Reporting on health and quality of life in South LA

Black, Latino children with autism seem less likely to get certain kinds of specialty care

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Eight year-old Michael Dedrick-Dwyer, who has cerebral palsy and autism, rides a horse with therapist Rebecca Reubens and a volunteer. A new study appearing in Pediatrics found racial differences in the ways children with autism used specialty care – for example, like that a neurologist would provide.

Black and Latino children living with autism appear to be using certain specialty care services less often than their white counterparts, according to a new report.

The study, published in the journal Pediatrics, found that minority children are less likely to see doctors who specialize in the brain, the mind or the digestive system, and as a result are less likely to undergo the tests those doctors can perform.

In South Los Angeles, early identification and intervention often doesn't happen for autism because of a widespread lack of access to health care, particularly to those providers who are qualified to diagnose the condition.

Areva Martin, the president and co-founder of Special Needs Network, Inc. said in an interview in March that the ideal window for diagnosis is when a child is 1 or 2 years old:

"If a child doesn't get identified before kindergarten or first grade, they've missed four or five years of that kind of intensive therapy," said Martin. "That can have a substantial impact on educational outcomes and the development of social skills."

Instead, said Martin, children often aren't diagnosed until they're 5 or 6. Late diagnosis is just one item on a list of challenges affecting South L.A. children with autism:

"You are talking about a community that is plagued with a lot of health issues," said Martin. "Today it's diabetes, obesity, cancer – unfortunately, African-Americans and Latinos in low-income communities are already on the wrong side of these health crises. All these disparities in terms of access to care and quality of care with autism have been no different."

The study, which looked at more than 3,600 young patients, echoed Martin and noted that "racial differences in use of care exist for many pediatric conditions." The disparities highlighted by their study could be due to several factors, wrote the authors:

  • It could be that minority children's autism presents itself differently and, as a result, requires different services.
  • "Physician referral bias" could also play a role – that is, if doctors believe white children are more likely to have autism, that could mean they'll refer white children at higher rates.
  • Because many patients with autism are self-referred to the doctor – in this case, that would mean a parent takes her or his child – families with better access to specialty medical care are more likely to see the proper doctors to get a timely diagnosis. White children "have better access" to that care than do their black and Latino counterparts, said researchers.
  • It could also be that white children are following up with doctor referrals at higher rates than minority children; the latter's parents may not fully grasp the seriousness of a referral to specialty care due to certain cultural beliefs.

Here's how the study's authors summed up the implications of their findings:

If nonwhite children use needed subspecialty care less frequently than white children, greater outreach to clinicians and minority communities may be necessary to inform them of needed subspecialty care. Alternatively, if white patients are receiving unnecessary referrals and procedures, then there is a need for better education regarding what care is appropriate.

California Healthline reports that state advocates were dealt a blow last week when the California Legislature voted to exclude coverage of applied behavioral analysis, a type of autism therapy, from Medi-Cal, which will be extended to more than a million additional state residents next year as part of the Affordable Care Act.

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