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Predictors of Age of Diagnosis for Children with Autism Spectrum Disorder: The Role of a Consistent Source of Medical Care, Race, and Condition Severity

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Abstract

Having a consistent source of medical care may facilitate diagnosis of autism spectrum disorders (ASD). This study examined predictors of age of ASD diagnosis using data from the 2011–2012 National Survey of Children’s Health. Using multiple linear regression analysis, age of diagnosis was predicted by race, ASD severity, having a consistent source of care (CSC), and the interaction between these variables after controlling for birth cohort, birth order, poverty level, parental education, and health insurance. While African American children were diagnosed earlier than Caucasians, this effect was moderated by ASD severity and CSC. Having a CSC predicted earlier diagnosis for Caucasian but not African American children. Both physician and parent behaviors may contribute to diagnostic delays in minority children.

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References

  • Adler, N. E., & Rehkopf, D. H. (2008). US disparities in health: Descriptions, causes, and mechanisms. Annual Review of Public Health, 29, 235–252.

    Article  PubMed  Google Scholar 

  • Adler, N. E., & Stewart, J. (2010). Health disparities across the lifespan: Meaning, methods, and mechanisms. Annals of the New York Academy of Sciences, 1186(1), 5–23.

    Article  PubMed  Google Scholar 

  • American Academy of Pediatrics Council on Children with Disabilities. (2005). Care coordination in the medical home: Integrating health and related systems of care for children with special health care needs. Pediatrics, 116(5), 1238.

    Article  Google Scholar 

  • Baker, D. W., Stevens, C. D., & Brook, R. H. (1994). Regular source of ambulatory care and medical care utilization by patients presenting to a public hospital emergency department. Journal of the American Medical Association, 271(24), 1909–1912.

    Article  PubMed  Google Scholar 

  • Barbaresi, W. J., Katusic, S. K., & Voigt, R. G. (2006). Autism: A review of the state of the science for pediatric primary health care clinicians. Archives of Pediatrics and Adolescent Medicine, 160(11), 1167–1175.

    Article  PubMed  Google Scholar 

  • Bazargan, M., Norris, K., Bazargan-Hejazi, S., Akhanjee, L., Calderon, J. L., Safvati, S. D., & Baker, R. S. (2005). Alternative healthcare use in the under-served population. Ethnicity & Disease, 15, 531–539.

    Google Scholar 

  • Becerra, T. A., von Ehrenstein, O. S., Heck, J. E., Olsen, J., Arah, O. A., Jeste, S. S., et al. (2014). Autism spectrum disorders and race, ethnicity, and nativity: A population-based study. Pediatrics, 134(1), e63–e71.

    Article  PubMed  PubMed Central  Google Scholar 

  • Billstedt, E., Gillberg, I. C., & Gillberg, C. (2005). Autism after adolescence: Population-based 13- to 22-year follow-up study of 120 individuals with autism diagnosed in childhood. Journal of Autism and Developmental Disorders, 35(3), 351–360.

    Article  PubMed  Google Scholar 

  • Bisgaier, J., & Rhodes, K. V. (2011). Auditing access to specialty care for children with public insurance. New England Journal of Medicine, 364(24), 2324–2333.

    Article  PubMed  Google Scholar 

  • Blackwell, D. L., Martinez, M. E., Gentleman, J. F., Sanmartin, C., & Berthelot, J. M. (2009). Socioeconomic status and utilization of health care services in Canada and the United States: Findings from a binational health survey. Medical Care, 47(11), 1136–1146.

    Article  PubMed  Google Scholar 

  • Blumberg, S. J., Foster, E. B., Frasier, A. M., Satorius, J., Skalland, B. J., Nysse-Carris, K. L., et al. (2012). Design and operation of the National Survey of Children’s Health, 2007: Program and collection procedures. (Vital and Health Statistics No. 55). Hyattsville, MD: Centers for Disease Control and Prevention National Center for Health Statistics.

  • Boss, E. F., Smith, D. F., & Ishman, S. L. (2011). Racial/ethnic and socioeconomic disparities in the diagnosis and treatment of sleep-disordered breathing in children. International Journal of Pediatric Otorhinolaryngology, 75(3), 299–307.

