Document Type

Dissertation

Degree

Doctor of Philosophy

Major

Psychology, Clinical-Community

Date of Defense

6-15-2023

Graduate Advisor

Emily Gerstein

Committee

Ann Steffen

Devin Banks

April Regester

Abstract

Awareness of autism is rising, yet social determinants of health continue to impact rates, ages of diagnosis, and diagnostic load. Different psychiatric labels carry stigmas; unequal rates of diagnoses may indicate biases in the healthcare system. This study investigates six prior diagnoses (ADHD, disorders of conduct, adjustment, anxiety, mood, and intellectual disability) assigned to children who are later diagnosed with autism. The study investigates how race, sex, and geographic factors were associated with age of diagnosis and diagnostic load. This study utilized a sample of 13,850 children aged 2-10 who were diagnosed with autism on Missouri Medicaid between 2015 and 2019. The sample was 78.16% male and 14.43 % Black, with 57.95% of children living in urban regions of the state. Results indicated that being White, living urban, and having more prior diagnoses was associated with older age of autism diagnosis, F(4, 12229) = 577.25, p < .001. Using logistic regressions, being White was associated with a child being more likely diagnosed with all prior diagnoses aside from intellectual disability. Being male was related to a higher likelihood of ADHD, but lower likelihood of intellectual disability. Findings showed that living rural was related to a higher likelihood of ADHD, Conduct, and intellectual disability diagnosis. Overall, being White was associated with older age of diagnosis and higher likelihood of most diagnoses, even in urban-only samples, potentially reflecting more access to providers and more office visits. Living in rural areas was also associated with earlier diagnosis and more prior diagnoses such as ADHD and conduct, which may be due to types of providers or specialists seen. Future research should look at barriers to diagnosis and the advantages and disadvantages of a higher diagnostic load.

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