Neurodevelopmental Disorders Diagnosed Later in Publicly Insured Children in the US

Caring parents and misbehaving boy during therapy session with counselor
A population-based cohort study in the US examined the data from over 2 million Medicaid patients to ascertain if there were any differences in the incidence and timing for diagnosis of neurodevelopmental disorders in publicly vs privately insured children.

About 1 in 4 publicly insured children in the United States received a neurodevelopmental disorder diagnosis by age 8. However, they receive those diagnoses later than privately insured children, according to a study published in JAMA Psychiatry.

A population-based cohort study examined the data from over 2 million Medicaid patients and about 1.3 million privately insured patients. By age 8, 23.9% of publicly insured children and 11.0% of privately insured children had received a diagnosis of autism spectrum disorder (ADHD), attention-deficit/hyperactivity disorder, learning disability, and/or other neurodevelopmental disorders (NDDs). The incidence was higher in boys than in girls: incidence of 1 or more neurodevelopmental disorders by age 8 years, 30.7% vs 16.7% among publicly insured children and 15.0% vs 6.7% among privately insured children.

Diagnoses were typically made earlier among privately insured children and were diagnosed earlier than publicly insured children, but the researchers say those differences were “generally small and nonsignificant” with a few exceptions including: ADHD was diagnosed, on average, 6 months earlier and speech and language disorders were diagnosed about 1.5 years later among publicly insured children.

Across the board, children who received a diagnosis of an NDD were more often White (Medicaid Analytic eXtract (MAX); 46.2% vs 37.8%), male (65.9%vs 48.0%), born preterm (15.2%vs 9.5%), small for gestational age (4.1%vs 2.9%), and with low birth weight (8.1% vs 4.2%) compared with children without NDDs.

Although the study used large datasets, the study couldn’t account for nondiagnosed disorders. They also could not identify possible underlying disorders in children diagnosed with more than 1 neurodevelopmental disorder.

The researchers state the study has “laid the groundwork that will enable research to increase our understanding of the role of factors such as maternal morbidities and advanced paternal age…and to identify potential modifiable risk factors such as nutrition, drugs of abuse, and other in utero drug exposures.”

“Our findings that publicly insured children tended to receive a diagnosis of NDDs somewhat later than privately insured children, and that there were substantial racial and ethnic discrepancies in both incidence and age at diagnosis — even within a cohort where all children are publicly insured, and thus, expected to be quite similar in terms of socioeconomic status — point toward disparities in health service access and use…as well as to the overdiagnosis and/or underdiagnosis of these disorders in certain racial and ethnic groups.”


Straub L, Bateman BT, Hernandez-Diaz S, et al. Neurodevelopmental disorders among publicly or privately insured children in the United States. JAMA Psychiatry. 2022;e213815. doi:10.1001/jamapsychiatry.2021.3815