Association of Race/Ethnicity and Social Disadvantage with Autism Prevalence

• Report: Association of Race/Ethnicity and Social Disadvantage with Autism Prevalence

• Report authors: Andres Roman-Urrestarazu, Robin van Kessel, Carrie Allison, Fiona Matthews, Carol Brayne, Simon Baron-Cohen

• Published by: JAMA Pediatrics, March 2021

SUMMARY

The researchers analysed data from 7,047,238 pupils aged five to 19 in state-funded schools using the Spring School Census 2017 from the National Pupil Database in England. A total of 119,821 pupils recorded as having autism were identified, of whom 21,660 also had learning difficulties. About 58 per cent of pupils with autism had an education, health and care plan (EHCP).

The research found 1.76 per cent of schoolchildren in England had autism. Previous research by the same group, using a school-based survey, suggested 1.57 per cent of children were autistic. The researchers say the increase is likely to be because autism has become better recognised by parents and schools.

Boys were almost four and a half times more likely to have autism than girls, with 2.81 per cent of boys recorded as having autism compared with 0.65 per cent of girls. The research also uncovered significant differences across ethnic groups and local authority areas. For example, 2.11 per cent of black pupils were diagnosed with autism compared with 0.85 per cent of those from a Roma/Irish Traveller background. When various factors such as sex and disadvantage were taken into account, the researchers worked out black pupils were 26 per cent more likely to be autistic than white pupils while Chinese pupils were 38 per cent more likely to be autistic than white pupils. Meanwhile, pupils from a Roma/Irish Traveller or Asian background were less likely to have autism compared with white pupils.

There were also marked differences in prevalence across the country. Solihull had the highest prevalence of autism at 3.38 per cent while the Cotswolds the lowest at 0.63 per cent. The report authors suggest this could be down to inconsistencies in diagnosis and eligibility for accessing support across different areas or it could be the prevalence of autism actually does vary across the country.

The ratio of female to male children with autism also varied. In Craven, North Yorkshire, 2.44 boys had autism for every girl while in Burnley, Lancashire, it was 12.87 boys to every one girl. The likelihood of having an EHCP also varied from place to place. Children in Barrow-in-Furness were most likely to have an EHCP while children in Newham were least likely.

Pupils with autism were more likely to come from a disadvantaged background with 35.23 per cent eligible for free school meals at some point compared with 25.8 per cent of all English school pupils. Pupils with a diagnosis of autism were 60 per cent more likely to also be socially disadvantaged and 36 per cent less likely to speak English than those without autism. The researchers say children from socially disadvantaged families may have higher odds of developing autism or it may be that having a child with autism increases the risk of a family experiencing poverty. The researchers suggest part of the reason why more black and mixed-race pupils are autistic is linked to increased social disadvantage among these groups.

IMPLICATIONS FOR PRACTICE

Accurate estimates of the prevalence of autism are vital when it comes to planning diagnostic, education, health and social care services and identifying possible barriers to diagnosis and support such as socioeconomic disadvantage, ethnicity, or sex. With the Covid-19 pandemic set to widen inequalities, practitioners and policymakers need to bear in mind the relationship between deprivation and autism.

FURTHER READING

• Autism in Black, Asian and Minority Ethnic Communities: A Report on The First Autism Voice UK Symposium, Mariama Seray Kandeh and others, Advances in Autism, February 2020

• The Association Between Socioeconomic Status and Autism Diagnosis in the United Kingdom for Children Aged 5–8 Years Of Age: Findings from the Born In Bradford Cohort, Brian Kelly and others, Autism, November 2017

• Prevalence of Autism-Spectrum Conditions: UK School-Based Population Study, Simon Baron-Cohen and others, British Journal of Psychiatry, August 2009