Time-Lag Between Diagnosis of Autism Spectrum Disorder and Onset of Publicly-Funded Early Intensive Behavioral Intervention: Do Race-Ethnicity and Neighborhood Matter?
Kids wait almost three years after autism diagnosis to begin state-paid EIBI, and race or neighborhood don’t explain the gap.
01Research in Context
What this study did
Stewart et al. (2018) tracked how long kids with autism wait to start Medicaid-funded Early Intensive Behavioral Intervention (EIBI).
They looked at race, ethnicity, and neighborhood income to see if any of those factors made the wait longer.
What they found
The average delay from autism diagnosis to first EIBI session was almost three years.
Surprisingly, race, ethnicity, and neighborhood wealth did not change the wait time.
How this fits with other research
Dimian et al. (2021) used the same Medicaid cohort and showed that every extra month of wait hurts later school scores. The 2018 paper found the delay; the 2021 paper proved the delay matters.
Barton et al. (2019) followed the same kids after they finally started EIBI. Even with funding, children used only 24–48 % of authorized hours. Long wait plus low use equals double trouble.
Spriggs et al. (2016) had earlier shown that Black children wait longer for the autism diagnosis itself. Yet once diagnosis is on paper, the 2018 study found race no longer predicts the EIBI wait—an apparent contradiction that points to bottlenecks inside the service system, not biased referral.
Why it matters
You now know the biggest slowdown happens after diagnosis, not before. Race and zip code are not the culprits at this stage, so screening for bias should shift to Medicaid paperwork, waiver slots, and provider shortages. Push your state for faster authorization and track each child’s wait time like a vital sign.
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02At a glance
03Original abstract
Health coverage of early intensive behavioral intervention (EIBI) for children with autism spectrum disorder (ASD) is rapidly expanding across the United States. Yet we know little about the time-lag between diagnosis and treatment onset. We integrated administrative, Medicaid claims, and Census data for children in an EIBI Medicaid waiver (n = 473) to examine the relationship between time-lag and (a) child race-ethnicity and (b) neighborhood racial composition, poverty, affluence, and urbanicity. We explored whether the relationship between child race-ethnicity and time-lag varies by neighborhood characteristics. Average time-lag between diagnosis and treatment onset was nearly 3 years. Child race-ethnicity and neighborhood characteristics did not predict time-lag. Reducing time-lag is critical to ensuring that children with ASD receive treatment as early as possible.
Journal of autism and developmental disorders, 2018 · doi:10.1007/s10803-017-3354-3