    Article  PubMed  Google Scholar 

  • Boudreau, A. A., Goodman, E., Kurowski, D., Perrin, J. M., Cooley, W. C., & Kuhlthau, K. (2014). Care coordination and unmet specialty care among children with special health care needs. Pediatrics, 133(6), 1046–1053.

    Article  PubMed  Google Scholar 

  • Bright Futures Steering Committee, & Medical Home Initiatives for Children With Special Needs Project Advisory Committee. (2006). Identifying infants and young children with developmental disorders in the medical home: An algorithm for developmental surveillance and screening. Pediatrics, 118(1), 405–420.

    Article  Google Scholar 

  • Broder-Fingert, S., Shui, A., Pulcini, C. D., Kurowski, D., & Perrin, J. M. (2013). Racial and ethnic differences in subspecialty service use by children with autism. Pediatrics, 132(1), 94–100.

    Article  PubMed  Google Scholar 

  • Buescher, A. V. S., Cidav, Z., Knapp, M., & Mandell, D. S. (2014). Costs of autism spectrum disorders in the United Kingdom and the United States. JAMA Pediatrics, 168(8), 721–728.

    Article  PubMed  Google Scholar 

  • Burgess, D. J., Ding, Y., Hargreaves, M., van Ryn, M., & Phelan, S. (2008). The association between perceived discrimination and underutilization of needed medical and mental health care in a multi-ethnic community sample. Journal of Health Care for the Poor and Underserved, 19(3), 894–911.

    Article  PubMed  Google Scholar 

  • Carr, T., & Lord, C. (2013). Longitudinal study of perceived negative impact in African American and Caucasian mothers of children with autism spectrum disorder. Autism, 17(4), 405–417.

    Article  PubMed  Google Scholar 

  • Casagrande, S. S., Gary, T. L., LaVeist, T. A., Gaskin, D. J., & Cooper, L. A. (2007). Perceived discrimination and adherence to medical care in a racially integrated community. Journal of General Internal Medicine, 22(3), 389–395.

    Article  PubMed  PubMed Central  Google Scholar 

  • Centers for Disease Control and Prevention. (2014). Prevalence of autism spectrum disorder among children aged 8 years-autism and developmental disabilities monitoring network, 11 sites, United States, 2010. Morbidity and Mortality Weekly Report, Surveillance Summaries, 63(2), 6–21.

    Google Scholar 

  • Centers for Disease Control and Prevention National Center for Health Statistics. (2013). State and Local Area Integrated Telephone Survey: 2011-2012 National Survey of Children’s Health [Data file]. http://www.cdc.gov/nchs/slaits/nsch.htm.

  • Chan, L., Hart, L. G., & Goodman, D. C. (2006). Geographic access to health care for rural Medicare beneficiaries. Journal of Rural Health, 22(2), 140–146.

    Article  PubMed  Google Scholar 

  • Coker, T. R., Elliott, M. N., Kataoka, S., Schwebel, D. C., Mrug, S., Grunbaum, J. A., et al. (2009). Racial/ethnic disparities in the mental health care utilization of fifth grade children. Academic Pediatrics, 9(2), 89–96.

    Article  PubMed  PubMed Central  Google Scholar 

  • Cook, N. L., Ayanian, J. Z., Orav, E. J., & Hicks, L. S. (2009). Differences in specialist consultations for cardiovascular disease by race, ethnicity, gender, insurance status, and site of primary care. Circulation, 119(18), 2463–2470.

    Article  PubMed  Google Scholar 

  • Cook, B. L., Barry, C. L., & Busch, S. H. (2013). Racial/Ethnic disparity trends in children’s mental health care access and expenditures from 2002 to 2007. Health Services Research, 48(1), 129–149.

    Article  PubMed  PubMed Central  Google Scholar 

  • Cummings, J. R., Lavarreda, S. A., Rice, T., & Brown, E. R. (2009). The effects of varying periods of uninsurance on children’s access to health care. Pediatrics, 123(3), e411–e418.

