Disparities in autism spectrum disorder diagnoses among 8-year-old children in Colorado: Who are we missing?
Girls and argumentative kids in Colorado are being missed for autism because they lack classic red-flag symptoms.
01Research in Context
What this study did
Researchers pulled medical records for 8-year-olds in Colorado. They compared kids who already had an autism diagnosis with kids who met research criteria but were never labeled.
The team looked for sex, behavior, and symptom differences between the two groups.
What they found
Girls and kids called 'aggressive' or 'argumentative' were the ones most often missed. These children had fewer classic red flags like language loss or sleep trouble.
Their files also had poorer notes, making signs easier to overlook.
How this fits with other research
Moss et al. (2009) saw the same gap in Minnesota: only 47 % of research-identified autism cases had a clinical label. Both studies used record reviews and show under-counting is long-standing.
Han et al. (2023) found that children who lose skills grab attention because symptoms are severe. Hamama et al. (2021) now show kids without that dramatic loss slip through, so the two papers together explain both ends of the recognition spectrum.
Sivertsen et al. (2012) proved chronic sleep problems are a big autism signal. The Colorado team saw missed kids rarely had sleep notes, underlining why absence of this red flag can lull clinicians.
Why it matters
When you see a disruptive girl or a child with vague notes, pause. Ask yourself: could this be autism even without regression or sleep issues? Push for structured screens and add clear symptom descriptions to your own reports so the next provider does not miss it.
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02At a glance
03Original abstract
Although autism can be reliably diagnosed as early as 2 years of age, many children are not diagnosed with autism until much later. We analyzed data to determine why many of the 8-year-old children who resided in Colorado and were identified as having autism through a review of their health and/or educational records did not have a documented clinical diagnosis of autism and were not eligible for special education services under an autism eligibility. We found that children who did not have a documented clinical diagnosis of autism and were not eligible for special education services under an autism eligibility were more likely to be female, aggressive, and argumentative. They had a poorer quality of information in their records and were less likely to have had a developmental regression, sleep problems, or an autism screener or diagnostic measure in their records. These results suggest that the symptoms characteristic of autism among this group of children may have been attributed to another disorder and that clinicians may be able to recognize autism more readily in children with more functional impairment and those who experience a developmental regression. We also discovered that differences in symptom presentations among children who had a documented clinical diagnosis of autism and/or were eligible for special education services under an autism eligibility were associated with different ages at autism diagnosis.
Autism : the international journal of research and practice, 2021 · doi:10.1177/1362361320950058