Racial/Ethnic Differences in Psychiatric and Medical Diagnoses Among Autistic Adults

Abstract

Background: Racial/ethnic disparities in access to diagnostic services are pervasive for autistic children. However, a few studies have examined racial/ethnic health disparities among autistic adults, who commonly experience higher rates of health conditions than non-autistic adults. We aimed at examining the intersection of autism and race/ethnicity in association with psychiatric and medical diagnoses. Methods: The study population included adult members of Kaiser Permanente Northern California enrolled from 2008 to 2012. We ascertained 1507 adults who had an autism diagnosis documented in their electronic medical records. We sampled a matched control group of adults without an autism diagnosis ( N = 15,070) at a 10:1 ratio. Our sample was 46% White, 17% Hispanic, 16% Asian, 7% Black, and 14% other race/ethnicity. We compared health diagnoses (a) between autistic and non-autistic adults within strata of race/ethnicity and (b) across race/ethnicity within strata of autistic and non-autistic adults. Lastly, we examined the interaction between autism and race/ethnicity on both multiplicative and additive scales. Results: Autistic adults were more likely to be diagnosed with most medical and psychiatric conditions compared with their non-autistic counterparts of the same race/ethnicity. Among autistic adults, Black, Hispanic, and Asian adults were less likely to be diagnosed with psychiatric conditions and Black and Hispanic autistic adults were more likely to be diagnosed with obesity than their White counterparts. In interaction models, we found that adults who were Black and autistic were disproportionately less likely to be diagnosed with psychiatric conditions and autoimmune disease and more likely to be diagnosed with hypertension than expected. Conclusion: Health vulnerabilities may be compounded at the intersection of autism and race/ethnicity. Future research should continue to apply an intersectional lens toward understanding and addressing these disparities. Our findings likely underestimate the health disparities that exist in uninsured autistic adults and those living in other parts of the United States.

Sounding the Alarm: Calling on Service Providers to Reduce Disparities in Autism Services for Latinos.

“…Further, those who are employed are more likely to have access to private health insurance. In fact, one study found a higher percentage of Latino adults with ASD were using public health insurance compared to non-Latino adults with ASD (Ames et al, 2022). The present study also found that Latinos with a first-time diagnosis of ASD did not significantly differ from White individuals with a first-time diagnosis of ASD across measures symptoms of ASD symptoms and distress.…”

Applications of identity-based theories to understand the impact of stigma and camouflaging on mental health outcomes for autistic people

“…As previously mentioned, much of the current literature focuses on studying social identities, autistic traits, mental health, and camouflaging in separate studies. Across these studies, research has demonstrated that (1) social identity influences how autistic people view themselves and how others view them [e.g., ( 79 )], (2) social exclusion can lead to poor mental health outcomes [e.g., ( 93 )], (3) people with other marginalized identities have greater mental health concerns [e.g., ( 129 )], (4) camouflaging to fit in can be physically and emotionally taxing [e.g., ( 11 )], and (5) autistic people from other historically marginalized groups experience health disparities [e.g., ( 130 – 133 )]. Future research is needed to integrate these areas; such research can account for these complex theories by utilizing more advanced statistical approaches like structural modeling and implementing person-centered approaches like mixed methods research.…”

Examining the utilization of participatory research with autistic youth in mainstream/public schools: a scoping review

“…In a survey completed Wood and Happé (2020), results indicate that autistic students benefit from autistic educators as they serve as a role model and advocate. In a review of autistic teachers lived experiences, StEvens (2022) found teachers with disabilities foster inclusion and can counteract deficit narratives toward disability, which can be useful for neurotypical and autistic students. Further research could delve into the interaction between autistic educators and autistic students to see how communication and collaboration would be impacted.…”