How Racial Inequities Delay Autism Diagnoses in Underserved Populations
- Ishaan S Ahuja
- May 1
- 3 min read
After exploring some of the neuroscience behind Autism Spectrum Disorder (ASD) and ASD’s link to gender in previous blog posts, my curiosity about sociocultural factors and Autism Spectrum Disorder remained. I want to investigate how race and ethnicity affect how Autism is diagnosed and understood.
As noted in my last blog, males have a higher prevalence rate for Autism than females due to various genetic mutations, and I wondered if certain races were more or less likely to have Autism due to other possible genetic reasons. I quickly found the National Institute of Mental Health (NIMH) states there isn’t really a correlation between ethnicity and race and Autism prevalence, and that Autism is as likely to occur or not, regardless of race or ethnicity. However, race and ethnicity do play a significant role in Autism diagnostic rates.
In this blog, I want to understand racial health disparities, so I took a look at Black and White Americans of all ages as an example. For the purpose of this blog, given the volume of research available, I am mainly focusing on Black and White Americans’ relationship with healthcare, particularly how it relates to Autism diagnoses in children.
A 2017 American Journal of Public Health study found Black children are 19% less likely to be diagnosed with Autism compared to White children. After some research, I found the primary culprit: socioeconomic status. Overall, Black populations have lower incomes compared to White people. Therefore, they often don’t have the money to get their children the appropriate medical attention needed, especially with the rising healthcare costs recently, according to this 2021 study. With fewer doctor visits as a result of lower incomes, many Black children go undiagnosed with ASD. The study states that Black and Latinx children often get diagnosed with ASD after an average of 8 doctor visits, which is a delay. However, since White households generally have higher incomes, they are able to give their children the medical care and attention they need, making a diagnosis like that of ASD more likely to occur.
Although finances may be the primary culprit for fewer Autism diagnoses in Black populations compared to White populations, it is not the only factor. When controlling for income levels by examining a Medicaid-receiving population’s Autism diagnostic rates, this study found that White children receive an Autism diagnosis at around 6.3 years of age, on average. In contrast, Black children receive an Autism diagnosis at around 7.9 years of age, on average.
Why is this happening? A major social factor is how different ethnic groups perceive doctors or visiting a doctor’s office, and these perceptions may influence the frequency with which individuals seek healthcare. These attitudes often have roots in the unfortunate history and current racist practices in medical care for minority ethnicities. This dark history started centuries ago. In 1845, Dr. J Marion Sims developed new surgical techniques in medical experiments and trials on enslaved Black women in the fields of obstetrics and gynecology. Unethical racist practices like this generated generations of distrust in medical professionals for Black women, with fewer seeking routine healthcare for themselves or their children. In a 2005 study, Black patients “reported higher levels of physician distrust than did Whites.”
As I mentioned before, according to this 2021 study, there’s a statistical correlation between the number of doctor visits and the likelihood of an early diagnosis of ASD. Since Black families are less likely to visit their doctor, this can explain the significant difference in average ages of Autism diagnosis between Black and White populations (7.9 years old vs. 6.3 years old).
So what does this mean? Less medical attention, lower ASD diagnostic rates, how do these affect individuals’ daily lives? Well, for an individual who is undiagnosed, a formal diagnosis can help explain some social behaviors a child may exhibit. A child may be able to get the appropriate educational attention and support in school that they need to succeed. For example, IEPs (Individualized Education Programs), as the name suggests, are specific education plans tailored to meet the individual needs of each student. I also saw this during an interview with one of my elementary school teachers, and it was interesting to observe that each student had a unique schedule and employed different strategies for various tasks. If all children of all races and ethnicities have IEPs and others, this can combat the diagnostic inequalities between races and ethnicities.
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