Age at Autism Spectrum Disorder (ASD) Diagnosis by Race, Ethnicity, and Primary Household Language Among Children with Special Health Care Needs, United States, 2009-2010

Heejoo Jo, Laura A Schieve, Catherine E Rice, Marshalyn Yeargin-Allsopp, Lin H Tian, Stephen J Blumberg, Michael D Kogan, Coleen A Boyle, Heejoo Jo, Laura A Schieve, Catherine E Rice, Marshalyn Yeargin-Allsopp, Lin H Tian, Stephen J Blumberg, Michael D Kogan, Coleen A Boyle

Abstract

We examined prevalence of diagnosed autism spectrum disorder (ASD) and age at diagnosis according to child's race/ethnicity and primary household language. From the 2009-2010 National Survey of Children with Special Health Care Needs, we identified 2729 3-17-year-old US children whose parent reported a current ASD diagnosis. We compared ASD prevalence, mean diagnosis age, and percentage with later diagnoses (≥5 years) across racial/ethnic/primary household language groups: non-Hispanic-white, any language (NHW); non-Hispanic-black, any language (NHB); Hispanic-any-race, English (Hispanic-English); and Hispanic-any-race, other language (Hispanic-Other). We assessed findings by parent-reported ASD severity level and adjusted for family sociodemographics. ASD prevalence estimates were 15.3 (NHW), 10.4 (NHB), 14.1 (Hispanic-English), and 5.2 (Hispanic-Other) per 1000 children. Mean diagnosis age was comparable across racial/ethnic/language groups for 3-4-year-olds. For 5-17-year-olds, diagnosis age varied by race/ethnicity/language and also by ASD severity. In this group, NHW children with mild/moderate ASD had a significantly higher proportion (50.8 %) of later diagnoses than NHB (33.5 %) or Hispanic-Other children (18.0 %). However, NHW children with severe ASD had a comparable or lower (albeit non-significant) proportion (16.4 %) of later diagnoses than NHB (37.8 %), Hispanic-English (30.8 %), and Hispanic-Other children (12.0 %). While NHW children have comparable ASD prevalence and diagnosis age distributions as Hispanic-English children, they have both higher prevalence and proportion of later diagnoses than NHB and Hispanic-Other children. The diagnosis age findings were limited to mild/moderate cases only. Thus, the prevalence disparity might be primarily driven by under-representation (potentially under-identification) of older children with mild/moderate ASD in the two minority groups.

Figures

Fig. 1
Fig. 1
Estimated prevalence of CSHCN aged 3–17 years with ASD by race/ethnicity/language, United States, 2009–2010. Racial/ethnic and primary household language groups were categorized as: non-Hispanic-white, any language (NHW); non-Hispanic-black, any language (NHB); Hispanic-any race, English (Hispanic-English); and Hispanic-any race, other language (Hispanic-Other). aPrevalence estimate is significantly different from NHW children
Fig. 2
Fig. 2
Estimated prevalence of ASD by race/ethnicity/language, parent-assessed severity, and age at diagnosis among children aged 5–17 years at survey, United States, 2009–2010. Weighted prevalence estimates are per 1000 non-institutionalized children in the US population. aAge at diagnosis is <5 years. bAge at diagnosis is ≥5 years. cP < 0.05 two-tailed z test comparing the prevalence estimate within each race/ethnicity/language group to the prevalence estimate among NHW children