    Article  PubMed  Google Scholar 

  • Daniels, A. M., & Mandell, D. S. (2013). Children’s compliance with American Academy of Pediatrics’ well-child care visit guidelines and the early detection of autism. Journal of Autism and Developmental Disorders, 43(12), 2844–2854.

    Article  PubMed  Google Scholar 

  • DeVoe, J. E., Baez, A., Angier, H., Krois, L., Edlund, C., & Carney, P. A. (2007). Insurance + access ≠ health care: Typology of barriers to health care access for low-income families. The Annals of Family Medicine, 5(6), 511–518.

    Article  PubMed  Google Scholar 

  • DeVoe, J. E., Petering, R., & Krois, L. (2008). A usual source of care: Supplement or substitute for health insurance among low-income children? Medical Care, 46(10), 1041–1048.

    Article  PubMed  Google Scholar 

  • DeVoe, J. E., Tillotson, C. J., & Wallace, L. S. (2009). Children’s receipt of health care services and family health insurance patterns. The Annals of Family Medicine, 7(5), 406–413.

    Article  PubMed  Google Scholar 

  • Dosreis, S., Weiner, C. L., Johnson, L., & Newschaffer, C. J. (2006). Autism spectrum disorder screening and management practices among general pediatric providers. Journal of Developmental and Behavioral Pediatrics, 27(2), S88–S94.

    Article  PubMed  Google Scholar 

  • Durkin, M. S., Maenner, M. J., Meaney, F. J., Levy, S. E., DiGuiseppi, C., Nicholas, J. S., et al. (2010). Socioeconomic inequality in the prevalence of autism spectrum disorder: Evidence from a U.S. cross-sectional study. PLoS ONE, 5(7), 1–8.

    Article  Google Scholar 

  • Eldevik, S., Hastings, R. P., Hughes, J. C., Jahr, E., Eikeseth, S., & Cross, S. (2009). Meta-analysis of early intensive behavioral intervention for children with autism. Journal of Clinical Child and Adolescent Psychology, 38(3), 439–450.

    Article  PubMed  Google Scholar 

  • Facione, N. C., & Facione, P. A. (2007). Perceived prejudice in healthcare and women's health protective behavior. Nursing Research, 56(3), 175–184.

    Article  PubMed  Google Scholar 

  • Filipek, P. A., Accardo, P. J., Ashwal, S., Baranek, G. T., Cook, E. H., Dawson, G., et al. (2000). Practice parameter: Screening and diagnosis of autism Report of the Quality Standards Subcommittee of the American Academy of Neurology and the Child Neurology Society. Neurology, 55(4), 468–479.

    Article  PubMed  Google Scholar 

  • Fiscella, K., Franks, P., Doescher, M. P., & Saver, B. G. (2002). Disparities in health care by race, ethnicity, and language among the insured: Findings from a national sample. Medical Care, 40(1), 52–59.

    Article  PubMed  Google Scholar 

  • Fiscella, K., Franks, P., Gold, M. R., & Clancy, C. M. (2014). Inequality in quality: Addressing socioeconomic, racial, and ethnic disparities in health care. Policy Perspectives, 283(19), 2579–2584.

    Google Scholar 

  • Flores, G. (2010). Technical report: Racial and ethnic disparities in the health and health care of children. Pediatrics, 125(4), e979–e1020.

    Article  PubMed  Google Scholar 

  • Flores, G., & Lin, H. (2013). Trends in racial/ethnic disparities in medical and oral health, access to care, and use of services in US children: Has anything changed over the years? International Journal for Equity in Health, 12(10), 9276-12.

    Google Scholar 

  • Fountain, C., King, M. D., & Bearman, P. S. (2011). Age of diagnosis for autism: Individual and community factors across 10 birth cohorts. Journal of Epidemiology and Community Health, 65(6), 503–510.

    Article  PubMed  PubMed Central  Google Scholar 

  • Gill, J. M., Mainous, A. G, I. I. I., & Nsereko, M. (2000). The effect of continuity of care on emergency department use. Archives of Family Medicine, 9(4), 333.

