Although heterogeneity inherent in Autism Spectrum Disorders (ASDs) has long been recognized, little is known about ways in which race, gender, socio-economic status, family culture and communication during clinical encounters affect the acquisition of diagnosis and related services. Considered a barrier to more rapid advancements in autism research, heterogeneity within ASDs has never been examined as a socio- cultural phenomenon where interpretation of atypical behavior is itself examined against socio-cultural expectations of normative development under default socio-economic circumstances. We propose to examine heterogeneity in ASDs as a socio-culturally based phenomenon in relation to three domains: 1) patterns of communication among African American caregivers and practitioners during clinical encounters that are vital for developing partnerships and that are vulnerable to misunderstanding;2) structural barriers to and opportunities for African American children receiving timely and accurate diagnosis and appropriate services;and 3) African American caregivers'knowledge about ASDs and the social networks relevant to information about diagnostic evaluations, interventions and services. We know from population-level demographic studies that there is an unprecedented scale of health and service disparities in autism diagnosis for African American children. The picture that emerges from these studies is of systematic delays in diagnosis and challenges to secure appropriate services once the diagnosis is received (Mandell, 2005, Mandell et al. 2007, Stahmer &Mandell 2007). In a significant number of children, ASDs are identified late in childhood or missed altogether (California Legislative Blue Ribbon Commission on Autism, 2005, 2007). This troubling picture repeats the pattern of healthcare and service disparities for African Americans across illness categories. Following recommendations of the Institute of Medicine to address health disparities at two levels, interactional and structural, (IOM, 1999), this two-year urban, multi-method ethnographic study examines disparities in diagnostic processes and service delivery related to acquisition of ASDs diagnosis, and communication during clinical encounters for a cohort of African American children living in the Los Angeles metropolitan area. We propose a novel combination of methods, urban ethnography (Lawlor, 2004;Mattingly &Lawlor, 2003) and social networks analysis (Valente, 1995, 2002;Valente, Paredes &Poppe, 1998) to follow a cohort of African American children diagnosed with ASDs, their primary caregivers and the practitioners who serve them, to document the children's'pathways to an ASDs diagnosis and services. The importance of early identification and intervention (Dawson &Osterling, 1997) and delayed diagnosis among economically disadvantaged populations (Mandell et al., 2007) make this study a critical step towards decreasing health and service disparities for African American children with autism in urban context and facilitating practitioner-family partnership in clinical encounters.
The project examines disparities in ASDs diagnosis and services for African American children in urban setting. Results of the project will help caregivers and practitioners to better communicate and partner during clinical encounters. The project will facilitate earlier diagnosis and services for African American children with ASDs which will help improve their developmental outcomes.
|Solomon, Olga; Lawlor, Mary C (2018) Beyond V40.31: Narrative Phenomenology of Wandering in Autism and Dementia. Cult Med Psychiatry 42:206-243|
|Angell, Amber M; Solomon, Olga (2018) Understanding parents' concerns about their children with autism taking public school transportation in Los Angeles County. Autism 22:401-413|
|Angell, Amber M; Frank, Gelya; Solomon, Olga (2016) Latino Families' Experiences With Autism Services: Disparities, Capabilities, and Occupational Justice. OTJR (Thorofare N J) 36:195-203|
|Solomon, Olga; Heritage, John; Yin, Larry et al. (2016) ‘What Brings Him Here Today?’: Medical Problem Presentation Involving Children with Autism Spectrum Disorders and Typically Developing Children. J Autism Dev Disord 46:378-93|
|Solomon, Olga; Angell, Amber M; Yin, Larry et al. (2015) ""You Can Turn off the Light If You'd Like"": Pediatric Health Care Visits for Children with Autism Spectrum Disorder as an Interactional Achievement. Med Anthropol Q 29:531-55|
|Solomon, Olga (2015) ""But-He'll Fall!"": Children with Autism, Interspecies Intersubjectivity, and the Problem of 'Being Social'. Cult Med Psychiatry 39:323-44|
|Angell, Amber M; Solomon, Olga (2014) The social life of health records: understanding families' experiences of autism. Soc Sci Med 117:50-7|
|Solomon, Olga; Lawlor, Mary C (2013) ""And I look down and he is gone"": narrating autism, elopement and wandering in Los Angeles. Soc Sci Med 94:106-14|