Nearly 2-Year Delay in Diagnosing Autism in Blacks. (Not Due to Poor Accessy to Care)

Article excerpt

WASHINGTON -- African Americans with autism are diagnosed nearly 2 years later than white children with the disorder, David S. Mandell, Sc.D., reported at an international conference sponsored by the National Institute of Mental Health.

Using data from a study of 406 autistic children identified in a three-county area that included Philadelphia, Dr. Mandell found that, on average, white children were first diagnosed at 6.3 years of age, while African American children were diagnosed at 7.9 years of age. Hispanic children and those of other racial and ethnic backgrounds were diagnosed at ages between the two.

Medicaid claims filed from 1991 to 1999 for autism services (ICD-9 code 299.00) were used to identify the children. In Pennsylvania, all autistic children are eligible for Medicaid services regardless of parental income, which makes the Medicaid database a representative sample of autistic children in the state, he said.

Studies have consistently reported negative biases toward minorities in the areas of diagnosis and treatment. But Dr. Mandell's results paint a picture of mental health care that is "frankly embarrassing," he said.

White children did enter the mental health services system at a younger age (6 years) than black children (7.1 years), but that difference does not fully account for the delayed diagnoses. The intensity of services proved greater for black and other minority children. Black children in the study had an average of 13 visits with a mental health professional over 10 months before being diagnosed, compared with four visits over 4 months for white children. "They had many more visits than white children yet still were not diagnosed," said Dr. Mandell of the University of Pennsylvania, Philadelphia.

Eighty percent of the study population was male--exactly the proportion that would be expected in a representative sample. Autism is known to affect four boys for every one girl in the general population. Research has shown no differences based on race, ethnicity, or socioeconomic status in either the prevalence or incidence of autism in children, Dr. Mandell said. He also noted that there are no differences in the prevalence or incidence of the disorder by race in the general population.

Dr. Mandell analyzed the data in two additional ways to see whether the results would be more encouraging.

First, he looked at a subset of the youngest children- those born after the disorder became better known and more easily recognized. A delay in diagnosis for black children (5.7 years), compared with white children (4.8 years) was still evident in this group, although the age at diagnosis did drop overall.

Second, he plotted the age distributions without factoring in age at first visit to mental health services. In this analysis, Dr. Mandell found that white race was the only variable significantly associated with young age at diagnosis. The average age at diagnosis was 5.5 years for white children, compared with 7.5 years for black children, in this analysis.

"These results highlight two issues. One is the general delay in diagnosing all children with autism," said Dr. Mandell, pointing out that the condition can often be diagnosed in children as young as 18 months. "The other is the glaring racial disparity in age at diagnosis."

The core features of autism--impaired verbal and non-verbal communication, impaired socialization, and stereotyped behaviors--and the constellation of signs that characterize it usually are considered to be very recognizable.

Yet overall, the average age at diagnosis was more than 6 years in this study. …