Minority children with autism lack access to specialists
Hispanic and African-American children are less likely to see specialists for autism or other conditions, according to a new study.
June 17th, 2013
09:13 AM ET

Minority children with autism lack access to specialists

Editor's Note: Dr. Arshya Vahabzadeh is a resident psychiatrist at Emory University's Department of Psychiatry and Behavioral Health.

African-American and Hispanic children are far less likely to be seen by specialists - for autism, but also other medical conditions - and also less likely to receive specialized medical tests than their white peers, according to a new study published Monday in the journal Pediatrics.

Dr. Sarahbeth Broder-Fingert and colleagues studied the records of 3,615 children with autism at the Massachusetts General Hospital,  specifically looking at the rates of both referral to specialists and medical tests undertaken.  They discovered that children from African-American and Hispanic families were far less likely to receive specialized care or specific medical tests such as a sleep study, colonoscopy, or endoscopy.

When compared to their white peers, African-American children were three times less likely to see a gastroenterologist or nutritionist, and half as likely to see a neurologist or mental health specialist, according to the study. The story is similar among children from Hispanic families.

If a child has autism, the best outcomes are achieved through a combination of early diagnosis of the disorder and early intervention with behavioral therapies.

Another important element is the treatment of conditions which often coexist with autism, such as  psychological, neurological, and gastrointestinal problems. A referral to a specialist is often needed.

Autism is a developmental disorder that affects between 1 in 50 and 1 in 88 children in the United States, according to the Centers for Disease Control and Prevention. It is characterized by difficulties in communication and social interaction. Coexisting neurological problems such as seizures, and psychiatric disorders such as attention deficit hyperactivity disorder (ADHD), are common and affect up to a third of children with autism. Gastrointestinal complaints such as constipation, acid reflux, and abdominal pain are also frequently seen, with symptoms reported in 17% to 85% of cases.

What's to blame?

The exact reasons behind these findings remain unclear. One explanation may be that minority families face greater barriers in accessing specialist services. Lower numbers of local specialists, transportation issues, and lack of a regular health care provider have all been identified as problems for minority children.

Additionally. minority families may have beliefs that lead to the use of non-traditional services, or attribution of a child’s symptoms to non-medical causes. Even when obtaining referral to a specialist, children from minority families can face challenges in maintaining regular follow-up.

Another issue that remains to be clarified is whether the symptoms of autism are the same across racial and ethnic groups. Some evidence suggests that there may well be differences. For instance, one study has shown that children from minority groups may have more co-occurring symptoms of aggression. If aggression becomes the dominant issue during consultations, then other medical issues may be missed, and opportunities for specialist referral lost.

One final possibility is that children from white families are being referred too frequently to specialists, with subsequent unnecessary medical investigation. This could certainly be a problem given the lack of standardized guidance on how to treat and assess medically complex symptoms in children with autism.

“This is the first study to identify these disparities in specialist referral in children with autism,” said Dr. Christopher McDougle, director of the Lurie Center for Autism at Massachusetts General Hospital, who was not involved with the current study. “Autism is a medically complex condition and we must ensure that people with autism receive the specialist treatment they need, irrespective of racial and ethnic background.”

This study adds to the body of research showing race and ethnicity as being important factors in the diagnosis and treatment of autism. Studies conducted during the last decade have consistently noted that children from minority groups face substantial delays in obtaining an autism diagnosis.

African-American children in particular are more likely to be initially misdiagnosed, and face an average delay in autism diagnosis of 18 months compared to their white peers. Some have suggested that while white children may be diagnosed with autism when they have mild to moderate symptoms, African-American children tend to be diagnosed when they have severe symptoms, with milder cases going undetected.

soundoff (24 Responses)
  1. Catherine

    Get these kids access to healthier foods – and away from processed foods, high fructose corn syrup, wheat... and bet their health will improve.

    June 17, 2013 at 10:39 | Report abuse | Reply
    • Caroline

      Big Phrma doesn't make money from people eating healthy. And if Big Pharma doesn't make money, they can't contribute on political elections to give them business.

      June 17, 2013 at 12:36 | Report abuse |
    • Betty

      Wish people wouldn't comment when they are clueless to the facts.

      June 17, 2013 at 22:59 | Report abuse |
    • Freebird96

      How about taking responability: do not have children unless YOU can afford it!! Gee, I wish I could of just "popped" more babies, but my husband & I new that a family of two was all we could really afford to raise–in the life we wish to live

      July 19, 2013 at 20:13 | Report abuse |
  2. Patrick

    This has to be a joke right? I am in a white family... I have two children with Autism... and you know what.. I had all these issues and the real culprit was the insurance companies. They denied us to see the specialists.. they would not pay for the therapies.. it had nothing to do with race. I know thats not the over all point.. but i just think the real culprit should be pointed at. Insurance Companies especially in Illinois.

    June 17, 2013 at 11:16 | Report abuse | Reply
    • Laura

      Yes, in Georgia as well. Autism treatment is supposed to be covered, but they will almost always state pre-existing condition or no treatment available or whatever they can come up with.

      June 17, 2013 at 14:06 | Report abuse |
  3. Brenda

    is the read question race or is it social class? I am guessing poor white people are just as unlikely to get specialized help. "One final possibility is that children from white families are being referred too frequently to specialists, with subsequent unnecessary medical investigation"... what the ()&(*^! does that mean? hello?.

    June 17, 2013 at 11:16 | Report abuse | Reply
    • jim

      Remember, this is CNN... so poor white people don't count.

