Health disparities in age of first concern and age of diagnosis for children with ASD, ADHD, and ASD+ADHD are evident in a national sample

Background: Autism Spectrum Disorder (ASD) is diagnosed in 1 out of 68 children. Individuals with ASD commonly meet criteria for comorbid conditions such as Attention Deficit-Hyperactivity Disorder (ADHD). Although previous diagnostic guidelines (DSM-IV) did not permit clinicians to assign co-occurring diagnoses of ASD+ADHD, this became allowable in 2013 (DSM-V). Due to this change and a high prevalence of ASD+ADHD, it is important for researchers and clinicians to be aware of groups vulnerable to delayed or incomplete diagnosis. Objective: Assess the impact of race, ethnicity, sex, poverty level, and diagnosing provider type on age of first concern and age of final diagnosis in children diagnosed with Autism Spectrum Disorder (ASD), Attention Deficit Hyperactivity Disorder (ADHD), and ASD+ADHD. Hypothesis: We predicted that age of first concern would vary by sex, race, poverty level, identifier of first symptoms, and comorbidities. We also predicted that age of final diagnosis would vary by sex, race, poverty level, identifier of first symptoms, and provider type. Method: Data were extracted from the CDC Survey of Pathways to Diagnostics and Services (SPDS) and the National Survey of the Diagnosis and Treatment of ADHD and Tourette Syndrome (DTAT). Parents/guardians of 5,959 children aged 3-17 completed the surveys; in the current sample, 2,966 cases were from DTAT and 2,993 were from SPDS. The datasets were recoded and merged for analysis. We used a series of ANOVAs to assess differences in the variables of interest, grouped by demographics (sex, race, poverty level), identifier of first concerns, previous and current co-morbid conditions, and provider type. Results: Age of first concern was significantly impacted (p Conclusion: Specific combinations of demographic factors increase vulnerability for later diagnosis. These findings suggest that provider- and patient-centered education is needed to increase surveillance in at-risk populations.