References

    1. American Psychiatric Association . Diagnostic and statistical manual of mental disorders, 4th edition, text revision (DSM-IV-TR) Washington, DC: American Psychiatric Publishing; 2000.
    1. Charman T, Baird G. Practitioner review: Diagnosis of autism spectrum disorder in 2- and 3-year-old children. Journal of Child Psychology and Psychiatry. 2002;43(3):289–305. doi: 10.1111/1469-7610.00022.
    1. Dawson G, Rogers S, Munson J, et al. Randomized, controlled trial of an intervention for toddlers with autism: The Early Start Denver Model. Pediatrics. 2010;125(1):e17–e23. doi: 10.1542/peds.2009-0958.
    1. Eapen V, Crnčec R, Walkter A. Clinical outcomes of an early intervention program for preschool children with autism spectrum disorder in a community group setting. BMC Pediatrics. 2013;13(1):3. doi: 10.1186/1471-2431-13-3.
    1. Reichow B. Overview of meta-analyses on early intensive behavioral intervention for young children with autism spectrum disorders. Journal of Autism and Developmental Disorders. 2012;42(4):512–520. doi: 10.1007/s10803-011-1218-9.
    1. Wallace KS, Rogers SJ. Intervening in infancy: Implications for autism spectrum disorders. Journal of Child Psychology and Psychiatry. 2010;51(12):1300–1320. doi: 10.1111/j.1469-7610.2010.02308.x.
    1. Centers for Disease Control and Prevention Prevalence of autism spectrum disorder among children aged 8 years—Autism and Developmental Disabilities Monitoring Network, 11 sites, United States, 2010. Surveillance summaries, March 28, 2014. Morbidity and Mortality Weekly Report. 2014;63(2):1–21.
    1. Centers for Disease Control and Prevention Mental health in the United States: Parental report of diagnosed autism in children aged 4–17 years—United States, 2003–2004. Surveillance summaries, May 5, 2006. Morbidity and Mortality Weekly Report. 2006;17:481–486.
    1. Blumberg SJ, Bramlett MD, Kogan MD, et al. Changes in prevalence of parent-reported autism spectrum disorder in school-aged U.S. children: 2007 to 2011–2012. National Health Statistics Reports. 2013;65:1–11.
    1. Boyle CA, Boulet S, Schieve LA, et al. Trends in the prevalence of developmental disabilities in US children, 1997–2008. Pediatrics. 2011;127(6):1034–1042. doi: 10.1542/peds.2010-2989.
    1. Kogan MD, Blumberg SJ, Schieve LA, et al. Prevalence of parent-reported diagnosis of autism spectrum disorder among children in the US, 2007. Pediatrics. 2009;124(5):1395–1403. doi: 10.1542/peds.2009-1522.
    1. Maenner M, Schieve LA, Rice CE. Frequency and pattern of documented diagnostic features and the age of autism identification. Journal of the American Academy of Child and Adolescent Psychiatry. 2013;52(4):401–413. doi: 10.1016/j.jaac.2013.01.014.
    1. Newschaffer CJ, Falb MD, Gurney JG. National autism prevalence trends from United States special education data. Pediatrics. 2005;115(3):e277–e282. doi: 10.1542/peds.2004-1958.
    1. Schieve LA, Rice CE, Yeargin-Allsopp M, et al. Parent-reported prevalence of autism spectrum disorders in US-born children: An assessment of changes within birth cohorts from 2003 to the 2007 National Survey of Children’s Health. Maternal and Child Health Journal. 2012;16(Suppl 1):S151–S157. doi: 10.1007/s10995-012-1004-0.
    1. Shattuck PT, Durkin M, Maenner M, et al. Timing of identification among children with an autism spectrum disorder: Findings from a population-based surveillance study. Journal of the American Academy of Child and Adolescent Psychiatry. 2009;48(5):474–483. doi: 10.1097/CHI.0b013e31819b3848.
    1. Yeargin-Allsopp M, Rice CE, Karapurkar T, et al. Prevalence of autism in a US metropolitan area. JAMA. 2003;289(1):49–55. doi: 10.1001/jama.289.1.49.
    1. Centers for Disease Control and Prevention Prevalence of autism spectrum disorders—Autism and Developmental Disabilities Monitoring Network, 14 sites, United States, 2006. Surveillance summaries, December 18, 2009. Morbidity and Mortality Weekly Report. 2009;58(SS10):1–20.
    1. Croen LA, Grether JK, Hoogstrate J, et al. The changing prevalence of autism in California. Journal of Autism and Developmental Disorders. 2002;32(3):207–215. doi: 10.1023/A:1015453830880.
    1. Dearlove J, Kearney D. How good is general practice developmental screening? BMJ. 1990;300(6733):1177–1180. doi: 10.1136/bmj.300.6733.1177.
    1. Mandell DS, Novak MM, Zubritsky CD. Factors associated with age of diagnosis among children with autism spectrum disorders. Pediatrics. 2005;116(6):1480–1486. doi: 10.1542/peds.2005-0185.
    1. Daley TC. From symptom recognition to diagnosis: children with autism in urban India. Social Science and Medicine. 2004;58(7):1323–1335. doi: 10.1016/S0277-9536(03)00330-7.
    1. Glascoe FP. Parents’ concerns about children’s development: Prescreening technique or screening test? Pediatrics. 1997;99(4):522–528. doi: 10.1542/peds.99.4.522.
    1. Heidgerken AD, Geffken G, Modi A, et al. A survey of autism knowledge in a health care setting. Journal of Autism and Developmental Disorders. 2005;35(3):323–330. doi: 10.1007/s10803-005-3298-x.
