Presentation Title (IN ALL CAPS)

MINORITY FEMALES ARE VULNERABLE TO MISSED OR DELAYED DIAGNOSIS OF AUTISM SPECTRUM DISORDER IN BOTH LOCAL AND NATIONAL HEALTHCARE SETTINGS

Departmental Affiliation and City, State, Zip for All Authors

Department of Physical Therapy, School of Health Professions, UNT Health Science Center, Fort Worth, TX, 76017; Department of Microbiology, Immunology, and Genetics, Graduate School of Biomedical Sciences, UNT Health Science Center, Fort Worth, TX, 76107; Texas College of Osteopathic Medicine, Fort Worth, TX, 76107; Department of Family Medicine, Texas College of Osteopathic Medicine, UNT Health Science Center, Fort Worth, TX, 76107; Department of Biostatistics, School of Public Health, UNT Health Science Center, Fort Worth, TX, 76017; Cook Children’s Medical Center, Fort Worth, TX, 76104; Cook Children’s Medical Center, Fort Worth, TX, 76104; Department of Pediatrics, Texas College of Osteopathic Medicine, UNT Health Science Center, Fort Worth, TX, 76107 and Cook Children's Medical Center, Fort Worth, TX, 76104; Cook Children’s Medical Center, Fort Worth, TX, 76104.

Classification

UNTHSC Faculty

Research Presentation Category

Health Disparities

Layperson Narrative or Summary (3-5 sentences)

An estimated 1 in 59 children is diagnosed with Autism Spectrum Disorder (ASD), and females are diagnosed 4-5 times less frequently than males. Recent evidence suggests that this difference in prevalence may not reflect true biological sex differences, but rather represents gender-based biases. Minority females may be at greatest risk for missed or delayed diagnosis of ASD, both locally and nationally.

Scientific Abstract

An estimated 1 in 59 children is diagnosed with Autism Spectrum Disorder (ASD), at a male to female ratio of 4:1 (CDC, 2018). Recent evidence suggests that prevalence differences represent diagnostic gender biases, not biological characteristics (Loomes et al., 2017). Given racial/ethnic disparities in age of diagnosis (Mandell et al., 2009), we hypothesized that minority females are vulnerable to missed or delayed diagnosis. National data were extracted from the CDC SLAITS database, which included children aged 3-17. A total of 840 cases (M = 686, F = 154) met inclusion criteria for the national sample. Local data were extracted from the electronic medical records of the Cook Children’s network in Fort Worth, Texas. A total of 2,034 cases (M = 1623; F = 411) met inclusion criteria for the local sample. In the local sample, the male to female ratio (M = 79.79%; F = 20.21%) was higher than U.S. prevalence estimates. The discrepancy was even larger in the CDC sample (M = 81.67%; F = 18.33%). Upon preliminary examination of sociodemographic effects in the national sample, mean age of first concern for Black Non-Hispanic females was higher than Black Non-Hispanic males at the same poverty level. Race/ethnicity impacts age of first concern, and minority females may be even more vulnerable to missed or delayed diagnosis. Rigorous research is needed to determine whether prevalence differences between males and females is biologically- or sociologically-driven. Provider- and patient-centered education may be required to increase surveillance among females, especially in vulnerable groups.

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MINORITY FEMALES ARE VULNERABLE TO MISSED OR DELAYED DIAGNOSIS OF AUTISM SPECTRUM DISORDER IN BOTH LOCAL AND NATIONAL HEALTHCARE SETTINGS

An estimated 1 in 59 children is diagnosed with Autism Spectrum Disorder (ASD), at a male to female ratio of 4:1 (CDC, 2018). Recent evidence suggests that prevalence differences represent diagnostic gender biases, not biological characteristics (Loomes et al., 2017). Given racial/ethnic disparities in age of diagnosis (Mandell et al., 2009), we hypothesized that minority females are vulnerable to missed or delayed diagnosis. National data were extracted from the CDC SLAITS database, which included children aged 3-17. A total of 840 cases (M = 686, F = 154) met inclusion criteria for the national sample. Local data were extracted from the electronic medical records of the Cook Children’s network in Fort Worth, Texas. A total of 2,034 cases (M = 1623; F = 411) met inclusion criteria for the local sample. In the local sample, the male to female ratio (M = 79.79%; F = 20.21%) was higher than U.S. prevalence estimates. The discrepancy was even larger in the CDC sample (M = 81.67%; F = 18.33%). Upon preliminary examination of sociodemographic effects in the national sample, mean age of first concern for Black Non-Hispanic females was higher than Black Non-Hispanic males at the same poverty level. Race/ethnicity impacts age of first concern, and minority females may be even more vulnerable to missed or delayed diagnosis. Rigorous research is needed to determine whether prevalence differences between males and females is biologically- or sociologically-driven. Provider- and patient-centered education may be required to increase surveillance among females, especially in vulnerable groups.