Race Differences in the Age at
Diagnosis Among David S. Mandell,
SC.D., John Listerud, M.D., Ph.D., Susan E. Levy, M.D. Abstract: J Am Acad Child Adolesc Psychiatry. 2002 Dec;41(12):1447-53 Findings Early recognition of autism spectrum disorder (AD) is critical because (1) educational and behavioral interventions are better if started early, (2) parents want to know and understand genetic risks before having more children, (3) the Individuals with Disabilities Act specifies that as of 3 years of age, children with disabilities are eligible throught he public educational system for special education, and (4) early detection can help children and families cope. By definition, onset of autistic disorder is before 3 years of age, yet consistently, the disorder is not diagnosed on average until children are 6 years old. While there are no differences by race or ethnicity in the prevalence of autism disorder, research shows differences in recognition and diagnosis and use of mental health services as a function of race. The goal of this study was to examine racial differences in the age at which Medicaid-eligible children first receive a diagnosis of AD and to examine time in mental health treatment until an AD diagnosis was received. Philadelphia Medicaid specialty mental health claims identified 406 children who received services in 1999 for AD. Claims from 1993-1999 were used to identify the date of first mental health visit, first receipt of AD diagnosis, and number of visits occurring between those dates. Linear regression was used to study the relationship among race, age at first diagnosis of AD, time in mental health treatment, and number of visits until the diagnosis was made. On average, white children received the AD diagnosis at 6.3 years of age, compared with 7.9 years for black children and 8.8 years for Latino children—the differences being significant (p <.001). White children entered the mental health system at an earlier age than black children (6.0 versus 7.1 years, p =.005); however, after adjusting for age, sex, and time eligible for Medicaid, black children required more time in treatment before receiving the diagnosis. Conclusions Generally, there is an overall delay in diagnosis, independent of race. One general reason for this delay is that pediatricians may wait too long before referring the child to a specialist. In addition, even some specialists may miss the diagnosis of ASD because the signs are subtle. In this study, 72% of white children and 58% of black children received a diagnosis of AD on their first visit to a specialty mental health setting. The authors suggest social and economic differences between families from different races and their doctors. Another study showed 65% of black families and 76% of white families had a regular doctor for their child. The authors conclude "more research is needed on the reasons for both the general delay in the diagnosis of autism and the differences in the age at diagnosis by race." |