    1. Mandell DS, Listerud J, Levy SE, et al. Race differences in the age at diagnosis among Medicaid-eligible children with autism. Journal of the American Academy of Child and Adolescent Psychiatry. 2002;41(12):1447–1453. doi: 10.1097/00004583-200212000-00016.
    1. Mandell DS, Wiggins LD, Carpenter LA, et al. Racial/ethnic disparities in the identification of children with autism spectrum disorders. American Journal of Public Health. 2009;99(3):493–498. doi: 10.2105/AJPH.2007.131243.
    1. Schieve LA, Boulet SL, Blumberg SJ, et al. Association between parental nativity and autism spectrum disorder among US-born non-Hispanic white and Hispanic children, 2007 National Survey of Children’s Health. Disability and Health Journal. 2012;5(1):18–25. doi: 10.1016/j.dhjo.2011.09.001.
    1. Shevell MI, Majnemer A, Rosenbaum P, et al. Profile of referrals for early childhood developmental delay to ambulatory subspecialty clinics. Journal of Child Neurology. 2001;16(9):645–650. doi: 10.1177/088307380101600904.
    1. Sices L, Feudtner C, McLaughlin J, et al. How do primary care physicians identify young children with developmental delays? A national survey. Journal of Developmental and Behavioral Pediatrics. 2003;24(6):409–417. doi: 10.1097/00004703-200312000-00002.
    1. Valicenti-McDermott M, Hottinger K, Seijo R, et al. Age at diagnosis of autism spectrum disorders. Journal of Pediatrics. 2012;161(3):554–556. doi: 10.1016/j.jpeds.2012.05.012.
    1. Bethell CD, Read D, Stein RE, et al. Identifying children with special health care needs: Development and evaluation of a short screening instrument. Ambulatory Pediatrics. 2002;2(1):38–48. doi: 10.1367/1539-4409(2002)002<0038:ICWSHC>;2.
    1. Bramlett, M. D., Blumberg, S. J., Ormson, A. E., et al. (2014). Design and operation of the National Survey of Children with Special Health Care Needs, 2009–2010. Vital and Health Statistics 1, (57), 1–271.
    1. Schieve LA, Gonzalez V, Boulet SL, et al. Concurrent medical conditions and health care use and needs among children with learning and behavioral developmental disabilities, National Health Interview Survey, 2006–2010. Research in Developmental Disabilities. 2012;33(2):467–476. doi: 10.1016/j.ridd.2011.10.008.
    1. Child and Adolescent Health Measurement Initiative. Query of 2007 National Survey of Children’s Health Data from the Data Resource Center for Child and Adolescent Health [Accessed 3/22/12]. As cited in Pringle B. A., Colpe L. J., Blumberg S. J., Avila R. M., Kogan M. D. (2012). Diagnostic history and treatment of school-aged children with autism spectrum disorder and special health care needs. National Center for Health Statistics Data Brief,97, 1–7.
    1. Garrison EG, Roy IS, Azar V. Responding to the mental health needs of Latino children and families through school-based services. Clinical Psychology Review. 1999;19(2):199–219. doi: 10.1016/S0272-7358(98)00070-1.
    1. Lassetter JH, Baldwin JH. Health care barriers for Latino children and provision of culturally competent care. Journal of Pediatric Nursing. 2004;19(3):184–192. doi: 10.1016/j.pedn.2004.01.007.
    1. Liptak GS, Benzoni LB, Mruzek DW, et al. Disparities in diagnosis and access to health services for children with autism: Data from the National Survey of Children’s Health. Journal of Developmental and Behavioral Pediatrics. 2008;29(3):152–160. doi: 10.1097/DBP.0b013e318165c7a0.
    1. Adams SH, Newacheck PW, Park MJ, et al. Medical home for adolescents: Low attainment rates for those with mental health problems and other vulnerable groups. Academic Pediatric. 2013;13(2):113–121. doi: 10.1016/j.acap.2012.11.004.
    1. Yu SM, Singh GK. Household language use and health care access, unmet need, and family impact among CSHCN. Pediatrics. 2009;124(Suppl 4):S414–S419. doi: 10.1542/peds.2009-1255M.
    1. American Academy of Pediatrics Council on Children with Disabilities Identifying infants and young children with developmental disorders in the medical home: An algorithm for developmental surveillance and screening. Pediatrics. 2006;118(1):405–420. doi: 10.1542/peds.2006-1231.
    1. Johnson CP, Myers SM, American Academy of Pediatrics Council on Children with Disabilities Identification and evaluation of children with autism spectrum disorders. Pediatrics. 2007;120(5):1183–1215. doi: 10.1542/peds.2007-2361.
    1. Levy SE, Giarelli E, Lee L, et al. Autism spectrum disorder and co-occurring developmental, psychiatric, and medical conditions among children in multiple populations of the United States. Journal of Developmental and Behavioral Pediatrics. 2010;31(4):267–275. doi: 10.1097/DBP.0b013e3181d5d03b.
    1. Stichter JP, O’Connor KV, Herzog MJ, et al. Social competence intervention for elementary students with Aspergers syndrome and high functioning autism. Journal of Autism and Developmental Disorders. 2012;42(3):354–366. doi: 10.1007/s10803-011-1249-2.

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