Young child at a medical check-up.
Lost opportunity: Most autistic children in the new study attended fewer than half of the recommended well-child visits.
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Missed check-ups, delayed autism diagnoses among low-income children

Autistic children from low-income families are diagnosed about eight months later than their wealthier peers, a new analysis of insurance claims in Virginia shows.

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Children from low-income families are diagnosed with autism about eight months later than their wealthier peers, regardless of how many ‘well-child’ visits they attend, according to a new study.

The analysis reviewed insurance claims for 253 autistic children who were born in Virginia in 2011. Those on Medicaid, government-funded health insurance for low-income families in the United States, were diagnosed with autism at 48.5 months of age, on average, compared with 40.7 months for those with private insurance.

The American Academy of Pediatrics recommends that children have health screenings at 12, 15, 18, 24, 30 and 36 months of age, and once a year after that. Early signs of autism typically appear in the second year of life, so these check-ups are important for early diagnosis. “The earlier you get diagnosed, the better your outcomes are,” says study leader Pamela DeGuzman, associate professor of nursing at the University of Virginia in Charlottesville.

But nearly one in five of the children in the study did not attend a single well-child visit between ages 1 and 5, and most children attended fewer than half of the recommended visits. Children on Medicaid are less likely to attend these checkups than are those with private insurance. The findings appeared in The Journal of Pediatrics in September.

For children who are still undiagnosed at their 3-year-old visit, “those who have Medicaid insurance are 85 percent less likely to be diagnosed” at that checkup than are privately insured children, DeGuzman says.

A prior study by DeGuzman also found that young children in rural Virginia attend fewer well-child visits than children living in urban areas. One reason for this difference may be that, in some parts of western Virginia, the closest developmental pediatrician lives more than three hours away by car.

The new work has some holes; because it’s based on insurance claims, it does not include details on race or income. And race, DeGuzman says, “is something that needs to be evaluated to see if this is, you know, another source of disparities that we need to address.”

Disparities in time to diagnosis for children on Medicaid could be tied to their family’s financial circumstances. People on Medicaid “are a lot less likely to have paid time off. They have less flexible schedules. Sometimes people are working more than one job,” DeGuzman says. All of those factors make it harder to get a child to the doctor. And “once you miss a visit, you're not likely to get that visit rescheduled in the correct time period,” she says.

To close the gap, medical facilities could call families who miss appointments for a well-child visit to reschedule, just as they do for immunizations, DeGuzman suggests. Still, these check-ups shouldn’t be a burden on parents, “who are already probably pretty taxed, because we’re talking about children on Medicaid, who are the most vulnerable,” she says.

“There’s a lot going on in people’s lives.”