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Autism: another example of how being poor is bad for you

Posted by Dr. Claire McCarthy  April 4, 2012 02:38 PM

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A study just came out with some very interesting information about how children with autism do or don't get better over time. Guess which ones did better?

The ones whose mothers were white and educated.

It's true. Researchers looked at the records of more than 6,000 children ages 2 to 14 with autism followed by the Department of Developmental Services in California. They found that for the most part, even though they made progress, children who were low-functioning when they were diagnosed stayed low-functioning. Children who were high-functioning at diagnosis made more progress.

And then there was a really interesting group, about 10 percent of the children, who they called "Bloomers". Bloomers started out low-functioning, and then made rapid progress and ended up as high-functioning.

The researchers also had birth data about the children, which gave them information about the mothers: their age, place of birth, race, education level, and whether or not they were on Medi-Cal, the public insurance for low-income people. This is where it got really interesting. The researchers found that:

  • Low-functioning children were more likely to have mothers who were minority/foreign born, less educated, and on Medi-Cal
  • High-functioning children were more likely to have mothers who were white, more educated, and not on Medi-Cal
  • Bloomers were more likely to have mothers who were white and educated
What the researchers didn't have was detailed information about what kind of treatments and services the children got, so we are left to guess about the reasons for these findings -- but it's not so hard to guess. Parents with more money and more education are more likely to be able afford more and better services. They can live in school districts that provide more. They are better able to fight for the needs of their children.

But it's more than that, because having a mother who was poor didn't just make it less likely that a child would "bloom" -- it made it more likely that they would be low-functioning, not high-functioning, at the start. Either being born to a poor, less-educated minority mother gets you off to a bad start -- or the high-functioning poor kids get passed by and never get diagnosed, let alone get services, because neither their parents or their schools have the resources to help them. It's probably both.

Being poor is bad for you. It's that simple. And it's not fair. Especially when you are a kid.

This is particularly bad news given that just last week the Centers for Disease Control reported that the rate of autism has risen to one in 88 (one in 54 in boys!). The largest increases were in Hispanic (110 percent) and black (91 percent) -- kids who, according to the study, are less likely to make real gains.

But here's the thing: it's not just autism. Being poor really is plain old bad for you, especially when you have a chronic disease like autism or asthma or obesity. I see it in my practice: despite my best efforts, children with chronic disease who are poor, whose parents are minority and less educated, do less well. There's so much about being poor that affects health -- your home environment (which can have unhealthy exposures), your ability to afford medications and get to appointments, your ability to be home with your children (instead of working two jobs to make ends meet) or enroll them in extra activities that could help them.

As I listen to news stories about the Supreme Court arguments over health insurance, I can't help feeling like we are colossally missing the point. Instead of getting upset over individual mandates, we should be getting upset -- really upset -- over the fact that so many people are doomed to poor health because of their income, their education, or the color of their skin.

Hope -- or the lack of it -- shouldn't be an accident of birth.

This blog is not written or edited by Boston.com or the Boston Globe.
The author is solely responsible for the content.

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About MD Mama

Claire McCarthy, M.D., is a pediatrician and Medical Communications Editor at Boston Children's Hospital . An assistant professor of pediatrics at Harvard Medical School and a senior editor for Harvard More »

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