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US Study Finds Disparities in Timing of Neurodevelopmental Disorder Diagnosis
Despite a higher incidence of neurodevelopmental disorder diagnoses, children with public insurance tended to receive a first diagnosis later than children with private insurance, according to findings published in JAMA Psychiatry.
“Because neurodevelopmental disorders are common and risks may be ameliorated with early intervention, identifying modifiable risk factors and opportunities for early intervention is needed,” wrote study lead author Loreen Straub, MD, MS, of Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, and coauthors.
Researchers investigated the incidence and timing of neurodevelopmental disorder diagnosis in US children and differences by population characteristics. The population-based cohort study included more than 2 million children with public insurance and 1.3 million children with private insurance.
By age 8, 23.9% of publicly insured children and 11.0% of privately insured children had been diagnosed with one or more of the following neurodevelopmental disorders: autism spectrum disorder, attention-deficit/hyperactivity disorder (ADHD), learning disability, speech or language disorder, developmental coordination disorder, intellectual disability, and behavioral disorder, according to the study. The risk of neurodevelopmental disorder diagnosis was substantially higher among boys and White children.
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“The substantially higher incidence and the tendency to earlier diagnosis in boys vs girls is not necessarily associated with higher susceptibility of boys to these disorders but might be partially due to symptoms presenting differently in boys and girls, which may be associated with both parental health care–seeking behaviors and clinician diagnostic behaviors,” researchers wrote. “For instance, girls tend to have more subtle symptoms of ADHD that are harder to identify. Consequently, these girls might be underdiagnosed and treated insufficiently, which could further cause additional issues in the future (eg, development of mental health disorders).”
Diagnoses tended to be established somewhat earlier for privately insured children, with the exception of ADHD, which was diagnosed an average half a year earlier in publicly insured children. Speech and language disorders, on the other hand, were diagnosed an average 1.5 years later in publicly insurance children.
The study also found that co-occurring neurodevelopmental disorders were common. More than 70% of children with autism spectrum disorder or intellectual disability had additional neurodevelopmental disorders, researchers found.
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