Differential access to neuropsychological evaluation in children with perinatal complications or autism spectrum disorder: Impact of sociodemographic factors

Abstract

Objective

Early childhood evaluation can identify deficits related to disruptions in early brain development and facilitate interventions. Access to care may differ by race/ethnicity or socioeconomic status. We explored neuropsychological evaluation access patterns and examined potential sociodemographic disparities in evaluation timing. Method: Participants were 213 children (age: M = 46.4 months, SD = 15.3 months) with a history of disrupted neural development due to perinatal complications (PC; n = 109) or autism spectrum disorder (ASD; n = 104). We used chi square tests of independence and one-way ANOVAs to compare groups on sociodemographics, referral sources, and cognition. Clinical sample means for cognitive and adaptive variables were compared to normative means to determine the presence of developmental delays. Differences in age at evaluation by race/ethnicity, caregiver education, and referral source, accounting for cognition, were explored with ANCOVAs. Results: The ASD group included significantly more White children and the PC group relatively more Black/African Americans. Children with ASD were referred by primary care physicians and caregivers/school staff; those with PC were referred by other medical providers. All participants performed more poorly than expected across all intellectual and adaptive domains, with greater delays in the ASD group. Children of caregivers with lower education were evaluated earlier in the PC group. For ASD, participants referred by primary care physicians were evaluated earlier. Conclusions: Children with PC and ASD exhibit cognitive delays and require neuropsychological evaluation. Disparities in access to care exist, particularly for minority children with ASD. Ways to promote equal access are discussed.

Keywords:

• Early brain insult
• perinatal complications
• autism spectrum disorder
• access to care
• sociodemographic factors

Acknowledgements

The authors would like to thank the children and families who were evaluated through the PINT Clinic at the Medical College of Wisconsin between 2000 and 2008, whose data is described in this study, as well as the referring providers within our tertiary medical center and at primary care practices in the surrounding area. We are also particularly grateful to the PINT Research Team at the Medical College of Wisconsin for their help with data management.

Disclosure statement

All authors declare that they have no potential conflicts of interest to disclose.

Data availability statement

Due to the nature of this research study (i.e. retrospective review of a clinical database), participants of this study did not agree for their data to be shared publicly, so supporting data are not available.

Additional information

Funding

This study was funded, in part, by a Vitality Award to Dr. Heffelfinger from the Medical College of Wisconsin.