Last month we published a study by Carbone et al (10.1542/peds.2019-2314) that identified challenges related to screening for autism spectrum disorder (ASD) and the risk of missing children who should be referred for further evaluation. That study also found that Hispanic children were less likely to be screened compared to non-Hispanic White children. Although there were no differences related to screening or diagnosis for African American compared to non-Hispanic White children, the number of African American children in that study sample was quite small. To better understand whether there are delays in the timing of diagnosing of ASD in African American children, Constantino et al (10.1542/peds.2019-3629) share with us an analysis of 584 African American children eventually diagnosed with ASD and describe the timing of that diagnosis relative to parents’ first concerns. The authors find that the average age of diagnosis was 64.9 months, more than 3 years after parents were first concerned. This is a far longer period of time to diagnosis than has been reported for non-Hispanic White children. Why is this?
The Carbone et al study noted that the screening tool used (e.g. the Modified Checklist for Autism in Toddlers (M-CHAT) or its revised version (M-CHAT-R) misses some children and can over-refer others. Yet even in that study, the time to eventual diagnosis was shorter than in the study by Constantino et al We asked Drs. Broder-Fingert (Boston Medical Center), Mateo (Boston Children’s Hospital), and Zuckerman (Oregon Health and Sciences University) to share their thoughts in a thought-provoking editorial (10.1542/peds.2020-015420) that raises issues of implicit biases that clinicians might have. These authors also propose other hypotheses for the delay in diagnosis if ASD in African American Children that reflects the systemic racism that plagues our country. They suggest actionable steps to address these structural racism issues and improve the time to diagnosis of autism for African American children. Both the study and commentary are must-reads if we are going to address racism. Their anti-racist suggestions may be what is needed to ensure that we do a better job demonstrating equity in the care and subsequent referral services we provide to all children.