MONDAY, June 17 (HealthDay News) -- Black and Hispanic children
with autism are markedly less likely than children from white
families to receive specialty care for complications tied to the
disorder, a new study finds.
Researchers from Massachusetts General Hospital for Children in
Boston found that the rates at which minority children accessed
specialists such as gastroenterologists, neurologists and
psychiatrists, as well as the tests these specialists use, ran well
below those of white children.
"I was surprised not by the trends, but by how significant they were," said study author Dr. Sarabeth Broder-Fingert, a fellow in the department of pediatrics at MassGeneral and Harvard Medical School. "Based on my own clinical experience and some of the literature that exists on this, I thought we'd probably see some differences between white and non-white children in getting specialty care . . . but some of these differences were really large, especially gastrointestinal services."
The study is published online June 17 in the journal
According to the U.S. Centers for Disease Control and
Prevention, about one in 50 school-age children has been diagnosed
with an autism spectrum disorder, a group of neurodevelopmental
problems marked by impairments in social interaction, communication
and restricted interests and behaviors. Research has indicated that
children with an autism spectrum disorder have higher odds of other
medical complications such as seizures, sleep disorders,
attention-deficit/hyperactivity disorder (ADHD), anxiety and
In the new study, Broder-Fingert and her team examined data from
more than 3,600 autism patients aged 2 to 21 over a 10-year span.
The vast majority of patients were white, while 5 percent were
black and 7 percent were Hispanic. About 1,500 of the autism
patients had received specialty care.
Most notably, almost 14 percent of white children used
gastroenterology or nutrition services, compared to only 9 percent
of blacks and 10 percent of Hispanics. Tests such as colonoscopies
and endoscopies were received far more by white children, while
psychiatric evaluations were also more sought-after by whites, and
Hispanics used fewer neurologic studies, sleep studies and
Broder-Fingert said that many children with autism have
gastrointestinal or sleep problems, which can lead to additional
behavioral issues if they aren't properly diagnosed or treated.
"I do worry because autism is such a complicated disorder," she said. "The children have some sort of communication difficulty, so if they have stomach problems or sleep problems they may have difficulty expressing that. I always worry these kids are not getting all the care they need in general, and minority kids are more at [risk] of not getting the care they need."
The research offered several possible reasons for the disparity,
but Broder-Fingert felt the most likely scenario is that doctors
don't necessarily know when to refer these patients to specialty
care, or to whom.
"And if some families are advocating more for services than others, doctors are more likely to be aware of it," she added. "So I worry that families of white children are more likely to come in and say, 'my kid needs a colonoscopy because he has a stomach ache.' I think it's a combination of parents' advocacy and physicians' lack of knowledge."
The findings offer hard data to back up some assumptions doctors
already had about how different populations are served, added Dr.
Patricia Manning-Courtney, associate professor of clinical
pediatrics and medical director of the Kelly O'Leary Center for
Autism Spectrum Disorders at Cincinnati Children's Hospital Medical
"If non-white children use services less, then we need better outreach to the minority community," Manning-Courtney said. On the other hand, "if white people are receiving unnecessary referrals and procedures, we need better education about what's needed," she added.
"There are no guidelines about how to proceed with evaluating [specialty care needs], which puts a lot back into the hands of parents," she said. "We allocate care for people who go after it the most, versus those who may need it the most."
Find out more about autism at the
U.S. National Institute of Neurological Disorders and
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