Impact of Gender, Racial Background, and Age at Diagnosis on Comorbidities In School-Aged Autistic Children.

Background: Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder that presents significant challenges in children’s functioning over their life course. Having co-occurring conditions or comorbidities is more common in ASD children than in general population (Al-Beltagi, 2021), and adds complexity to treatment, parental-care, and education. In U.S., 1:31 children are diagnosed with ASD, and 3:1 are boys (Shaw et al., 2025). Although more ASD children are diagnosed at early age, some are still diagnosed after age-5, and more of these children are of non-white racial-ethnic-background (Maenner et al., 2023). Presently, not enough is yet known about comorbidity-related needs of ASD children in middle (6-11yrs) and later childhood (12-17yrs) age-periods, both of which are important to their school functioning and social interaction with others, and thus also critical to their future life-related outcomes. Study investigates 2 research questions: (1) prevalence of 11 common comorbidities, (2) whether factors of children’s gender, racial-background, and age-at-diagnosis, significantly influence the presence of each comorbidity (Intellectual Disability, Epilepsy, Learning Disability, Speech and Language, ADHD, Behavior Conduct, Anxiety, Depression, Vision Disorder, Digestion-Eating difficulties, and inadequate Sleep hours), while controlling for childhood-age-period. Bioecological theory (Bronfenbrenner, 1986) supports the study with the belief that identifying comorbidities and factors that may associate with them helps to improve health-treatments, childrearing supports, and education and well-being of ASD children, and thus also builds guiding knowledge for social workers in creating social justice and equity for ASD-related care (Olaitan & Olaitan, 2022). The study is also grounded in a family-centered-care perspective, which emphasizes that social workers be part of any collaborating teams with other professionals in the community whenever partnering with families of ASD children on the best ways to address comorbidities in ASD children’s care (Bishop-Fitzpatrick et al., 2019; Humphrey, 2024; Kouo et al., 2022).

Methods: Study-design is cross-sectional-correlational, with secondary-data from the 2022-2023 National Survey of Child Health (publicly-available, University-IRB-approved). Nationally representative sample includes N=2819 (4.2%) ASD children (N=1360, 4.5%, 6-11yrs, and N=1459, 3.9%,12-17yrs). Data are reported by primary-caregivers, mostly parents. Analytics include descriptive statistics and multivariate Logistic Regression.

Results: Study profiles ASD children’s gender, racial-background, and age-at-diagnosis, and family characteristics. Prevalence on most frequent comorbidities (40%-60%) include LD, Behavior Conduct, Speech-Language difficulties, ADHD, Low sleep-hours, and Anxiety). Comorbidities are significantly (p<0.05-p<0.001) but differentially influenced by children’s gender, racial-background, and age-at-diagnosis. Study limitations, practice implications, and future research are provided.

Conclusions: Substantial proportion of ASD children suffer from more than one comorbidity, and are diagnosed with some comorbidities after age 5. Although early assessment of comorbidities is key to building ASD children’s healthcare treatments and parental and educational guidance, reassessment of some comorbidities also becomes key to care and well-being of ASD children during middle-later childhood periods. By applying current knowledge on comorbidities from the current study, social workers in schools, healthcare, and community are integral to advocacy and quality care by assuring access for timely assessments and reassessments of comorbidities and in collaboration with other professionals, to improve care services facilitated or created for ASD children and their families.