Abstract
Background and Objective
Racial disparities in diagnosis and receipt of services for early childhood developmental
delay (DD) are well known but studies have had difficulties distinguishing contributing
patient, healthcare system, and physician factors from underlying prevalence. We examine
rates of physician diagnoses of DD by preschool and kindergarten entry controlling
for a child's objective development via scoring on validated developmental assessment
along with other child characteristics.
Methods
We used data from the preschool and kindergarten entry waves of the Early Childhood
Longitudinal Study, Birth Cohort. Dependent variables included being diagnosed with
DD by a medical provider and receipt of developmental services. Logistic regression
models tested whether a child's race was associated with both outcomes during preschool
and kindergarten while controlling for the developmental assessments, as well as other
contextual factors.
Results
Among 7950 children, 6.6% of preschoolers and 7.5% of kindergarteners were diagnosed
with DD. Of preschool children with DD, 66.5% were receiving developmental services,
while 69.1% of kindergarten children with DD were receiving services. Children who
were Black, Asian, spoke a primary language other than English and had no health insurance
were less likely to be diagnosed with DD despite accounting for cognitive ability.
Black and Latinx children were less likely to receive services.
Conclusions
Racial minority children are less likely to be diagnosed by their pediatric provider
with DD and less likely to receive services despite accounting for a child's objective
developmental assessment. The pediatric primary care system is an important target
for interventions to reduce these disparities.
Keywords
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Article Info
Publication History
Published online: May 18, 2021
Accepted:
May 10,
2021
Received:
January 19,
2021
Footnotes
Conflict of competing interest: The authors have no financial relationships relevant to this article to disclose. It should be noted Dr. Peter Szilagyi, Editor-in-Chief of Academic Pediatrics, is part of the authorship group.
Identification
Copyright
© 2021 Published by Elsevier Inc. on behalf of Academic Pediatric Association
