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Friday, December 25, 2020

Change in Diagnosis Pattern

In The Politics of Autism, I discuss evaluation and diagnosis of young children.

Alix S. Winter, Christine Fountain, Keely Cheslack-Postava, and Peter S. Bearman have an article at Proceedings of the National Academy of Sciences titled The Social Patterning of Autism Diagnoses Reversed in California between 1992 and 2018."


Rates of autism diagnosis in the United States have historically been higher among more advantaged social groups—Whites and those of higher socioeconomic status (SES). Using data from all births in the state of California in 1992 through 2016, we find that these trends reversed during our study period. By 2018, diagnosed autism incidence rates for 3- to 6-y-old children were higher for children of Black and Asian mothers than children of non-Hispanic White mothers and were higher for children of lower SES than of higher SES parents. These reversals point to the fundamental role that access to knowledge and resources plays in driving increased autism prevalence and shifting patterns of autism cases over the past quarter-century.


As rates of autism diagnosis increased dramatically over the past number of decades, prevalence rates were generally highest among Whites and among those of higher socioeconomic status (SES). Using a unique, population-level dataset, we find that rates of autism diagnosis continued to be on the rise in recent years, but who is diagnosed changed during the study period. Our data consist of birth records of all 13,272,573 children born in the state of California in 1992 through 2016 linked to autism caseload records for January 1992 through November 2019 from California’s Department of Developmental Services. California’s diagnosed autism incidence rate rose from 0.49 per 1,000 3–6 y olds in 1998 to 3.49 per 1,000 3–6 y olds in 2018, a 612% increase. However, diagnosed incidence rates did not rise uniformly across sociodemographic groups. By 2018, children of Black and Asian mothers were diagnosed at higher rates than children of non-Hispanic White mothers. Furthermore, among children of non-Hispanic White and Asian mothers, children of lower SES were diagnosed at higher rates than children of higher SES. These changes align with sociological theories of health disparities and contain important clues for more fully understanding the autism epidemic.

From the article:

Multiple factors likely help account for the recent rise of autism diagnoses among children of lower SES parents and parents of color. In 2006, the American Academy of Pediatrics recommended universal screening for autism during well-child visits at 18 mo of age (40), a recommendation that, if implemented, decouples autism diagnosis from parents’ access to knowledge. Additionally, autism has strong advocacy in the United States (41) and in California specifically. As of 2009, California’s state Senate includes the Senate Select Committee on Autism and Related Disorders, which has spearheaded legislation to improve linguistic and cultural competency at the DDS’ regional centers and among DDS vendors. The Committee has also held hearings on “ensuring fair and equal access to regional center services for Autism Spectrum Disorders,” among other topics (42). Collectively, these and other advocacy efforts have likely contributed to the deconcentration of autism diagnoses from children of high SES, White parents, in turn, broadening access to the services that an autism diagnosis unlocks.