Are more rich kids autistic?

28 Aug

That is the question researchers at the University of Wisconsin studied in a recent paper in the Wisconsin Medical Journal: Socioeconomic Disparity in the Prevalence of Autism Spectrum Disorder in Wisconsin.

The brief report looked at the data used in the 2002 CDC prevalence study that reported 1 in 150 children are diagnosed with autism in the U.S.. The data are collected through the Autism and Developmental Disabilities Monitoring (ADDM) Network.

Here is one of the tables
:

Prevalence vs SES for Wisconsin

Prevalence vs SES for Wisconsin

What’s it say? Basically, if you are wealthy or have a high level of education, your kid is much more likely to be diagnosed autistic.

The authors are pretty limited in what they can say. They didn’t look into the “why”. That they did say was this:

Although the positive association with SES reported here is consistent with early observations of autism and some previous epidemiologic studies,2-3,5 the reason for this association and the potential role of SES differences in access to health and educational services for ASD cannot be determined from the data available.

and:

Further research is also needed to examine whether the association reported in this paper is a result of differential access to health services, other sources of ascertainment bias, or SES differences in the risk of developing ASD.

Do I think that kids of wealthy parents are really 2.5 times more likely to *be* autistic? No. But, are they more likely to *get* a diagnosis? It sure looks like it.

I am not surprised. There are very large disparities by geography (state to state, rural vs. urban) and by ethnicity in much of the CDC’s ADDM network data. I was surprised that the disparity by socio-economic-status was so large.

18 Responses to “Are more rich kids autistic?”

  1. Emily August 28, 2009 at 14:55 #

    I’ve often wondered this very thing with those very questions in mind about the interaction between money and the ability to take advantage of the appropriate health care mechanisms for an accurate diagnosis, not to mention being able to afford the sequelae of therapies, et al. My hairdresser’s daughter is diagnosed with Asperger’s, but she was not evaluated until she entered the public school system; our son was evaluated at age 3. We are not “wealthy,” but we are reasonably well off and have health insurance. My guess is that this contrasting scenario plays out frequently, with delays in diagnosis or no diagnosis at all in less advantaged families. Compounding it is likely a reduction of resources locally in their school district or specific school that would preclude expending any resources on evaluating any but the most extreme or obvious cases of difference.

  2. Gareth August 28, 2009 at 19:29 #

    You are right in one respect: “Basically, if you are wealthy or have a high level of education, your kid is much more likely to be diagnosed autistic.” This is because the service is so expensive that it is made difficult to access. This is true both of the nationalised health service here in the UK and its insurance-based US counterpart. Negotiating the artificial difficulties put into place by the paymasters requires intelligence and resources.

    However, there are other correlations which, if not acknowledged in the original analysis, can skew the results: there is an association between late Dx & HF/early Dx & LF that requires more research; there is also an association between privately funded service providers and their diagnosis rates that requires further attention.

    Added to that is the “obvious” fact that this survey is based on data gathered in the USA, where less affluent and therefore uninsured (or underinsured) families are less likely to get a Dx in the first place for the simple reason that it, and the subsequent intervention programme, costs money.

  3. Club 166 August 28, 2009 at 20:36 #

    The fact that those in a lower SES get diagnosed less as autistic does not surprise me. There are a number of possible reasons for this.

    As already noted, negotiating bureaucratic labyrinths requires time and money. Higher SES families are more likely to have at least one parent available to facilitate this. Having adequate health insurance also helps.

    Two factors that also MAY come into play are a general distrust of the medical establishment by many members of lower SES groups; and conversely, greater stereotyping of children of color, where behavior is seen as “bad” or “antisocial” rather than being representative of autism.

    Joe

  4. ebohlman August 28, 2009 at 21:32 #

    Another possible is that children from families with lower SES are likely to get more “dismal” diagnoses; I vaguely recall some work from the 90s showing that given the same presenting information, kids who were poor or brown were more likely to be assigned to Mental Retardation as opposed to Specific Learning Disabilities than were white kids. Similarly adults of low SES were more likely to be diagnosed with schizophrenia as opposed to depression when all other things were equal (note that this would lead to the use of “tranquilizing” rather than “energizing” medication; the former would appear more desirable in groups that are perceived as threatening).

  5. Kelly Stone August 29, 2009 at 04:51 #

    I believe if you examine India as an example, you might find this to be the case. The extreme class distinction allows a select group education as well as “immunizations” for young children.

    Kelly

  6. Navi August 29, 2009 at 07:03 #

    It’s also that those in the US with health insurance are more likely to see a dr regularly, and then get referred to Early On, which is a free federal program that evaluates developmental disabilities regardless of wealth. But, if you lack a concern or knowledge of the program, you’d never contact them. I’d be interested to know the socioeconomic makeup of Early On participants (we actually had Medicaid at the time of Early On referral, but then we are also a bit better educated than your average Medicaid recipient)

  7. David N. Brown August 29, 2009 at 07:57 #

    I think there’s a strong possibly that autism is more common among the poor. As we discussed for another post recently, there’s some evidence that autistics are undervaccinated. I would consider that, in turn, to be an indicator of geographic isolation and/or poverty.

