In The Politics of Autism, I discuss evaluation and diagnosis.
This study focused on timing of ASD identification in education versus health settings, including variation by key demographic factors, and the extent to which ASD characteristics are documented in educational evaluations for DD versus ASD eligibility. Educational settings are an important source of ASD identifcation, as they are by law accessible to all children and not just those with access to healthcare insurance coverage. Further, all states offer Part C services that provide evaluation and early intervention services to children from birth to age 3 years. Despite this access, our study found that children with records from education-only sources received their first comprehensive developmental evaluation and were identified with ASD over a year later than children with records from health sources. The median age of first evaluation for children from education-only sources was over 4 years, compared to under 3 years for children seen in health or health and education sources. This late age of evaluation is inconsistent with evidenced-based practices in early intervention for ASD as well as any DDs, which indicate that interventions provided in sensitive periods of brain development in early childhood can lead to positive outcomes (e.g., Campbell & Ramey, 1994; Dawson et al., 2012). The finding of later age of evaluation also implies that it is not educational eligibility practices and the use of the DD category instead of the ASD category that are delaying ASD identification; children were seen for any kind of evaluation in educational settings later than those seen in health setting.
Later evaluation and later identification in education-only sources was a consistent finding across sex, race/ethnicity, and presence of ID. Children with ID were identified earlier than children without ID across all record sources, but education-only sources were significantly later than health and health and education sources. In addition, Black, non-Hispanic, Asian, and Hispanic children were more likely to have education-only records compared to White, non-Hispanic children, which may suggest disparities in access to evaluations in health settings that might have resulted in earlier identification and intervention. Our findings are consistent with past research that both identified relatively later age ofidentification in education settings (Pettygrove et al., 2013) as well as lower utilization of health source evaluations for Black children (Yeargin-Allsopp et al., 2003) and Hispanic children (Pettygrove et al., 2013). In our analyses, age of identification and age of frst evaluation did not differ for health-only compared to health and education evaluations for most groups, with the exception that Black, non-Hispanic children with health-only records were evaluated later than Black, non-Hispanic children with health and education records. Black children with health-only and educational-only records had similar median age of first evaluation. This finding may suggest that, for Black children in our sample, access to services in both the educational and health systems facilitated earlier evaluation
