Bennett, L. M., Paskov, K., Kent, J., McNealis, M., Sutaria, S., Dods, O., Harjadi, C., Stockham, N., Ostrovsky, A., & Wall, D. P. (2023). Racial and ethnic disparities in geographic access to autism resources across the US. JAMA 6(1), 1-14. https://pubmed.ncbi.nlm.nih.gov/36689227/

Reviewed by Simon Celiberti-Byam (Extern) and Mary Jane Weiss, PhD, BCBA-D
Association for Science in Autism Treatment

Why review this topic?

As discussed by these researchers, Autism Spectrum Disorder (ASD)’s prevalence has grown significantly in the last five years, as reflected by a threefold increase in the number of children born with ASD. Concerns around children with ASD of color receiving access to resources and services are longstanding and have been amplified with the uptick in the number of children with ASD. Although these concerns have become more and more prevalent in recent years, the size, extent, and specific locations of these access gaps to autism services have yet to be identified on a national scale. Evaluating geographic regions defined by localized community patterns will help identify areas within the United States where families who belong to minoritized racial and ethnic groups have disproportionately lower access to services. It is critical that we look at health disparities in autism services access, as this has not yet been examined as much as disparities observed with other health areas or conditions such as cancer and cardiovascular disease.

What did the researchers do?

Bennett et al. (2023) conducted this study over a 9-month period which involved 530,965 children with ASD receiving services from their schools during the years 2017 and 2018. The researchers looked at six racial and ethnic categories including American Indian or Alaskan Native, Asian, Black or African-American, Hispanic or Latino, Native Hawaiian or other Pacific Islander, and White. The population-based cross-sectional study obtained data using the GapMap database, CDRC survey, and information from 912 core-based statistical areas (CBSAs). CBSAs are geographic divisions of the US based on commuting times to urban centers and are a valuable tool for understanding a population’s access to services. To analyze, understand, and interpret the differences in access to ASD resources between the six racial and ethnic groups, Bennett et al. (2023) used a sophisticated statistical analysis (i.e., a linear least-squares regression analysis with a non-negativity constraint) to model the number of GapMap autism resources within each CBSA as a function of the radical and ethnic composition of autistic children in a CBSA. This analysis produced a nationwide estimate of the number of resources available per child depending on the child’s race and ethnicity, as well as their geographic area.

What did the researchers find?

In their analysis, the researchers compared the total number of autistic children with the raw total number of autism resources per CBSA. Results showed that several minority racial and ethnic groups had access to fewer than the median number of resources per autistic child. Specifically, Bennett et al. (2023) found that Black and Hispanic autistic children experienced the highest disparities in access to ASD services. The results of the analysis by proportion of autistic children in each racial and ethnic group were consistent with the national results, revealing that CBSAs with the largest proportions of Black or Hispanic autistic children also had significantly fewer resources than other CBSAs. The data clearly revealed disparities in resource allocation and confirmed that areas with high proportions of Black or Hispanic autistic children had fewer resources and reduced access to care. There were 84 CBCAs with no autism resources and the authors shared the locations of 15 of the most populous ones. These included micropolitan areas (e.g., Dunn, North Carolina, and Eagle Pass, Texas) and metropolitan areas (e.g., Hanford-Corcoran, California and Brownsville-Harlingen, Texas) to name a few. The researchers offered a full data set for readers that might want to look more closely at specific areas of geographic disparity.

What are the strengths and limitations of the study? 

Although the study involved a very large sample size, some questions remain about the findings. The study may have over-generalized the complexities and variability within racial and ethnic groups; a finer analysis may shed more light on the issues of access by race and ethnicity. Specifically, the difference in access to autism resources for English speaking Hispanics, compared to non-English speaking Hispanics, would be an important area for future research. Interestingly, it was found that Asian children with ASD had greater access to autism services in comparison with White children, and it would help to know why that was the case. It may be that socioeconomic status needs to be examined as an additional, relevant variable. This study did not specifically assess whether communities whose individuals have higher socioeconomic status have greater access to autism resources than communities of lower socioeconomic status.

What do the results mean?

The results are a call to action and suggest that there are large racial and ethnic disparities across the US in access to care for autistic children. This means that tens of thousands of minority children with ASD in the US may not be receiving the proper support and services. In the meantime, action is clearly needed to reduce these disparities. It may help to learn from communities that have more success in meeting the needs of racial and ethnic groups that historically have been underserved. It may also be helpful to look at other health equity initiatives that have been successfully initiated. Finally, advocating to include autism services in health inequity analyses is vital to ensuring continued assessment, consideration, and resolution of this issue.

Citation for this article:

Celiberti-Byam, S., & Weiss, M. J. (2023). Research Synopsis: Racial and ethnic disparities in geographic access to autism resources across the US. Science in Autism Treatment, 20(8).

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