Disparities in Documented Diagnoses of Autism Spectrum Disorder Based on Demographic, Individual, and Service Factors.
Lisa D Wiggins, Maureen Durkin, Amy Esler and 10 others
PMID 31868321WHAT IT FOUND
25.2% of children whose records showed enough ASD symptoms to meet surveillance criteria had no documented ASD diagnosis.
They were more likely to be non-Hispanic Black, Hispanic, or other non-Hispanic race, evaluated after age 3, have no intellectual disability, or need fewer supports.
Key findings
01Of 4,498 children meeting ADDM ASD surveillance status, 1,135 (25.2%) had no documented ASD diagnosis in health or education records.
02Among children without a documented ASD diagnosis, 55.3% were not known to receive ASD services in public school.
03Children without a documented ASD diagnosis were more likely to be non-Hispanic Black, other non-Hispanic race, or Hispanic than non-Hispanic White, and more likely to have first evaluation after age 3, intellectual functioning outside the disability range, or need for fewer supports.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
The ADDM surveillance areas are not nationally representative, so the findings may not apply to all U.S. communities. ASD case status was determined from records, not by direct clinical evaluation, so some children may have been classified differently if assessed directly. Records may have missed an ASD diagnosis given after abstraction, or an earlier diagnosis that was not written in the reviewed records. Children without a documented diagnosis may have received ASD services outside public school, and the study did not survey comprehensive service use or insurance status. Some children with social and behavioral deficits may be better described by another condition rather than ASD. Access to education records varied by site, and some sites reviewed only some school districts within their surveillance areas.
Declared interests
The ADDM sites were funded by the Centers for Disease Control and Prevention, and the article is supported by U.S. government Public Health Service funding. The supplied text does not include an author conflict-of-interest declaration.
The easy way to misread this
Do not read the absence of a documented ASD diagnosis as proof that a child does not have ASD. The children were classified as ASD surveillance cases from health and education records, not through direct clinical evaluation, and some may have been diagnosed elsewhere or not documented.