Abstract

Objective

Early childhood evaluation can identify deficits related to disruptions in early brain development and facilitate interventions. Access to care may differ by race/ethnicity or socioeconomic status. We explored neuropsychological evaluation access patterns and examined potential sociodemographic disparities in evaluation timing. Method: Participants were 213 children (age: M = 46.4 months, SD = 15.3 months) with a history of disrupted neural development due to perinatal complications (PC; n = 109) or autism spectrum disorder (ASD; n = 104). We used chi square tests of independence and one-way ANOVAs to compare groups on sociodemographics, referral sources, and cognition. Clinical sample means for cognitive and adaptive variables were compared to normative means to determine the presence of developmental delays. Differences in age at evaluation by race/ethnicity, caregiver education, and referral source, accounting for cognition, were explored with ANCOVAs. Results: The ASD group included significantly more White children and the PC group relatively more Black/African Americans. Children with ASD were referred by primary care physicians and caregivers/school staff; those with PC were referred by other medical providers. All participants performed more poorly than expected across all intellectual and adaptive domains, with greater delays in the ASD group. Children of caregivers with lower education were evaluated earlier in the PC group. For ASD, participants referred by primary care physicians were evaluated earlier. Conclusions: Children with PC and ASD exhibit cognitive delays and require neuropsychological evaluation. Disparities in access to care exist, particularly for minority children with ASD. Ways to promote equal access are discussed.

中文翻译：

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围产期并发症或自闭症谱系障碍儿童神经心理学评估的差异化：社会人口因素的影响

摘要

客观的

早期儿童评估可以识别与早期大脑发育中断相关的缺陷并促进干预。获得护理的机会可能因种族/民族或社会经济地位而异。我们探索了神经心理学评估访问模式，并检查了评估时间的潜在社会人口差异。方法：参与者是 213 名儿童（年龄：M  = 46.4 个月，SD  = 15.3 个月），有因围产期并发症（PC；n  = 109）或自闭症谱系障碍（ASD；n = 104）。我们使用独立性的卡方检验和单向方差分析来比较各组的社会人口统计学、推荐来源和认知。将认知和适应性变量的临床样本平均值与规范平均值进行比较，以确定发育迟缓的存在。使用 ANCOVA 探索了按种族/民族、照料者教育和转诊来源进行评估时的年龄差异，并考虑了认知。结果：ASD 组包括明显更多的白人儿童，而 PC 组包括相对更多的黑人/非洲裔美国人。患有 ASD 的儿童由初级保健医生和护理人员/学校工作人员转诊；那些有 PC 的人被其他医疗服务提供者转诊。所有参与者在所有智力和适应性领域的表现都比预期的要差，ASD 组的延迟更大。PC 组较早地对受教育程度较低的看护人的孩子进行了评估。对于 ASD，初级保健医生转诊的参与者更早进行了评估。结论：患有 PC 和 ASD 的儿童表现出认知延迟，需要神经心理学评估。在获得护理方面存在差异，特别是对于患有 ASD 的少数民族儿童。讨论了促进平等获取的方法。