Access to Diagnosis and Care Among Latino Children with ASDs

Background: The striking increase in prevalence has lead to research, advocacy, and practice to improve early identification and treatment of children with ASDs. However, research has shown disproportionate diagnosis and care among children from racial/ethnic minority groups, and from lower levels of SES. At the provider level, the availability of services, cultural and linguistic competency, and biased care systems have further contributed to disparities. Although Latino children are the largest culturally distinct ethnic group of children in the U.S., there is a dearth of information about Latino children and families in ASD research. Identifying factors that limit access to diagnosis and care for Latino children with ASDs will greatly inform the research community and enhance the development of early identification and intervention programs for Latino children and their families.

Objectives: The aim of this study is to compare the timing of diagnosis, access to treatment and service utilization for non-Latino White and Latino children in Wisconsin and determine the role of maternal education in service use. 

Methods: Forty-eight Latino caregivers and 59 non-Latino White caregivers were administered a questionnaire on their sociodemographic characteristics and experiences with their child’s diagnosis, and service use. Families were recruited through service agencies and support groups. Children were between 3 and 21 years of age (μ=9.6; SD=4.5) at the time of the study. Latino mothers had significantly lower levels of education than non-Latino White mothers. T-tests and Chi-squares were conducted to identify differences between groups on service and access variables. Linear and logistic regressions were conducted to control for important variables and to test a mediation model. 

Results: Latino children were diagnosed with ASD nearly a year later compared to non-Latino White children (μ =3.89, SD=1.51 and μ =2.99, SD=1.76 respectively). Fifty three percent of Latino children (53%) ever received early intervention services compared to 77.6% of non-Latino White children.  The majority of non-Latino White children (81.4%) ever received intensive autism therapy compared to 41.7% of Latino children. Latino children received significantly fewer services overall than non-Latino White children.  In addition to controlling for child’s age and number of behavior problems, level of maternal education (which was significantly correlated with all outcome variables) was tested as a mediating variable between ethnicity and outcomes.  Level of education mediated the relationship between being Latino and age-of-diagnosis and between being Latino and whether the child received birth to three services.  However, non-Latino White children remained significantly more likely to receive intensive autism therapy and a greater number of services overall than Latino children, even taking into account level of maternal education.  

Conclusions: Latino children were found to be diagnosed later and to have lower access to services and treatment compared with non-Latino White children. Lower education levels may account for some of these differences, however, not with all outcomes. Given the importance of early diagnosis and intervention these findings suggest strategies specific to the Latino population are necessary to improve early identification, service and treatment access. Research and clinical implications are discussed.