    Article  PubMed  Google Scholar 

  • Goin-Kochel, R. P., Mackintosh, V. H., & Myers, B. J. (2006). How many doctors does it take to make an autism spectrum diagnosis? Autism, 10(5), 439–451.

    Article  PubMed  Google Scholar 

  • Gourdine, R. M., & Algood, C. L. (2014). Autism in the African American population. In V. B. Patel, V. R. Preedy, & C. R. Martin (Eds.), Comprehensive guide to autism (pp. 2455–2467). New York, NY: Springer.

  • Harstad, E., Huntington, N., Bacic, J., & Barbaresi, W. (2013). Disparity of care for children with parent-reported autism spectrum disorders. Academic Pediatrics, 13(4), 334–339.

    Article  PubMed  Google Scholar 

  • Heidgerken, A. D., Geffken, G., Modi, A., & Frakey, L. (2005). A survey of autism knowledge in a health care setting. Journal of Autism and Developmental Disorders, 35(3), 323–330.

    Article  PubMed  Google Scholar 

  • Herlihy, L. E., Brooks, B., Dumont-Mathieu, T., Barton, M. L., Fein, D., Chen, C. M., & Robins, D. L. (2014). Standardized screening facilitates timely diagnosis of autism spectrum disorders in a diverse sample of low-risk toddlers. Journal of Developmental and Behavioral Pediatrics, 35(2), 85–92.

    Article  PubMed  PubMed Central  Google Scholar 

  • Hertz-Picciotto, I., & Delwiche, L. (2009). The rise in autism and the role of age at diagnosis. Epidemiology, 20, 84–90.

    Article  PubMed  PubMed Central  Google Scholar 

  • Johnson, C. P., & Myers, S. M. (2007). Identification and evaluation of children with autism spectrum disorders. Pediatrics, 120(5), 1183–1215.

    Article  PubMed  Google Scholar 

  • Kalb, L. G., Freedman, B., Foster, C., Menon, D., Landa, R., Kishfy, L., & Law, P. (2012). Determinants of appointment absenteeism at an outpatient pediatric autism clinic. Journal of Developmental and Behavioral Pediatrics, 33(9), 685–697.

    Article  PubMed  Google Scholar 

  • Keenan, M., Dillenburger, K., Doherty, A., Byrne, T., & Gallagher, S. (2010). The experiences of parents during diagnosis and forward planning for children with autism spectrum disorder. Journal of Applied Research in Intellectual Disabilities, 23(4), 390–397.

    Article  Google Scholar 

  • Kenney, G. M., Coyer, C., & Anderson, N. (2013). Racial and ethnic differences in access to care and service use for children with coverage through Medicaid and Children’s Health Insurance Program: A summary. Urban Institute. http://www.urban.org/publications/412780.html.

  • King, T. M., Tandon, S. D., Macias, M. M., Healy, J. A., Duncan, P. M., Swigonski, N. L., et al. (2010). Implementing developmental screening and referrals: Lessons learned from a national project. Pediatrics, 125(2), 350–360.

    Article  PubMed  Google Scholar 

  • Kuhlthau, K., Nyman, R. M., Ferris, T. G., Beal, A. C., & Perrin, J. M. (2004). Correlates of use of specialty care. Pediatrics, 113(3), e249–e255.

    Article  PubMed  Google Scholar 

  • Lee, C., Ayers, S. L., & Kronenfeld, J. J. (2009). The association between perceived provider discrimination, health care utilization, and health status in racial and ethnic minorities. Ethnicity & Disease, 19(3), 330.

    Google Scholar 

  • Lillie-Blanton, M., & Hoffman, C. (2005). The role of health insurance coverage in reducing racial/ethnic disparities in health care. Health Affairs, 24(2), 398–408.

    Article  PubMed  Google Scholar 

  • Matson, J. L., Wilkins, J., & Gonzalez, M. (2008). Early identification and diagnosis in autism spectrum disorders in young children and infants: How early is too early? Research in Autism Spectrum Disorders, 2(1), 75–84.

