Racial and Ethnic Differences in Rates of Prolonged Autism Diagnosis Process & Prior Diagnoses in Mental Health Specialty Care.
Veronica I Underwood Carrasco, Katharine E Zuckerman, Christina Charlesworth and 3 others
PMID 41879956WHAT IT FOUND
Most children diagnosed with autism in specialty mental health care were diagnosed at the first visit, but just over 21% had a prolonged diagnosis process.
Asian, American Indian/Alaska Native, and Hispanic children were less likely than white children to have that delay.
Key findings
01In the cohort of 21,586 children, 70.8% were diagnosed at the first specialty mental health visit, 8.0% were diagnosed between 1-90 days, and just over 21% had a prolonged diagnosis process of more than 90 days.
02Asian, American Indian/Alaska Native, and Hispanic children were less likely than white children to have a prolonged diagnosis process, with differences of -6.3 percentage points, -4.2 percentage points, and -2.6 percentage points.
03Among children with a prolonged diagnosis process, ADHD was the most common prior diagnosis (38.6%), followed by speech and language disorders (21.0%), and speech and language disorders were more commonly diagnosed before autism in most racial and ethnic minority groups than in white children.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
The study used specialty mental health claims only, so it missed children who never accessed specialty mental health care and diagnoses made in other settings. It measured only time after entry into specialty mental health care, not the total wait before that visit. Claims data cannot show whether diagnoses were accurate, what testing was performed, or whether autism instruments were culturally appropriate. The analysis included 24 states and used a one-year look-back and two-year look-forward, so other states or time periods may differ. Race and ethnicity categories came from Medicaid claims, which did not capture a race for Hispanic children or multiple categories for multiracial children, and language information was often missing. Missing race was kept as an indicator, which may have introduced bias. The more than 90-day definition of a prolonged diagnosis process was a choice, and a different definition could change results.
Declared interests
The authors declared no conflicts of interest relevant to this article.
The easy way to misread this
Do not conclude that Asian, American Indian/Alaska Native, and Hispanic children now have easier access to accurate autism diagnosis. The study measured only time after a specialty mental health visit, not total wait before that visit, service use, or diagnostic accuracy.