Understanding disparities in autism diagnosis and care: A socioecological perspective
- 1Department of Child and Adolescent Psychiatry, Children’s Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
- 2Covenant HealthCare College of Medicine at Central Michigan University, Saginaw, Michigan, United States of America
- 3Department of Psychiatry, Covenant HealthCare College of Medicine at Central Michigan University, Saginaw, Michigan, United States of America
Abstract
Disparities in autism spectrum disorder (ASD) identification and care are well documented across racial and ethnic, socioeconomic, and geographic lines, yet their underlying mechanisms are incompletely understood. This paper applies the Socioecological Model (SEM) as an organizing framework to examine how individual, interpersonal, community, organizational, and policy-level factors interact to produce inequitable trajectories in ASD diagnosis and service access. At the individual level, heterogeneity in symptom presentation, co-occurring psychiatric conditions, and diagnostic tools normed on Western, predominantly White samples contribute to variation in recognition. Girls from minoritized racial and ethnic backgrounds face compounded delays related to both sex-related camouflaging and cultural assessment bias. At the interpersonal level, provider-family communication, trust, and stigma shape whether developmental concerns are raised, referrals are completed, and services are engaged. Systematic reviews document that caregivers from minoritized groups report lower perceived quality of care and greater barriers to diagnostic follow-through. At the community level, neighborhood disadvantage, school resource variability, and culturally embedded interpretations of child development influence help-seeking and access to early intervention. At the organizational level, inconsistent screening adherence, limited diagnostic capacity, lengthy waitlists, and inequitable reimbursement structures create structural bottlenecks that disproportionately affect publicly insured and minoritized families. At the policy level, variation in state insurance mandates, Medicaid reimbursement rates, workforce distribution, and telehealth regulatory frameworks establish the conditions under which all lower-level factors operate. Recent surveillance data indicate that ASD prevalence among Hispanic, Black, and Asian or Pacific Islander children now exceeds that of White children in some cohorts, reflecting expanded screening and policy reform. However, convergence in prevalence does not constitute equity. Disparities in age at diagnosis, co-occurring intellectual disability, service intensity, and long-term outcomes persist. This paper also addresses training and workforce implications, arguing that sustainable equity requires structural competency education, workforce diversification, and community-partnered approaches integrated across career stages. The SEM framework highlights that disparities in ASD care are not attributable to individual clinical factors alone but emerge from the interaction of relational, institutional, and structural forces. Coordinated, multilevel strategies that extend beyond improved symptom recognition to systemic transformation are necessary to ensure timely, culturally responsive, and universally accessible care for all children.
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BibTeX
@article{bala2026understanding,
title = {{Understanding disparities in autism diagnosis and care: A socioecological perspective}},
author = {Abishek Bala and Christa Deban and Henry Hoskinson and Manal Mukhtar and Aditya Shah and Aymen Syeda and Aateqa Hashmi},
journal = {PLOS Mental Health},
year = {2026},
month = sep,
doi = {10.1371/journal.pmen.0000703},
url = {https://journals.plos.org/mentalhealth/article?id=10.1371/journal.pmen.0000703},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Understanding disparities in autism diagnosis and care: A socioecological perspective
AU - Abishek Bala
AU - Christa Deban
AU - Henry Hoskinson
AU - Manal Mukhtar
AU - Aditya Shah
AU - Aymen Syeda
AU - Aateqa Hashmi
PY - 2026
DA - 2026/09/10
JO - PLOS Mental Health
DO - 10.1371/journal.pmen.0000703
UR - https://journals.plos.org/mentalhealth/article?id=10.1371/journal.pmen.0000703
AB - Disparities in autism spectrum disorder (ASD) identification and care are well documented across racial and ethnic, socioeconomic, and geographic lines, yet their underlying mechanisms are incompletely understood. This paper applies the Socioecological Model (SEM) as an organizing framework to examine how individual, interpersonal, community, organizational, and policy-level factors interact to produce inequitable trajectories in ASD diagnosis and service access. At the individual level, heterogeneity in symptom presentation, co-occurring psychiatric conditions, and diagnostic tools normed on Western, predominantly White samples contribute to variation in recognition. Girls from minoritized racial and ethnic backgrounds face compounded delays related to both sex-related camouflaging and cultural assessment bias. At the interpersonal level, provider-family communication, trust, and stigma shape whether developmental concerns are raised, referrals are completed, and services are engaged. Systematic reviews document that caregivers from minoritized groups report lower perceived quality of care and greater barriers to diagnostic follow-through. At the community level, neighborhood disadvantage, school resource variability, and culturally embedded interpretations of child development influence help-seeking and access to early intervention. At the organizational level, inconsistent screening adherence, limited diagnostic capacity, lengthy waitlists, and inequitable reimbursement structures create structural bottlenecks that disproportionately affect publicly insured and minoritized families. At the policy level, variation in state insurance mandates, Medicaid reimbursement rates, workforce distribution, and telehealth regulatory frameworks establish the conditions under which all lower-level factors operate. Recent surveillance data indicate that ASD prevalence among Hispanic, Black, and Asian or Pacific Islander children now exceeds that of White children in some cohorts, reflecting expanded screening and policy reform. However, convergence in prevalence does not constitute equity. Disparities in age at diagnosis, co-occurring intellectual disability, service intensity, and long-term outcomes persist. This paper also addresses training and workforce implications, arguing that sustainable equity requires structural competency education, workforce diversification, and community-partnered approaches integrated across career stages. The SEM framework highlights that disparities in ASD care are not attributable to individual clinical factors alone but emerge from the interaction of relational, institutional, and structural forces. Coordinated, multilevel strategies that extend beyond improved symptom recognition to systemic transformation are necessary to ensure timely, culturally responsive, and universally accessible care for all children.
SN - 2837-8156
ER -