Multiracial school children sitting at their desks in a classroom.

Community View: A higher proportion of black autistic children in New Jersey are diagnosed with intellectual disabilities compared to their white autistic peers.

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New Jersey data show that black children are more likely than white children to be diagnosed with autism. Pediatrics. Autism with mental retardation is more common in children from poorer states than in richer areas. Research It shows.

There are racial and ethnic disparities in autism diagnoses It has been rejected throughout the United States In the last 20 years. And the distribution gaps between white, black and Hispanic children in New Jersey are historically narrow, the data show. 2014 And 2018. But the new analysis, which examined data collected from 2000 to 2016, shows significant racial, ethnic and socioeconomic disparities in the diagnosis of intellectual disability in children with autism.

“We did not expect the level of variation we saw,” said the study investigator. Josephine ShenoudaProgram Manager and Epidemiologist at Rutgers New Jersey School of Medicine in Newark.

Universal autism testing could go a long way in bridging these gulfs, which likely reflect differences in diagnosis rather than actual differences in prevalence, Shenouda et al.

The work says it’s unclear what drives the demographic differences Andres Roman-Urestrazu, director of psychology and behavioral sciences at the University of Cambridge in England, who was not involved in the study. The data comes from the US Centers for Disease Control and Prevention’s Autism and Developmental Disabilities Surveillance (2011).ADDM) network, which relies on children’s education and clinical records but lacks information on their insurance status, so it provides only part of the picture, Roman-Urestrazu says. “Knowing how the United States health care system works is important, as race is an important factor to consider. That is my main criticism.”

TA new study of the prevalence of autism among 8-year-olds with and without intellectual disabilities in four New Jersey counties, which make up a quarter of the state’s 8-year-olds. Together, these counties showed a consistently higher prevalence of autism than the other 10 ADDM sites, and the range is very diverse. Examining county-level data, he says, provides valuable insights into who gets notified and when. David Mandelprofessor of psychiatry at the University of Pennsylvania in Philadelphia, who was not involved in the study.

Of the 29,470 children in the study, researchers identified 1,505 with autism and 2,764 with mental retardation.

Autism without mental retardation was 30 percent less likely to be diagnosed in non-Hispanic black children compared to non-Hispanic white children, Shenoda’s team found. And it was about 60 percent compared to children living in affluent areas.

Because public school funding is tied to property taxes, children from poor neighborhoods tend to attend poorly funded schools, where their developmental problems are less likely to be properly identified, Mandel said. Systemic racism can affect how health care and education professionals view minority children, he said. “For black children with developmental disabilities, we’ve got a lot of data and a long history of those developmental disabilities being often missed or misdiagnosed.” He says that autistic black children must be severely disadvantaged to get the same attention as autistic white children.

Overall, about 1 in 42 white children without intellectual disabilities have autism, the study found. That number is 1 in 82 for black children. If the figures for white children can be considered close to the true prevalence, authorities are missing about half of black children with autism, Mandel said.

ohOver the 16-year study period, the prevalence of autism in New Jersey went from 1 in 104 children in 2000 to 1 in 31 children in 2016. The prevalence of autism without intellectual disability has increased fivefold. Mental retardation only doubled. These disparate developmental stages may be due to better recognition of autistic children with average or above-average intellectual abilities, Shenouda says.

The differences aren’t a change in the 2013 autism diagnostic criteria, Shenouda says, because the team generally used the same case definition throughout the study period, and many of the children identified were not routinely diagnosed.

A 2017 study found that outside the U.S., a similar trend has occurred, with the highest number of new diagnoses at the less-affected end of the spectrum. Children in Australia. Based on the racial and economic diversity of the four New Jersey counties, Shenoda and her colleagues suspect the region’s numbers are more representative of America than other ADM study sites, suggesting the New Jersey site may predict future national trends.

Across all demographic categories, children do not appear to receive the early screening tests recommended by the American Academy of Pediatrics. 18 and 24 months, Shenouda says. But even when children are examined, most of them Do not accept Recommended monitoring, previous studies have shown.

One obstacle, Shenoda says, is that many underserved families get their regular health care through federally qualified health centers that meet specific screening guidelines: These publicly funded clinics offer care regardless of a person’s ability to pay, but they must: US Defense Services Task Force Advice against universal screening.

“If I think of something that helps children be identified and I think of the biggest impact for the target communities, it’s to follow the advice and use effective screenings at 18 and 24 months,” she said.

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