  8. passionlessDrone August 29, 2009 at 13:16 #

    Hello friends –

    It is possible there are actually more wealthy autistics. Wealthy parents are more likely to have attended college, and therefore be older when they have children. Also, wealthy parents are more likely to have math or engineering backgrounds, which tend to be over represented in the autism community.

    – pD

    • Sullivan August 29, 2009 at 14:59 #

      It is possible there are actually more wealthy autistics. Wealthy parents are more likely to have attended college, and therefore be older when they have children. Also, wealthy parents are more likely to have math or engineering backgrounds, which tend to be over represented in the autism community.

      It’s possible. But, very unlikely to be a factor of 2.6 as noted in the paper. Keep in mind that they are using ADDM data. The CDC lists the prevalence data they use as being collected by “case enumeration”. They count already identified cases. My recollection is that Wisconsin had the largest gap in prevalence based on ethnicity, which to me is a clear sign that they are not counting everyone. Race/ethnicity has been studied and it is either not a factor or not a very large one.

  9. Mike Stanton August 29, 2009 at 18:15 #

    When Lorna Wing reviewed the epidemiology of autism in her 1993 paper, The Definition and Prevalence of Autism: A Review she identified nine studies that collected data on social class. Two studies found an association and seven did not.

    A more recent study by Baird (2006) found that parental education was a factor in diagnosis. Parents who did not complete their secondary education were less likely to have a local diagnosis of autism. But once this was controlled for, socio-economic status was not a significant factor.

  10. Mike Stanton August 30, 2009 at 11:51 #

    Disambiguation

    I should have written “Children of parents who did not complete their secondary education were less likely to have a local diagnosis of autism.”

  11. Matt August 31, 2009 at 13:42 #

    There are a lot of good points being made here.

    Just as a clarification, the ADDM Network identifies ASD cases independently of a previous diagnosis. Children who have been to a health care provider and did not get diagnosed could still be considered a case. This does not, however, completely rule out the possibility of ascertainment bias due to SES.

    • Sullivan September 1, 2009 at 09:04 #

      Matt,

      thank you very much for taking the time to respond here. We here at lbrb have a great admiration for the Waisman Center.

      I appreciate your comment–I am somewhat confused by the description of methods in the ADDM (as cited in the paper) which includes discussion of screening vs. the CDC’s statement that the ADDM uses “case enumeration”.

  12. Matt September 2, 2009 at 20:20 #

    Sullivan,

    Thank you for the kind words about the Waisman Center.

    I can understand how making distinctions based on those terminologies can seem ambiguous. The ADDM Network methods screen existing records and evaluations, as opposed to directly screening all children. For children showing signs of ASD, de-identified information is sent to an expert reviewer who assigns a surveillance case definition comparing the abstracted information to DSM-IV criteria. The children who are given an ASD case definition are counted (enumerated) over a geographically-defined population.

    We also record if a child has been previously diagnosed, and there is some interesting work by Shattuck and Mandell looking at disparities in identification and age of diagnosis of ASD in the US.

    • Sullivan September 2, 2009 at 21:50 #

      Matt,

      thanks for the clarification.

      So they do screen, but this is substantially different from a prevelence study which might take a smaller group of children and screen for possible ASD, then test those potentials with ADOS or ADI type tests. Correct?

      As to Shattuck (Waisman Center alum, if I recall correctly) and Mandell–they are two very respected researchers to those of us here at lbrb. We have a “Mandell” category, and I recently discussed Dr. Shattuck’s grant to look at adolescents.

  13. Annette June 10, 2010 at 15:05 #

    This may be a karmic issue. Rich people are much more obsessed with material things than poorer people. Autistic children are often obsessed with things. The rise in autism may also be caused by our rise in materialism. I was born in the 1960s, and back then, people were much less materialistic. There were less avenues to lure people into buying products. There were no malls, internet and shopping magazines.

  14. Calli Arcale June 10, 2010 at 20:15 #

    There were no malls in 1960? Wow. I did not know that. I thought that 1956 was earlier than 1960. That’s when Southdale Center opened in Edina, MN; it’s North America’s oldest fully-enclosed mall. (It was not the first, however; the Arcade of Cleveland opened in 1890. The difference is that Southdale is still operating. Southdale was, however, heavily influential in later mall design — to the chagrin of its architect, actually. It’s an interesting story.) Of course, non-enclosed malls are much, much older. The basic concept is at least 1300 years old.

    And no shopping magazines? I guess you’ve never heard of the Sears Catalog, which has been around since the 19th Century.

    No. Materialism is not the cause of autism. And being obsessed with things isn’t the same thing as being materialistic. If you’ve got an autistic child obsessed with dinosaurs, this is not comparable to somebody with a $16,000 credit tab from a year’s worth of shopping sprees at the local mall. Plus, most autistic people don’t enjoy shopping malls in the least, which are very stimulating environments.

  15. Chris June 11, 2010 at 01:27 #

    Hey, I remember going to Southdale in the late 1960s!

    The mall I go to now opened in 1950! I also remember going to malls in a suburb of Caracas, Venezuela in the 1960s (we moved from Venezuela to Bloomington, MN).

    I grew up in the 1960s, I remember there were lots of stores, commercials, and lots and lots of catalogs. It was all about the materialism post World War II (and some of the late 1960s counter culture was a reaction to that).

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