Autism Spectrum Disorder (ASD) is a development disorder that targets and affects a person's behavior and communication. The disease is referred to as a development disorder since the symptoms appear in the first two years of an individual's life. Regardless, the disease can be diagnosed at any age. Individuals diagnosed with ASD have difficulty interacting with other people and also have repetitive and restricted behaviors. Additionally, the disease negatively affects an individual's ability to function properly in areas such as school or work. Autism is often known as a spectrum disorder because there is a wide range of symptoms that different individuals experience. The disease is a lifelong disorder which affects people across all ethnic, racial, and economic background. For this reason, the American Academy of Pediatrics recommends that all children be screened (NIMH, 2018). Although it is a lifelong disease, early detection leads to treatments and services which can improve an individual's ability to function.
Although scientists are yet to establish the exact cause of ASD, certain influencers may trigger the disease. Some of those risk factors include deficient birth weight, older parents, having a sibling who has the disease, and certain genetic conditions. Various researchers have established that conditions such as fragile X syndrome, Rett syndrome, and Down syndrome are more likely to suffer from ASD (NIMH, 2018). Considering the wide range of symptoms, there is no definite way of handling autism patients since the symptoms tend to be more severe in some cases than others. However, working closely with a medical professional who specializes in that field can help get the right treatment program. It is recommended that treatment should start as soon as the diagnosis is made as proper care can significantly reduce the person's difficulties while making use of their strengths and learning new skills. Nevertheless, some disparities occur to autism patients. Such disparities deter them from accessing the much-needed help that they require. The disparities occur in terms of race, gender, and social-economic status.
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Racial Disparities
In most cases, autism is often diagnosed later after the onset of symptoms, and it is usually worse among minority groups. Late diagnosis can be due to slow response to parental concerns or lack of information that symptoms of the disease manifest early. Minority groups have often been disadvantaged in terms of access to vital services such as education or healthcare. Such disadvantages often lead to misdiagnosis or lack of detection since the parents do not know what symptoms to look out for. The results of this are delayed or missed ASD diagnosis, situations familiar with medically underserved ethnic minorities. In 2017, the American Journal of Public Health conducted a study that revealed that compared to white children, black and Hispanic children are 19% and 65% respectively less likely to be diagnosed with autism (Organization for Autism Research, 2018). It can, therefore, be concluded that disparities in the diagnosis of autism as well as access to quality healthcare continue to rise among minorities. Bishop-Fitzpatrick & Kind (2017) also conducted nine surveys involving African American and Latino communities. All nine studies examined disparities in healthcare quality and access among the minorities. The studies found out that both Latino and African American parents with children who have ASD are more likely to report the lack of access to a personal doctor or nurse compared to white parents (Bishop-Fitzpatrick & Kind, 2017). For those who had doctors, they were barely there and spent less time with the child and was not sensitive about family values. What is more, the doctor did not make the parents feel like partners in helping their sick child, and in some cases, the doctor did not convey substantial and helpful information.
Additional findings from the research also suggested that nonwhite parents are more likely to report receiving coordinated care than white parents (Bishop-Fitzpatrick & Kind, 2017). Similarly, the findings from this research echoed those of the American Journal of Public Health that diagnosis for minorities is lower than that of whites. The disparities were also noted in terms of medical insurance policies. For white parents, their insurance policies were always updated, which facilitated easier access to better treatment options. Therefore, children who were diagnosed with ASD could enroll in the programs fast enough to begin the process of therapy. On the flip side, African American and Hispanic parents did not have the best insurance policies, which meant that they had to settle for doctors that they could afford. The cases of misdiagnosis, therefore, can be attributed to disparities in insurance policies. According to both studies, the situation has not improved, and the disparities are still rampant. It is an unfortunate reality since the people who suffer most are ASD patients, who require constant and high-quality medical attention.
Gender Disparities
Halladay et al. (2015) found out that the rate of ASD diagnosis is higher in males than females. Irrespective of this understanding, there has been little research to show valid reasons for such disparities. If such research were available, bridging the gap between the differences would lead to better diagnosis and access to healthcare for both men and women. In comparison, the ratio of men to women with autism has always been 4.1 until recently when researchers established a possible bias in the comparison (Halladay et al., 2015). Nevertheless, there is a greater prevalence of attention towards male ASD patients than females. While the ratio is not definite, and there may be some variability, there is some truth in that men get more attention than women in terms of diagnostics and treatment. Some of the attributes to the ratio variability are differences in ascertainment procedures due to the wide range of estimates as well as an intellectual quotient (Halladay et al., 2015). The sex bias is often seen where the girls with ASD are compounded by lower IQ than boys. Consequently, the prevalence difference between male and female ASD patients may be due to diagnostic differences.
