In a letter to the Journal of Autism of Developmental Disorders. Maureen S. Durkin and Barbara L. Wolfe write about a 2007-2009 "plateau" in the number of white children in the U.S. with an autism special education classification:
Perhaps the best explanation for the plateau noted by Nevison and Zahorodny is that the recession adversely affected the ability of families of children with autism to access diagnostic services. The cost of obtaining a diagnosis of autism in the U.S., at more than $2000, would have been prohibitive during the recession for many parents who experienced lapses in insurance coverage and loss of income needed to cover out-of-pocket payments for autism diagnoses. Research has shown that parental job loss often leaves children with private health insurance uninsured, with an estimated 311 children in the U.S. losing coverage for every 1000 parents who become unemployed (Fairbrother et al. 2010). In addition, while data specific to autism testing are difficult to find, we know from research on cancer that people without health insurance are less likely than others to report use of recommended diagnostic testing (Seeff et al. 2004). During the great recession, five million Americans lost employment-based health insurance, with white Americans being disproportionately affected due to their greater reliance on this type of insurance than other groups (Holahan 2011). These findings are consistent with Nevison and Zahorodny’s (2019) observation that the plateau in autism prevalence occurred only for white children, and with the possibility that the recession could have had as big an impact as any other hypothesized environmental exposure on the number of children receiving services for autism during this period.