Disparities in diagnoses received prior to a diagnosis of autism spectrum disorder
Related Experiment Video
Updated: Jul 18, 2026
Testing Sensory and Multisensory Function in Children with Autism Spectrum Disorder
Published on: April 22, 2015
David S Mandell1, Richard F Ittenbach, Susan E Levy
1Center for Autism and Developmental Disabilities Research and Epidemiology, University of Pennsylvania, Philadelphia, PA, USA. mandelld@mail.med.upenn.edu
Insights
African-American children are less likely to receive an autism diagnosis on their first visit compared to white children. Instead, they are more often diagnosed with ADHD-related disorders, suggesting ethnic disparities in early autism diagnosis.
Area of Science:
- Child Psychology
- Medical Diagnostics
- Health Disparities
Background:
- Early diagnosis of autism spectrum disorder (ASD) is crucial for timely intervention and improved outcomes.
- Existing research suggests potential ethnic and racial disparities in healthcare access and diagnostic practices within the United States.
- Understanding these disparities is essential for promoting equitable care for all children.
Purpose of the Study:
- To investigate ethnic differences in the preliminary diagnoses assigned to children before an autism diagnosis.
- To identify specific diagnostic patterns associated with ethnicity in a Medicaid-eligible pediatric population.
- To explore potential contributing factors to observed diagnostic variations.
Main Methods:
- Retrospective analysis of diagnostic data from 406 Medicaid-eligible children.
- Comparison of diagnostic assignments between African-American and white children during initial specialty care visits.
- Statistical analysis to determine the likelihood of receiving specific diagnoses (autism, ADHD, adjustment disorder, conduct disorder) based on ethnicity.
Main Results:
- African-American children were 2.6 times less likely than white children to receive an autism diagnosis during their first specialty care visit.
- Among children not diagnosed with autism initially, ADHD was the most frequent diagnosis.
- African-American children were significantly more likely than white children to be diagnosed with adjustment disorder (5.1 times) or conduct disorder (2.4 times) compared to ADHD.
Conclusions:
- Significant ethnic variations exist in the initial diagnostic pathways for children, potentially delaying autism identification in African-American youth.
- Discrepancies in diagnoses like adjustment disorder and conduct disorder suggest possible differences in symptom reporting, clinical interpretation, or symptom presentation influenced by ethnicity.
- Addressing these diagnostic disparities is critical to ensure equitable and timely access to appropriate care and interventions for autism spectrum disorder across all ethnic groups.
Abstract:
This study estimated differences by ethnicity in the diagnoses assigned prior to the diagnosis of autism. In this sample of 406 Medicaid-eligible children, African-Americans were 2.6 times less likely than white children to receive an autism diagnosis on their first specialty care visit. Among children who did not receive an autism diagnosis on their first visit, ADHD was the most common diagnosis. African-American children were 5.1 times more likely than white children to receive a diagnosis of adjustment disorder than of ADHD, and 2.4 times more likely to receive a diagnosis of conduct disorder than of ADHD. Differences in diagnostic patterns by ethnicity suggest possible variations in parents' descriptions of symptoms, clinician interpretations and expectations, or symptom presentation.
Related Concept Videos
01:19Autism Spectrum Disorder
These core symptoms manifest differently among individuals, ranging from mild to severe. The disorder's complexity extends beyond its clinical presentation, encompassing a diverse range of biological, cognitive, and sociocultural influences.
01:10Documentation of Nursing Diagnosis
In some settings, data-driven computerized decision support systems are in place, allowing for more accurate nursing diagnoses. The database within one of these systems includes diagnostic labels defining characteristics, activities, and indicators for nursing. A nurse enters assessment...
01:27Diagnostic and Statistical Manual of Mental Disorders (DSM)
01:30Attention-Deficit/Hyperactivity Disorder
Diagnostic Criteria and Symptoms
To diagnose ADHD, symptoms must manifest before age 12 and be evident across multiple settings.
01:25Formulating and Validating Nursing Diagnosis II
Risk nursing diagnoses represent clinical judgments of an individual, family, or community more vulnerable to developing the health problem than others...
01:30Oppositional Defiant Disorder
Diagnostic Criteria and...