Associations Between Sociodemographic Predictors and Age of Referral for Autism Spectrum Disorder (ASD) Diagnosis Since the Beginning of the COVID-19 pandemic.

Researchers studied when children got referred for autism diagnosis during COVID-19. They found children were referred at an average age of 37 months (over 3 years), which is later than recommended. During the worst part of the pandemic, referrals happened even later. Surprisingly, race didn't affect referral timing, but community education levels and income did. This suggests the pandemic delayed autism diagnoses and that where families live affects when children get help.

This cross-sectional study examined factors associated with age of autism referral during COVID-19 (March 2020-May 2023) using electronic health records from 507 children. Mean referral age was 37.3 months, with 83.2% receiving Medicaid, 42.6% Latino/Hispanic, and 29.8% Black non-Hispanic. Children were referred later during the acute pandemic phase versus endemic phase (40.4 vs 35.4 months). Contrary to expectations, race and ethnicity were not significantly associated with referral age.

However, lower population educational attainment was associated with earlier referrals, while higher median income was linked to later referrals during the endemic phase. Findings suggest pandemic timing affected referral patterns, with complex socioeconomic influences on autism diagnostic access.

Findings highlight need for systematic approaches to ensure timely autism referrals, particularly in underserved populations. Healthcare systems should implement early screening protocols and address pandemic-related delays. Community-level factors warrant consideration in referral practices.

Cross-sectional design limits causal inference. Single healthcare system may not be generalizable. Study period encompasses varying pandemic phases. Limited discussion of potential confounding variables or methodological details in abstract.

Sociodemographic characteristics, such as race and ethnicity, are associated with delays in ASD diagnosis. However, limited literature has examined the characteristics associated with delayed diagnosis since the start of the COVID-19 pandemic. This study aimed to identify the individual and aggregate sociodemographic characteristics associated with the age at which a child receives a referral for a diagnosis (from March 2020 to May 2023) and evaluate the impacts of the pandemic on this association. Using cross-sectional data obtained from patients' electronic health records and the U.S.

Census Bureau, we examined associations using linear regressions (N = 507). A subgroup analysis was conducted comparing two pandemic-related time frame phases: acute (March 2020-December 2021) and endemic (January 2022-May 2023). The mean age of referral was 37.3 months; 83.2% were Medicaid recipients, 42.6% were Latino/Hispanic, and 29.8% were Black non-Hispanic. Children were referred for an evaluation at an older age during the acute phase compared to the endemic phase (40.4 vs. 35.4 months).

There were no significant associations between race and ethnicity and age of referral. Population educational attainment was negatively associated with the age of referral (p < 0.05). The subgroup analysis showed a positive association between median population income and age of referral during the endemic phase (p < 0.05). Referrals to receive a diagnosis occur later than the screening recommendations.

Future work should focus on developing health system-wide practices, particularly among health systems serving large proportions of underserved populations, targeting early referrals for an evaluation to receive an ASD diagnosis.