One theory causes gender disparities, where it proposes that females who have autism are protected against some severe symptoms of the disease through the Female Protective Effect (Hull & Mandy, 2017). Based on the theory, females should have a higher rate of ASD factors in comparison to their male counterparts. Such additional risk factors are required for the female to surpass the higher diagnostic threshold imparted by FPE. To substantiate the theory, genetic analysis of ASD cohorts revealed less burden of de novo Copy Number Variations (CVCs) in males than females (Hull & Mandy, 2017) Once inherited, CVCs are more transferrable to unaffected mothers than fathers, which means that female experience greater risk of transmission of the CVCs. Similarly, epidemiological studies have also tackled the FPE hypothesis. Considering that females have a higher burden of ASD risk, their siblings are also at higher risk (Halladay et al., 2015). This is because parents have an increased burden of potential transmitting the risk to their siblings. Therefore, compared to males, females have increased the potential of transferring the risk compared to males. As noted above, females with ASD are different from males in that they are underrepresented in the IQ distribution, especially at the higher end. Males with ASD showed more repetitive behaviors than females with the same disease. It can be concluded that females may be under-diagnosed due to differences in symptom presentation.
Social-Economic Disparities
According to recent research by European Studies, an increased risk of ASD is associated with low social, economic status (SES) of an individual (Delobel-Ayoub et at., 2015). The prevalence of ASD was significantly higher in areas that showed a high deprivation level as well as the highest number of unemployed adults, single-parent families, or immigrants. Delobel-Ayoub et at. (2015) conducted a study to prove the relevance of the theory. The researchers included children aged eight from Haute-Garonne, France. The children used in the research were only included if one had a diagnosis of ASD or ID in their medical records. Due to the lack of individual social-economic data, the researchers used other methods such as the French version of the European Index of Deprivation (Delobel-Ayoub et at., 2015). The prevalence of ASD per 1000 children was 3.6%, where out of the 500 children with ASD, 51.4% also had AD (Delobel-Ayoub et at., 2015). The study also substantiated the association between ASD and AD. For instance, severe ASD without AD was rampant only in areas with immigrants. While this is the case, isolated severe ID increased with an increase in deprivation level, from the least to most deprived. Although the SES levels increased during the research, the rise did not affect the results. However, the prevalence of ID was found to be rampant than that of ASD. It is only, when associated with ID, that the prevalence of ASD is seen to be significantly higher in most deprived areas. The study revealed some links that were previously not explored concerning SES and ASD. For instance, factors such as family structure, low maternal education level, and low family income resulted in severe ASD. An important point to note is that situations that worsened the household income during the research also resulted in more risk factors associated with ASD.
Conclusion
ASD is a mental disorder that affects an individual's communication and behavior. The disease, though detectable early, affects individuals across all racial and social-economic backgrounds. As mentioned above, it is referred to as a spectrum disorder since the symptoms range from one individual to the next. Due to the delicate nature of the disease, ASD patients require constant care from qualified health professionals. However, this is not the case for some disadvantaged groups as they lack access to quality healthcare despite needing it the most. Such disparities deny ASD patients a chance to improve their conditions. Various researchers have researched the issues, among them racial, social-economic, and gender disparities. Racial disparities normally affect minorities such as Hispanic and African Americans, where, as noted above, have fewer chances of getting diagnostics and treatment of Autism Spectrum Disorder.
Compared to minorities, white populations have better access to services, which often leads to early detection and treatment for the disease. Gender disparities gear towards women, where the theory of FPE requires women to pass through a higher diagnostic threshold. Although the number of men with autism is higher compared to that of women, treatment favors men. When it comes to social-economic disparities, low SES is associated with increased ASD risks. Although the disparities have existed for a long time, affirmative action is long overdue. The more the gaps widen, the more ASD patients suffer, and the more difficult it will be to find and implement solutions. Various educational programs should be put in place, particularly in low SES areas. Doing so will educate people on the facts of the disease so that they will know how to handle such situations. Moreover, it will ensure that ASD patients get the treatment and care they require for survival.
References
Bishop-Fitzpatrick, L., & Kind, A. J. (2017). A Scoping Review of Health Disparities in Autism Spectrum Disorder. Journal of Autism and Developmental Disorders , 47 (11), 3380-3391.
Delobel-Ayoub, M., Ehlinger, V., Klapouszczak, D., Maffre, T., Raynaud, J. P., Delpierre, C., & Arnaud, C. (2015). Socioeconomic Disparities and Prevalence of Autism Spectrum Disorders and Intellectual Disability. Plos One , 10 (11), E0141964.
Halladay, A. K., Bishop, S., Constantino, J. N., Daniels, A. M., Koenig, K., Palmer, K., ... & Taylor, J. L. (2015). Sex and Gender Differences in Autism Spectrum Disorder: Summarizing Evidence Gaps and Identifying Emerging Areas of Priority. Molecular Autism , 6 (1), 36.
Hull, L., & Mandy, W. (2017). Protective Effect or Missed Diagnosis? Females with Autism Spectrum Disorder. Future Neurology , 12 (3), 159-169.
NIMH. (2018). Autism Spectrum Disorder. Retrieved from https://www.nimh.nih.gov/health/topics/autism-spectrum-disorders-asd/index.shtml
Organization for Autism Research. (2018). Racial Disparities in Autism Diagnosis . Retrieved from https://researchautism.org/racial-disparities-in-autism-diagnosis/
