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Exploring Intersectionality in the Medical Care of a Latino Child With Autism
Aisha James1, Carlos Torres1, Erin Carroll1
1Department of Pediatrics, MassGeneral for Children, Boston, Massachusetts.
Insights
A 10-year-old boy with autism and ADHD experienced a stroke due to Moyamoya disease. This case highlights healthcare barriers for neurodivergent patients and discusses strategies for equitable care.
Area of Science:
- Pediatric Neurology
- Neurodevelopmental Disorders
- Health Equity
Background:
- Autism and ADHD present unique challenges in healthcare settings.
- Moyamoya disease is a rare cerebrovascular disorder.
- Intersectionality of patient factors can impact medical care.
Purpose of the Study:
- To describe a case of Moyamoya disease and stroke in a pediatric patient with autism and ADHD.
- To analyze barriers to equitable care for neurodivergent patients.
- To explore the role of intersectionality in healthcare delivery.
Main Methods:
- Case report of a 10-year-old boy.
- Review of clinical presentation, diagnostic imaging (CT scan), and diagnosis.
- Analysis of care barriers through the lens of intersectionality.
Main Results:
- The patient was diagnosed with Moyamoya disease complicated by stroke.
- Delayed imaging scheduling and language discordance were identified as care barriers.
- Neurodivergence, race, ethnicity, and language intersect to influence care.
Conclusions:
- Healthcare systems must address barriers faced by neurodivergent patients.
- Understanding intersectionality is crucial for providing equitable care.
- Strategies are needed to mitigate the impact of systemic oppression in clinical practice.
Abstract:
Felix is a boy aged 10 years with autism and attention-deficit/hyperactivity disorder who presents to the pediatric emergency department for acute behavior change, including decreased interactivity, decreased speech, bruxism, and new urinary incontinence. He is admitted during the weekend, and scheduling of magnetic resonance imaging is delayed. Eventually, he has a computed tomography scan of his head, which shows an abnormal diffuse hypodensity involving the frontal lobe with extension into the cortex, all concerning for ischemia, and he is ultimately diagnosed with Moyamoya disease complicated by stroke. Felix and his family self-identify as Latino and Black and prefer to use a language other than English for medical discussions. Through this case, we (1) reflect on the barriers to clinical care faced by patients with autism; (2) define intersectionality and explore how neurodivergence, race, ethnicity, and parental-provider language discordance can augment and inhibit the provision of equitable care; and (3) discuss strategies that may mitigate the impact of oppression on clinical care.
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