    Article  Google Scholar 

  • Mayer, M. L., Skinner, A. C., & Slifkin, R. T. (2004). Unmet need for routine and specialty care: Data from the National Survey of Children with Special Health Care Needs. Pediatrics, 113(2), e109–e115.

    Article  PubMed  Google Scholar 

  • Murphy, M. M., Simons, J. P., Ng, S. C., McDade, T. P., Smith, J. K., Shah, S. A., et al. (2009). Racial differences in cancer specialist consultation, treatment, and outcomes for locoregional pancreatic adenocarcinoma. Annals of Surgical Oncology, 16(11), 2968–2977.

    Article  PubMed  Google Scholar 

  • National Academy of State Health Policy. (2010). Long term services and supports and chronic care coordination: Policy advances enacted by the Patient Protection and Affordable Care Act. http://www.ncsl.org/research/health/the-medical-home-model-of-care.aspx.

  • 2011/12 National Survey of Children’s Health. Maternal and Child Health Bureau in collaboration with the National Center for Health Statistics. 2011/12 NSCH SPSS Indicator Data Set prepared by the Data Resource Center for Child and Adolescent Health, Child and Adolescent Health Measurement Initiative. www.childhealthdata.org.

  • Pedersen, A., Pettygrove, S., Meaney, F. J., Mancilla, K., Gotschall, K., Kessler, D. B., et al. (2012). Prevalence of autism spectrum disorders in Hispanic and non-Hispanic white children. Pediatrics, 129(3), e629–e635.

    Article  PubMed  Google Scholar 

  • Pinto-Martin, J. A., Young, L. M., Mandell, D. S., Poghosyan, L., Giarelli, E., & Levy, S. E. (2008). Screening strategies for autism spectrum disorders in pediatric primary care. Journal of Developmental & Behavioral Pediatrics, 29(5), 345–350.

    Article  Google Scholar 

  • Raphael, J. L., Guadagnolo, B. A., Beal, A. C., & Giardino, A. P. (2009). Racial and ethnic disparities in indicators of a primary care medical home for children. Academic Pediatrics, 9(4), 221–227.

    Article  PubMed  Google Scholar 

  • Rogers, S. J., & Vismara, L. A. (2008). Evidence-based comprehensive treatments for early autism. Journal of Clinical Child and Adolescent Psychology, 37(1), 8–38.

    Article  PubMed  PubMed Central  Google Scholar 

  • Sansosti, F. J., Lavik, K. B., & Sansosti, J. M. (2012). Family experiences through the autism diagnostic process. Focus on Autism and Other Developmental Disabilities, 27(2), 81–92.

    Article  Google Scholar 

  • Sell, N. K., Giarelli, E., Blum, N., Hanlon, A. L., & Levy, S. E. (2012). A comparison of autism spectrum disorder DSM-IV criteria and associated features among African American and white children in Philadelphia County. Disability and Health Journal, 5(1), 9–17.

    Article  PubMed  Google Scholar 

  • Shattuck, P. T., Durkin, M., Maenner, M., Newschaffer, C., Mandell, D. S., Wiggins, L., et al. (2009). Timing of identification among children with an autism spectrum disorder: Findings from a population-based surveillance study. Journal of the American Academy of Child & Adolescent Psychiatry, 48(5), 474–483.

    Article  Google Scholar 

  • Shields, A. E., Comstock, C., & Weiss, K. B. (2004). Variations in asthma care by race/ethnicity among children enrolled in a state Medicaid program. Pediatrics, 113(3), 496–504.

    Article  PubMed  Google Scholar 

  • Sices, L. (2007). Developmental screening in primary care: The effectiveness of current practice and recommendations for improvement. Commonwealth Fund. www.commonwealthfund.org.

  • Starfield, B., & Shi, L. (2004). The medical home, access to care, and insurance: A review of evidence. Pediatrics, 113(4), 1493–1498.