      June 17, 2013 at 14:37 | Report abuse |
    • skeptical

      You hit the nail on the head. I've worked for a pediatric neurologist for years, and what I see is exactly what you've described.

      June 17, 2013 at 19:33 | Report abuse |
  4. Timmy Suckle

    I kissed my way up to VP at a health insurance company. Now I take over $600,000 of your health care dollars for NO VALUE ADDED to your health care. And that’s just me. Now think about how many other VPs, Directors, Managers, etc. are at my company alone. Now multiply that by thousands of others at hundreds of other health insurance companies. From 10 to 25% of your health care dollars go towards administration that adds NO VALUE to your health care. But my company’s PAC dollars will continue to fool you little people into thinking that a single payer system will be bad. Little people like you are so easy to fool. Little people also don’t realize that a single payer system is the ONLY system that would allow little people (as an entire country) to negotiate better health care prices. Little people don’t realize that the Medical Cartels already know that. And that is the reason why the Medical Cartels spend so much PAC money from the hospitals and doctors lobbying against a single payer system. Some little people say that a single payer system would cost you little people more. But if that were true, then wouldn’t the hospitals and doctors WANT that extra money? Yes they would. So why do the Medical Cartels lobby against a single payer system? It’s because the Medical Cartels know it would allow little people to negotiate better health care prices. And that’s what the Medical Cartels are afraid of. Period.
    But us big wigs at insurance companies, hospitals, and pharmacy companies don’t ever need to worry about health care no matter what it costs. We get our health care paid for one way or another by you little people. And we get the little people that work at our companies to contribute to our PACs. And us big wigs say it’s to protect the little peoples’ jobs. But in reality it would be in the little peoples’ best interest to NOT contribute to the PAC. Again, little people are so easy to be fooled. I won’t ever have to worry about losing my job with so many little people being brain washed by the Medical Cartels’ PAC money. Not only that, the Medical Cartels’ PAC money is used to elect so many republicans that will never allow a single payer system. Republicans have always fought against any meaningful health care reform. But that’s what our Medical Cartels’ PACs pay them for. Politicians can be bought so easily.
    Pretty soon the only people that will be able to afford health care is us big wigs. And that’s the way it should be. We don’t want you little people using up the resources when we need them. And once again, I thank you little people for capping my SS tax at the $113,700 level. Now I only pay 1.2% SS tax and you little people pay 6.2%. Also, thank you for extending my tax breaks. I’m using the extra money on my vacation houses.

    June 17, 2013 at 11:54 | Report abuse | Reply
    • chris

      sad but true

      June 17, 2013 at 12:42 | Report abuse |
    • mirage

      I understand and appreciate that you stated the truth in you're comment. However, referring to hard working Americans as "little people" is offensive and I think many people may disregard your well put and well thought out comment. If you want to get the point across you may want to consider editing it.

      June 17, 2013 at 14:18 | Report abuse |
    • jim

      Mirage–you realize this guy is joking, right? But then, on the internet no one knows you're a dog.

      June 17, 2013 at 14:38 | Report abuse |
    • Clarissa Thompkins

      I certainly do not pretend to have all of the answers to our health care issues in this country, but I believe that there are enough bright people in our great country to figure it out. One thing that I am sure of however, what we have done in the past is not working. Research shows that when the disadvantaged are healthier, the country as a whole is healthier. Yes, those who could afford health care regardless of how it is structured would be healthier if the disadvantaged were healthier. It also goes without saying also that there is a lot of money to be saved by preventative care that a better health care system would grant us. I know we are the greatest country in the world, and many of us feel that that means we can not learn anything from any other country. Nevertheless, we really could and should. Other developed countries have better health care systems than the U.S.. I know this shocks some people and others just choose to ignore this fact or to find a way to just not believe it. However, it is true. Their health care cost less, the patients have better outcomes and many illnesses are simply prevented in the first place. If the thought of everyone being healthy does not appeal to all, don't focus on everyone else. Just focus on yourself and what others becoming healthier will mean for you.

      June 25, 2013 at 23:37 | Report abuse |
  5. Fiona

    How about his explanation for the disparity: white moms and dads go to great lengths to have their kids deemed "autism spectrum" so the kids can get extra attention and serives on the public dime? It's very common in my state.

    June 17, 2013 at 23:34 | Report abuse | Reply
    • Alene

      Yeah, that sounds like a plausible explanation. Who in their right mind would WANT their child to be autistic or labeled autistic? I think your logic is a bit faulty. There might be a few families who would do this to receive SSI, but I don't buy a doctor diagnosing a kid if they weren't autistic. It is not an easy process to get a diagnosis.

      June 18, 2013 at 19:49 | Report abuse |
  6. Agrav8td

    Exactly, this is not a class or color issue. It's an insurance company issue. But for some reason we let them get away with their continuous and increasing lack of coverage, yet skyrocketing premiums. We point fingers at each other instead of where the real blame lies.

    June 18, 2013 at 12:35 | Report abuse | Reply
  7. CM

    It's not a race thing. It's a poverty thing. If you are living in poverty you do not have the means to get your child to a specialist. Only just recently in January did Occupational Therapy begin to be covered for kids on state insurance. And additionally, transportation can be an issue when you have nothing.

    June 18, 2013 at 19:15 | Report abuse | Reply
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    June 19, 2013 at 21:41 | Report abuse | Reply
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    September 25, 2013 at 00:57 | Report abuse | Reply
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