New autism diagnoses tend to be clustered within specific NHS service regions, suggesting that where individual life may influence whether they receive an autism diagnosis and access to special education needs support.
The latest findings, from researchers from the University of Cambridge in collaboration with researchers from the London School of Economics and Political Science and Newcastle University, are published today in the Lancet Child & Adolescent Health.
After analysing all new autism cases across England using NHS health service boundaries for possible hotspots, some areas stand out. For example, 45.5% of the NHS Rotherham catchment area had higher-than-average new autism diagnoses clusters. For NHS Heywood, this amounted to 38.8% of its catchment area and 36.9% for NHS Liverpool, pointing at a possible health service effect towards who receives an autism diagnosis.
The research team used four years’ worth of data from the Summer School Census, which collected data from individuals aged 1-18 in state-funded schools in England. Of the 32 million pupils studied, more than 102,000 new autism diagnoses were identified between 2014 and 2017.
After adjusting for age and sex, the researchers found that one in 234 children was given a new autism diagnosis during those four years. New diagnoses tend to happen when children are transitioning to a new school, whether that is into the nursery (1-3 years), primary school (4-6), or secondary school (10-12 years).
Particular communities appeared to have different rates, varying by ethnicity and deprivation.
Lead researchers Dr Andres Roman-Urrestarazu from the Department of Psychiatry and Cambridge Public Health at the University of Cambridge said: “Autism diagnoses are more common among Black students and other minority ethnic groups. Why this is the case is not clear, and so we need to explore the role played by social factors such as ethnicity and area deprivation as well as the nature of local services.”
The likelihood of receiving an autism diagnosis more than tripled among girls depending on their ethnicity and social and financial situation compared to white girls without financial disadvantages who speak English as their first language.
In contrast, boys’ likelihood of receiving an autism diagnosis increased more than five-fold depending on their ethnicity and social and financial situation compared to white boys without financial disadvantages who speak English as their first language.
Boys and young men are already more likely to receive autism diagnoses, but the social determinants that could affect a diagnosis remain an open question.
Dr Robin van Kessel, co-lead researcher from the Department of Health Policy at the London School of Economics and Political Science said: “These new findings show how social determinants interact and can combine to increase the likelihood of an autism diagnosis significantly. As a result, individuals from a minority ethnic background experiencing economic hardship may be significantly more likely to receive an autism diagnosis than their peers.”
Professor Carol Brayne from Cambridge Public Health said: “There are clear inequalities in an individual’s likelihood of receiving an autism diagnosis, whether they are socioeconomic factors, ethnicity or even which NHS region or local authority someone lives in.”