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Opinion: Use relief funds for autism, other developmental care disparities

COVID-19 has upended many aspects of our lives — not least among them is the inability to access timely and adequate healthcare. While this has led to frustration and even tragedy for many Michigan residents, the sad reality is that poor healthcare is the norm for low-income, minority individuals — particularly those with autism spectrum disorders (ASD) and other developmental disabilities (DD).

As a pediatrician whose practice includes children with autism and other developmental disabilities, I know this reality firsthand: The number of autistic families we diagnosed as “in-crisis” surged during the pandemic. Now help may be on the way in the form of a massive COVID-19 relief package approved by Congress in time for Autism Awareness Month.

Part of the relief funding distributed to state and local governments should be used to address the vast disparities in access to quality care and services for individuals with autism and other developmental disabilities, particularly those in our most at-risk communities.

The Centers for Disease Control and Prevention report that roughly 1 in 6 American children ages 3-17 have one or more developmental disabilities. It is also widely understood that early recognition and referral to services leads to improved child outcomes, increased school readiness, decreased family stress and lower societal cost.

Despite the fact that autism knows no demographic, racial or ethnic boundaries, we do know that an ASD diagnosis for African American children occurs more than a year later than in Caucasian children. In underserved communities this disparity is even more pronounced; for example, while the national average age of ASD diagnosis is 4.3 years, a study done by Wayne State University found children in Detroit were more likely to receive an initial diagnosis on average at 6.6 years. Furthermore, African American children with ASD are more likely to be misdiagnosed with conditions such as adjustment disorder or conduct disorder.

Beyond delays in accessing care and receiving a diagnosis, we must consider the limited availability of therapeutic services, and the practicality of accessing them. In Detroit, children with ASD wait an average of nine months between diagnosis and initiation of services.

Given a delayed diagnosis from the start, it’s clear that this population is not accessing autism-specific services until after age 7 — a significant gap from the optimal time of intervention for most developmental and behavioral problems, which is commonly thought to be before age 5. Taken together, these factors significantly contribute to increased academic disparities, prolonged behavioral challenges, increased family stress, and a greater divide in the achievement gap.

While it remains true that the structural inequalities in our society that effect the most marginalized and underserved populations are innumerable and will require decades-long solutions, there are things that we can do now to change the future. I suggest starting here:

► Increased funding for early intervention, early childcare providers, and public education with a focus on special education.

► Improved access to pediatric healthcare providers who can assess and identify children for DD and ASD in a timely matter. This means improved public transportation, increased reimbursement for Medicaid claims, and student loan repayment for primary care physicians who go on to work in low-income, underserved areas.

► Improved education and reimbursement for early childcare providers to support their professional development and incentivize these careers to increase the workforce

► Address care and academic integration at the point of the child. Our systems of care work in silos, limiting the benefit children could receive from a fully integrated model of clinical, behavioral health, and educational programming

During his campaign, President Joe Biden promised to “build back better.” So far, he hassigned the $1.9 trillion relief package with further investments coming to address infrastructure, climate change, education, health care and more. What happens with the money distributed to state and local governments is the next question.

Every day that passes makes it increasingly clear that life won’t ever truly look the same as it did before the pandemic, but our leaders now have a chance to make it better than before.

Dr. Nicole Hamp is a Developmental Behavioral Pediatric fellow at University of Michigan Medicine/Mott Children’s Hospital and a board member of the Autism Alliance of Michigan.”