Delays in Autism Diagnosis for U.S. Spanish-speaking Families: The Contribution of Appointment Availability

ABSTRACT

Promoting equity in health services requires an understanding of the mechanisms that produce disparities. Utilizing a sequential, mixed-methods, explanatory study design, we analyzed child-, family-, and organizational-level factors and their association with wait times for an ASD diagnostic evaluation among 353 families scheduled for English and Spanish language appointments (27% Spanish language). A subset of parents and caregivers participated in English and Spanish language focus groups to provide their perspectives on the diagnostic process. Spanish language was associated with greater completion of, and time to evaluations than English language. The only variable found to mediate associations with time-to-evaluation was appointment availability – an organizational factor. Qualitative results elucidate potential explanations for greater Spanish language evaluation completion (e.g., fewer community-based diagnostic options). Results serve as a case study to support the utility and importance of analyzing the influence of organizational-level factors on delays and disparities for childhood health and mental health services. We discuss our findings in relation to strategies that can be widely applied to support equitable services access for childhood diagnostic and intervention services.

Disclosure statement

Dr. Sheldrick and Dr. Carter are co-creators of the POSI, which is one of the two first-stage screeners used in this study. They conduct research related to this instrument but receive no royalties. Dr. Carter is also co-creator of the BITSEA, which is one of the two first-stage screeners used in this study. Dr. Carter receives royalties on the sale of the BITSEA, which is distributed by MAPI Research Trust.

Supplementary material

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Additional information

Funding

This research was supported by the National Institute of Mental Health under Grant R01MH104400; Health Resources Services Administration under Grant Health Resources and Services Administration under Grant R40MC26195; and Autism Speaks under grant AS #7415.