Socioeconomic Status & Autism Spectrum Disorder

Introduction

Previous studies have looked at the connection between Socioeconomic Status (SES) and other health conditions. This blog serves as an overview of the current research on SES and ASD. The blog will begin with an overview of SES and what researchers may be looking for when exploring the possible correlation between SES and Autism Spectrum Disorder (ASD). Then it will summarize two studies that have examined SES and ASD, and how their conclusions differ from one another. Finally, it will discuss the accessibility of autism services and how improving access and education about autism is crucial for reducing socioeconomic disparities in obtaining services related to ASD.

The majority of the research cited comes from over a decade ago, underscoring the pressing need for new investigations into socioeconomic disparities and strategies to broaden access to essential services.

What does Socioeconomic Status (SES) Include?

According to the American Psychological Association (2024), “socioeconomic status (SES) encompasses not only income but also educational attainment, occupational prestige, and subjective perceptions of social status and social class. SES reflects quality-of-life attributes and opportunities afforded to people within society and is a consistent predictor of a vast array of psychological outcomes.” Frequently, the relationship between income and health is regularly talked about and researched. 

For example, households with incomes below the federal poverty line experience higher rates of illness and premature death. However, it’s not just the low income itself, but also the lack of resources that leads to social disadvantages like housing insecurity, living in unsafe neighborhoods, poor education opportunities, and unfavorable working conditions. These factors can both directly and indirectly impact physical, mental, and developmental health negatively. 

What’s the Connection Between Autism Prevalence and SES?

Study #1

Maureen Durkin and colleagues (2010) led a multi-institution study that looked at the prevalence of Autism Spectrum Disorder (ASD) and found that children from low income households are less likely to be diagnosed with ASD compared to kids from more affluent neighborhoods. Though this study was conducted over a decade ago, Durkin and her team (2010) were able to analyze education and health care data from 1.3 million eight-year-old children reported by the Center for Disease Control (CDC). When comparing SES categories by area-level education, income, and poverty indicators to ASD diagnosis amongst the children, they found that the prevalence of ASD increased with increasing SES among White, Black, and Hispanic children.

This may be in part due to the lack of accessibility to healthcare – such as being able to partake in early screening and having more education on how to identify developmental differences. However, it should also be noted that other studies have found conflicting findings. For instance, epidemiological studies in Sweden and Denmark, where there is universal access and no economic barriers to obtaining autism diagnoses and services, found that ASD was not associated with SES advantage, and rather may be associated with SES disadvantage (Durkin et al., 2010; Steffenburg & Gillberg, 1986; Gillberg & Steffenburg, 1982).

 

Study #2

There has been an increase of research exploring the impact of SES on health status, specifically to reduce health inequalities. However, SES has been particularly conflicting to understand when looking at it from the ASD prevalence perspective. Studies in European countries have shown that Autism Spectrum Disorder (ASD) prevalence may be higher for those in more disadvantaged backgrounds with particular focus on occupational class, maternal education, and/or household income (Durkin et al., 2010).

Delobel-Ayoub et al. (2015) conducted a study of children aged 8 from the childhood disability registry in South-Western France. Researchers found a significantly higher prevalence of Autism Spectrum Disorder (ASD) diagnosis in areas with:

1. High levels of deprivation
2. High percentage of unemployed adults
3. High percentage of individuals without a diploma
4. High percentage of immigrants
5. High percentage of single-parent families

Once more, this research highlights the intricate relationship and potential interconnectedness between autism spectrum disorder (ASD) and socioeconomic status (SES), but continues to pose questions about how we can best combat the health disparities we are noticing as a result of educational level of parents, occupation, household income, etc. This study also exemplifies the complex mechanisms that don’t just include SES such as underlying environmental factors.

Considering these factors, the most pertinent inquiry should revolve around how we can enhance the accessibility and cultural responsiveness of services and support systems for autistic individuals. 

How can we Increase Accessibility?

One way to educate the public about ASD would be raising awareness about the early indicators of ASD in children and how it manifests in adults, whether through conducting community workshops or creating accommodating spaces to address the needs of individuals and families affected.  Equally crucial is for communities to foster environments where parents and caregivers can offer mutual support and cultivate meaningful connections within their community (Bearss et al., 2022). Communities and/or organizations could offer affordable and accessible assessment centers for individuals and families to receive evaluations, without the costs and barriers associated with the traditional healthcare systems. Additionally, efforts could be made to ensure healthcare facilities, educational settings, and public spaces are sensory-friendly environments (Bearss et al., 2022).

Conclusion

While these goals may seem ambitious, it is crucial to pursue them so that individuals can obtain an accurate diagnosis and gain access to the necessary services and resources to support their needs. Continuing to research and understand how we can provide outreach for those from diverse backgrounds will aid in promoting just access to healthcare.

 

References

American Psychological Association. (2024). Socioeconomic status. Psychology topics. https://www.apa.org/topics/socioeconomic-status

Bearss, K., Kim, S. J., & Locke, J. (2022). Accessible, Equitable, and Personalized Care for Autistic Individuals. Journal of clinical medicine, 11(17), 5217. https://doi.org/10.3390/jcm11175217

Delobel-Ayoub, M., Ehlinger, V., Klapouszczak, D., Maffre, T., Raynaud, J. P., Delpierre, C., & Arnaud, C. (2015). Socioeconomic Disparities and Prevalence of Autism Spectrum Disorders and Intellectual Disability. PloS one, 10(11), e0141964. https://doi.org/10.1371/journal.pone.0141964

Durkin, M. S., Maenner, M. J., Meaney, F. J., Levy, S. E., DiGuiseppi, C., Nicholas, J. S., Kirby, R. S., Pinto-Martin, J. A., & Schieve, L. A. (2010). Socioeconomic inequality in the prevalence of autism spectrum disorder: evidence from a U.S. cross-sectional study. PloS one, 5(7), e11551. https://doi.org/10.1371/journal.pone.0011551

Gillberg, C., & Schaumann, H. (1982). Social class and infantile autism. Journal of autism and developmental disorders, 12(3), 223–228. https://doi.org/10.1007/BF01531368

Steffenburg, S., & Gillberg, C. (1986). Autism and autistic-like conditions in Swedish rural and urban areas: a population study. The British journal of psychiatry: the journal of mental science, 149, 81–87. https://doi.org/10.1192/bjp.149.1.81

U.S. Centers for Disease Control and Prevention. (2024). Socioeconomic factors. Health equity. https://www.cdc.gov/dhdsp/health_equity/socioeconomic.htm