New autism diagnoses tend to be clustered within specific NHS service regions, suggesting that location may influence autism diagnosis likelihood.
New research by the University of Cambridge with support from the London School of Economics and Political Science and Newcastle University addresses whether there may be an element of ‘postcode lottery’ when it comes to who receives an autism diagnosis.
An autism diagnosis can be a lengthy process. Firstly, the individual or their parents/guardian will speak with a healthcare professional, which may lead to an autism assessment by an autism expert. Following the assessment, a report will be given that will outline whether the professional delivers an autism diagnosis or not.
The research was published in The Lancet Child & Adolescent Health.
Analysing children with an autism diagnosis across England
The researchers used four years of data from the Summer School Census, which collected data from individuals aged between one and 18 year old in state-funded schools in England. There were 32 million pupils studied, and more than 102,000 children received a new autism diagnosis between 2014 and 2017.
When the team adjusted for age and sex, they found that one in 234 children was given a new autism diagnosis during that period. Moreover, new diagnoses tended to occur when children moved to a different or new school, whether that was into the nursery (one-three years), primary school (four-six years), or secondary school (10-12 years).
Do location, ethnicity, and social and financial situation impact diagnoses?
The researchers looked into four key areas: location, ethnicity, social and finance. This was to establish whether these areas impacted autism diagnosis likelihood.
Following the analysis process, they found that some areas in England stood out clearly for new autism diagnoses. For example, 45.5% of the NHS Rotherham catchment area had a higher-than-average new autism diagnoses cluster. At NHS Heywood, this amounted to 38.8% of its catchment area and 36.9% for NHS Liverpool, which indicates varying numbers of new autism diagnosis cases.
Furthermore, particular communities appeared to have different rates, which seemed to connect to ethnicity and deprivation.
Lead researcher Dr Andres Roman-Urrestarazu from the Department of Psychiatry and Cambridge Public Health at the University of Cambridge, said: “Autism diagnoses are more common among Black students and other minority ethnic groups. Why this is the case is not clear and so we need to explore the role played by social factors such as ethnicity and area deprivation as well as the nature of local services.”
The researchers found that autism diagnosis likelihood more than tripled in girls depending on their ethnicity, and social and financial situation compared to white girls without financial disadvantages who also speak English as their first language.
Contrastingly, the likelihood of boys receiving an autism diagnosis increased by more than five-fold depending on their ethnicity, social, and financial situation compared to white boys who speak English as their language and without financial issues.
Dr Robin van Kessel, the co-lead researcher from the Department of Health Policy at the London School of Economics and Political Science, said: “These new findings show how social determinants interact and can combine to significantly increase the likelihood of an autism diagnosis. As a result, individuals from a minority ethnic background experiencing economic hardship may be significantly more likely to receive an autism diagnosis than their peers.”
Professor Carol Brayne from Cambridge Public Health, said: “There are clear inequalities in an individual’s likelihood of receiving an autism diagnosis, whether they are socioeconomic factors, ethnicity or even which NHS region or local authority someone lives in.”