    PubMed  Google Scholar 

  • Steyerberg, E. W., Neville, B., Weeks, J. C., & Earle, C. C. (2007). Referral patterns, treatment choices, and outcomes in locoregional esophageal cancer: A population-based analysis of elderly patients. Journal of Clinical Oncology, 25(17), 2389–2396.

    Article  PubMed  Google Scholar 

  • Strickland, B. B., Singh, G. K., Kogan, M. D., Mann, M. Y., van Dyck, P. C., & Newacheck, P. W. (2009). Access to the medical home: New findings from the 2005–2006 National Survey of Children with Special Health Care Needs. Pediatrics, 123(6), e996–e1004.

    Article  PubMed  Google Scholar 

  • Toomey, S. L., Chien, A. T., Elliott, M. N., Ratner, J., & Schuster, M. A. (2013). Disparities in unmet need for care coordination: The national survey of children’s health. Pediatrics, 131(2), 217–224.

    Article  PubMed  Google Scholar 

  • Trivedi, A. N., & Ayanian, J. Z. (2006). Perceived discrimination and use of preventive health services. Journal of General Internal Medicine, 21(6), 553–558.

    Article  Google Scholar 

  • Vismara, L. A., & Rogers, S. J. (2010). Behavioral treatments in autism spectrum disorder: What do we know? Annual Review of Clinical Psychology, 6, 447–468.

    Article  PubMed  Google Scholar 

  • Visser, S. N., Danielson, M. L., Bitsko, R. H., Holbrook, J. R., Kogan, M. D., Ghandour, R. M., et al. (2014). Trends in the parent-report of health care provider-diagnosed and medicated attention-deficit/hyperactivity disorder: United states, 2003–2011. Journal of the American Academy of Child & Adolescent Psychiatry, 53(1), 34–46.

    Article  Google Scholar 

  • Wagner, J., & Abbott, G. (2007). Depression and depression care in diabetes relationship to perceived discrimination in African Americans. Diabetes Care, 30(2), 364–366.

    Article  PubMed  Google Scholar 

  • Zimmerman, F. J. (2005). Social and economic determinants of disparities in professional help-seeking for child mental health problems: Evidence from a national sample. Health services research, 40(5 pt 1), 1514–1533.

    Article  PubMed  PubMed Central  Google Scholar 

  • Zuckerman, K. E., Mattox, K., Donelan, K., Batbayar, O., Baghaee, A., & Bethell, C. (2013). Pediatrician identification of Latino children at risk for autism spectrum disorder. Pediatrics, 132(3), 445–453.

    Article  PubMed  PubMed Central  Google Scholar 

  • Zuckerman, K. E., Nelson, K., Bryant, T. K., Hobrecker, K., Perrin, J. M., & Donelan, K. (2011). Specialty referral communication and completion in the community health center setting. Academic Pediatrics, 11(4), 288–296.

    Article  PubMed  Google Scholar 

  • Zuvekas, S. H., & Taliaferro, G. S. (2003). Pathways to access: Health insurance, the health care delivery system, and racial/ethnic disparities, 1996–1999. Health Affairs, 22(2), 139–153.

    Article  PubMed  Google Scholar 

  • Zwaigenbaum, L., Bryson, S., & Garon, N. (2013). Early identification of autism spectrum disorders. Behavioural Brain Research, 251, 133–146.

    Article  PubMed  Google Scholar 

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Author Contributions

Mrs. Emerson designed the study, conducted the statistical analysis, analyzed the data, wrote the initial draft of the paper, and participated in revising the manuscript and addressing the reviewers' comments. Dr. Morrell assisted with manuscript development, provided guidance on statistical analysis, and participated in revising the manuscript and addressing the reviewers' comments. Dr. Neece assisted with manuscript development, provided guidance on statistical analysis, and participated in revising the manuscript and addressing the reviewers' comments.

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Emerson, N.D., Morrell, H.E.R. & Neece, C. Predictors of Age of Diagnosis for Children with Autism Spectrum Disorder: The Role of a Consistent Source of Medical Care, Race, and Condition Severity. J Autism Dev Disord 46, 127–138 (2016). https://doi.org/10.1007/s10803-015-2555-x

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