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Disparities in the Diagnosis of Autism Spectrum Disorder According to Aboriginality and Remoteness
While Aboriginal children suffer persistent disadvantages across most measurable aspects of health and wellbeing, research indicates that they have an 80% lower prevalence of autism spectrum disorder (ASD) with comorbid intellectual disability (ID).
Objectives:
We estimated the prevalence of ASD with ID in children born from 1983-2005 in Western Australia according to Aboriginality, geographic remoteness and over time. In this way, we aimed to clarify whether the lower rate amongst Aboriginal children is a function of access to diagnostic services and whether access is improving over time.
Methods:
We linked registry data to access information on Aboriginality, remoteness, birth year and the diagnosis of ASD with ID in all children born from 1983-2005 in Western Australia. Non-parametric trend tests were used to assess trends over time.
Results:
In Aboriginal children, the prevalence of ASD with ID (23.3/10,000) was about half that of non- Aboriginal children (45.8/10,000) The prevalence of ASD with ID decreased with increasing levels of remoteness for all children, though the trend was only significant in non-Aboriginal children (possibly due to larger numbers). Over time, there was no evidence of an increasing trend in the prevalence of ASD with ID in Aboriginal children (P-value = 0.75). In contrast, over time, there was a significantly increasing prevalence in non-Aboriginal children (P-value <0.0005).
Conclusions:
Improved diagnostic opportunities for ASD with ID are needed for Aboriginal children and all non-metropolitan children. In addition, a particular focus is needed in Aboriginal children to address the lack of increase over time in this population. With assistance from health-care workers to ensure access, this would enable more children to receive suitable early interventions, other services and funding which would improve children’s life opportunities and the Quality of Life of their families.