Disparities in Diagnoses Received Prior to a Diagnosis of Autism Spectrum Disorder

J Autism Dev Disord (2007) 37:17951802 DOI 10.1007/s10803-006-0314-8

ORIGINAL PAPER

Disparities in Diagnoses Received Prior to a Diagnosis of Autism Spectrum Disorder

David S. Mandell Richard F. Ittenbach Susan E. Levy Jennifer A. Pinto-Martin

Published online: 8 December 2006 Springer Science+Business Media, LLC 2006

Abstract This study estimated differences by ethnicity in the diagnoses assigned prior to the diagnosis of autism. In this sample of 406 Medicaid-eligible children, African-Americans were 2.6 times less likely than white children to receive an autism diagnosis on their rst specialty care visit. Among children who did not receive an autism diagnosis on their rst visit, ADHD was the most common diagnosis. African-American children were 5.1 times more likely than white children to receive a diagnosis of adjustment disorder than of ADHD, and 2.4 times more likely to receive a diagnosis of conduct disorder than of ADHD. Differences in diagnostic patterns by ethnicity suggest

possible variations in parents descriptions of symptoms, clinician interpretations and expectations, or symptom presentation.

Keywords Autistic disorder Autism spectrum disorder African-Americans Minorities Child health services Community mental health services

Despite increasing evidence that autism can be accurately identied in very young children (Baird et al., 2001; Bryson, Rogers, & Fombonne, 2003; Charman et al., 2005; Lord et al., 2006), diagnosis is often delayed until children are of school age (Howlin & Moore, 1997; Mandell, Listerud, Levy, & Pinto-Martin, 2002; Man-dell, Novak, & Zubritsky, 2005a). This delay may be due to inadequate screening practices (Dearlove & Kearney, 1990; Dobos, Dworkin, & Bernstein, 1994; Sices, Feudtner, McLaughlin, Drotar, & Williams, 2003), pediatricians slow response to parental concerns (Glascoe, 1997; Shevell, Majnemer, Rosenbaum, & Abrahamowicz, 2001), the low sensitivity of screening instruments for autism (Dumont-Mathieu & Fein, 2005), and a general lack of awareness of symptoms (Shah, 2001). Some researchers have suggested that the similarity of the features of autism with other disorders can lead to misdiagnosis (Cuccaro et al., 1996; Noterdaeme, Amo-rosa, Mildenberger, Sitter, & Minow, 2001; Ohta, Nagai, Hara, & Sasaki, 1987). Symptoms common to autism, such as delayed speech, poor response to others and behavioral difculties, can lead to misdiagnosis of language impairment or Attention Decit/ Hyperactivity Disorder (ADHD). In older children, the presence of repetitive behaviors may steer clinicians toward a diagnosis of obsessive-compulsive disorder...