ARTICLES
Race Differences in the Age at Diagnosis Among Medicaid-Eligible Children With Autism

https://doi.org/10.1097/00004583-200212000-00016Get rights and content

ABSTRACT

Objective:

To examine racial differences in the age at which Medicaid-eligible children first receive an autistic disorder (AD) diagnosis and to examine time in mental health treatment until an AD diagnosis was received.

Method:

Philadelphia Medicaid specialty mental health claims identified 406 children who received services in 1999 for AD. Claims from 1993–1999 were used to identify the date of first mental health visit, first receipt of AD diagnosis, and number of visits occurring between those dates. Linear regression was used to examine the relationship among race, age at first diagnosis of AD, time in mental health treatment, and number of visits until the diagnosis was made.

Results:

On average, white children received the AD diagnosis at 6.3 years of age, compared with 7.9 years for black children (p < .001). White children entered the mental health system at an earlier age (6.0 versus 7.1 years, p = .005); however, after adjusting for age, sex, and time eligible for Medicaid, black children required more time in treatment before receiving the diagnosis.

Conclusions:

Important disparities exist in the early detection and treatment of autism. These disparities may be the result of differences in help-seeking, advocacy and support, and clinician behaviors.

Section snippets

Subjects

All 406 children and adolescents in this sample were Medicaideligible residents of Philadelphia County during fiscal year 1999. They all had birth dates between January 1983 and May 1996. All received at least two Medicaid claims in FY 1999 for specialty mental health services related to a diagnosis of autistic disorder (ICD-9 code 299.00). Because data on diagnoses and service utilization were available starting from July 1992, and it was important for the purposes of this study to have

RESULTS

Table 1 provides information on the characteristics of the sample by race. African-American children were, on average, the oldest group, while white children were the youngest. The same was true of the amount of time eligible for Medicaid before the autistic disorder diagnosis was made. On average, white children first received their autism diagnosis at 6.3 years of age, compared with 7.9 years for African-American children and 8.8 years for Latino children. On average, white children entered

DISCUSSION

The results of this study suggest that large and important racial differences exist in the detection and diagnosis of children with autistic disorder. In this study, African-American children received their diagnosis on average a year and a half later than white children. While white children entered mental health services at an earlier age, this difference did not explain the difference in the age at diagnosis. Once in treatment, African-American children required three times the number of

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    This work was supported by grants from the Centers for Disease Control (CCU32094) and the National Institute of Mental Health (5T32MH019292-12).

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