s early intervention program. Participants (n = 4,296) were children aged from birth to 36 months who were enrolled in EarlySteps. The Battelle Developmental Inventory, Second Edition (BDI-2) and demographic section of the Baby and Infant Screen for Children with aUtism Traits- Part 1 (BISCUIT: Part 1) were administered to a parent or caregiver as part of the EarlySteps assessment protocol. ASD screenings were refused by 23.3 % of children sampled. Females were found to be at greater risk for screening refusal (adjusted odds ratio (OR) = 1.338, 95 % CI 1.106–1.618). African American children were less likely to have screening refused than other ethnicities (OR = .746, CI 95 % .609–.915). Previous diagnoses of Down syndrome (OR = 3.934, 95 % CI 1.785–6.462), cerebral palsy (OR = 2.744, 95 % CI 1.436–5.243), seizure disorders (OR = 2.271, 95 % CI 1.208–3.638), and other genetic conditions (OR = 2.271, 95 % CI 1.273–4.052) were also found to increase risk of refusal. Children with a family history of ASD were less likely to have screening refused (OR = .351, 95 % CI .244–.505). Clinical applications and the need for more research on factors related to ASD screening refusal are highlighted.
    Full-text · Article · Oct 2015 · Journal of Developmental and Physical Disabilities
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    • "Recent studies reported that more Caucasian children than African American children were diagnosed on the milder spectrum of ASD, suggesting that cultural differences may confuse the severity of the diagnosis (Baio et al. 2014; Jarquin et al. 2011). African American family beliefs and interpretations of symptoms have been relatively unexplored, despite some ASD investigators noting that the diagnosis may be assigned differentially by the child's culture due to misinterpreted HCP and family interactions (Barton et al. 2012; Bhasin and Schendel 2007; Jarquin et al. 2011; Mandell et al. 2007). The aggregate of these proposed cultural factors reveals a need for exploratory research with African American families to discover their cultural perspectives on caring for children with ASD and the perceptions of family care among ASD professionals. "
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    ABSTRACT: Cultural factors such as health care access and autism spectrum disorder (ASD) symptom interpretations have been proposed as impacting delayed diagnosis and treatment for African American children with ASD. A qualitative study of urban African American families caring for their child with autism was conducted with 24 family members and 28 ASD professionals. Cultural caring meant families protected their child from harm including potential or actual distrustful encounters, and took action for their child and community to optimize their child's health and address the knowledge deficits of ASD within their community. Families and professionals believed cultural influences delayed families' receiving and seeking appropriate health care for the African American child with ASD affecting timely autism diagnosis and treatment.
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