How Can Occupational Therapy Support Underserved Minority Groups Following the Changes to the Autism Diagnosis?

SIGNFICANCE: In this study, we attempt to answer the following research questions: How can occupational therapy support underserved minority groups following the changes to the autism diagnosis? If the disparity in diagnosis of autism among underserved minority children continues to expand, what is occupational therapy’s role?

In this study, we review the advocacy role of occupational therapists (OTs) in supporting underserved minority groups relating to the changes in diagnostic criteria for autism. On March 28, 2014, the Centers for Disease Control and Prevention issued a report on the prevalence of autism spectrum disorder (ASD) within the United States. The Autism and Developmental Disabilities Monitoring Network (ADDM) data pool was utilized to provide statistical data regarding the rates of ASD. The results of the longitudinal study revealed that 1 out of 68 children are identified as having a diagnosis of ASD. Furthermore, the study identified disparities in the rates of the autism diagnosis on the basis of race—specifically noting that Caucasian children are being diagnosed at a much higher rate than their African American and Hispanic counterparts. The revelation that such a disparity is not supported with etiological data is alarming. With the rates of autism growing each year, experts in the field recognize the need to revisit the diagnostic criteria. Hence, the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM–5) includes changes to the diagnosis criteria of ASD. Some theorists suggest that those children in need of a diagnosis will be deprived of receiving services on the basis of not meeting the criteria. If that theory holds true, one may inquire how the current disparity in diagnoses will be affected. Furthermore, are OTs up for the challenge of becoming advocates?

METHOD: An intensive search was undertaken to identify research for the review. Databases and sites searched included ERIC, Google Scholar, Medline, PubMed, CINAHL, OTSEEKER, and PsycINFO. A search strategy was developed that included inclusion and exclusion criteria, required population, and used key search terms. Articles written within the last 5 yr researching the diagnosis of ASDs were included. Keyword phrase searches included disparities in autism, DSM–5 changes, and studies identifying future projections in the diagnosis.

RESULTS: An initial search revealed a small amount of articles meeting the search criteria (N = 66). Of the articles meeting the criteria, there was a projected significant decrease in the rates of the autism diagnosis. Hence, the underserved minority groups are suspected to experience a significant decrease in rates of diagnosis.

CONCLUSION: The primary limitation of this systematic review is the lack of significant data. The changes to the DSM–5 are still novel. Therefore, the meta-analyses are projections and hypotheses. Despite this limitation, OTs must be aware of the current health disparities in the diagnosis of autism. The changes to the DSM–5 suggest a growing disparity in the diagnosis of autism in underserved minority groups. Many OTs find themselves being one of the initial points of contacts for families concerned with their child’s development. For minority families, or those with low socioeconomic factors, OTs’ role should be that of an advocate.