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Black children with autism experience delays in diagnosis, Wash U study says

"Failure to address these disparities may seriously compromise outcomes for children affected by autism. We must do better,” researcher says
Credit: KSDK

ST. LOUIS — Black children with autism are diagnosed several months behind white children with autism, according to researchers at Washington University School of Medicine.

The study involved 594 Black children at four autism centers across the country and found, on average, children were 5 1/2 years old when they were diagnosed -- even though parents first had expressed concerns about their kids' development three years earlier, the study says.

White children, in comparison, are diagnosed an average of six months earlier.

Although it’s possible to diagnose autism in children before age 2, most kids are 4 or older when they receive a diagnosis.  

"This study reveals major roadblocks to receiving a diagnosis of autism, which has significant consequences for young children and their families,” said the paper’s first author, John N. Constantino, MD, the Blanche F. Ittleson Professor of Psychiatry and Pediatrics at Washington University. 

“In our current national conversation about race, preventable disparities in diagnosis and treatment services deserve a high priority because failure to address these disparities may seriously compromise outcomes for children affected by autism. We must do better.”

The new study detailing the nature of delays in the timing of autism diagnosis among African American children was published online Monday in the journal Pediatrics.

One of the most common and ominous markers of the effects of these racial disparities involves the rate at which they are additionally affected by intellectual disability. Recently published data collected by Constantino, Rob Fitzgerald, PhD, assistant professor of child psychiatry, and colleagues at other academic institutions, as well as the U.S. Centers for Disease Control and Prevention, show that 22% of white children with autism also have an intellectual disability. But among African American children, the rate of intellectual disability in those with autism tops 44%.

Historically, it has been presumed that an excess burden of intellectual disability is due to the fact that, on average, only some of the most severely affected minority children receive an autism diagnosis. But that no longer holds true in the United States, Constantino explained. The diagnostic prevalence of autism is approximately the same across races, at one in 54 children, leaving the stark and persistent disparity in intellectual disability between the races unexplained.

“Remarkably, among the African American children with autism in the new study, intellectual disability was not related to the factors that usually predict cognitive strengths and weaknesses,” said Constantino, also the director of the university’s William Greenleaf Eliot Division of Child & Adolescent Psychiatry. “Household income, the IQ levels of blood relatives, and preterm birth often are linked to cognitive outcomes, but those factors did not explain the disproportionate burden of intellectual disability suffered by African American children with autism. There is an ethical imperative to determine whether leveling the playing field for the timing of diagnosis and the quality and quantity of developmental therapy might resolve this disparity.”

In this study, the researchers found that a lack of health insurance was not involved in driving the delay between parents expressing concerns and African American children receiving diagnoses.

“Late diagnoses were not linked to a lack of general access to care or an inability of parents to recognize a problem,” Constantino said. “Resolving missed opportunities for timely and appropriate developmental therapy is a necessary next target for attempting to prevent the cognitive impairments that disproportionately complicate autism in young African Americans. Reducing this added burden is key to enhancing the ability of children with autism to learn, adapt and contribute to the community around them.”

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