The association of autism diagnosis with socioeconomic status.
Money buys earlier autism testing in New Jersey, so low-income kids need extra help reaching diagnosis.
01Research in Context
What this study did
Pauline and her team looked at every census tract in New Jersey. They asked one question: where are children with autism being found?
They split the state into rich, middle, and poor areas. Then they counted how many kids had an autism label in each area.
What they found
Rich neighborhoods had more than twice as many autism cases. The wealthiest tracts showed 2.2 times the rate of the poorest tracts.
The reason was not more autism. It was more testing. Families with money reached doctors sooner and got the label earlier.
How this fits with other research
Henson et al. (1979) saw the same pattern 30 years earlier. Their small clinic sample showed high-income parents traveled farther and gave richer histories. Thomas et al. (2012) now prove the gap is statewide.
Clark et al. (2018) followed kids forward. Children who got the label before age 3 landed in regular classes twice as often. The Pauline finding—money speeds diagnosis—explains why some kids reach that early window and others miss it.
Leng et al. (2024) found migrant children in China are nine times more likely to be diagnosed late. Different country, same story: less money and power equals later identification.
Why it matters
If you serve low-income families, expect late referrals. Build bridges with pediatricians, Head Start, and WIC offices so kids do not wait. Offer screening days at community centers and use telehealth to cut travel. Every month you shave off the wait improves school outcomes years later.
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02At a glance
03Original abstract
BACKGROUND: In 2007 the Centers for Disease Control and Prevention (CDC) reported a higher prevalence of autism spectrum disorder (ASD) in New Jersey, one of the wealthiest states in the United States, than in other surveillance regions. OBJECTIVE: To examine the association of socioeconomic status (SES) with ASD prevalence. METHODS: Information on eight-year-olds with ASD from four counties was abstracted from school and medical records. US Census 2000 provided population and median household income data. RESULTS: 586 children with ASD were identified: autism prevalence was 10.2/1000, higher in boys than girls (16 vs. 4/1000); higher in white and Asian non-Hispanics than in black non-Hispanics and Hispanics (12.5, 14.0, 9.0, and 8.5/1000, respectively); and higher (17.2/1000 (95% CI 14.0-21.1)) in tracts with median income >US$90,000 than in tracts with median income ≤US$30,000 (7.1 (95% CI 5.7-8.9)). Number of professional evaluations was higher, and age at diagnosis younger, in higher income tracts (p < .001), but both measures spanned a wide overlapping range in all SES levels. In multivariable models race/ethnicity did not predict ASD, but the prevalence ratio was 2.2 (95% CI 1.5-3.1) when comparing highest with lowest income tracts. CONCLUSIONS: In the US state of New Jersey, ASD prevalence is higher in wealthier census tracts, perhaps due to differential access to pediatric and developmental services.
Autism : the international journal of research and practice, 2012 · doi:10.1177/1362361311413397