Journal of Autism and Developmental Disorders

, Volume 48, Issue 2, pp 361–376 | Cite as

Parental Action and Referral Patterns in Spatial Clusters of Childhood Autism Spectrum Disorder

  • David Schelly
  • Patricia Jiménez González
  • Pedro J. Solís
Original Paper


Sociodemographic factors have long been associated with disparities in autism spectrum disorder (ASD) diagnosis. Studies that identified spatial clustering of cases have suggested the importance of information about ASD moving through social networks of parents. Yet there is no direct evidence of this mechanism. This study explores the help-seeking behaviors and referral pathways of parents of diagnosed children in Costa Rica, one of two countries in which spatial clusters of cases have been identified. We interviewed the parents of 54 diagnosed children and focused on social network connections that influenced parents’ help seeking and referral pathways that led to assessment. Spatial clusters of cases appear to be a result of seeking private rather than public care, and private clinics are more likely to refer cases to the diagnosing hospital. The referring clinic rather than information spread appears to explain the disparities.


Autism spectrum disorder Diagnostic disparities Help-seeking behavior Social networks Healthcare Physician referral 


Author Contributions

This research was part of DS’s dissertation at the University of Wisconsin. PJG was the institutional sponsor at the HNN. PJS participated in data collection and interpretation. All authors read and approved the final manuscript.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  1. 1.Department of Occupational TherapyClarkson UniversityPotsdamUSA
  2. 2.Hospital Nacional de Niños “Dr Sáenz Herrera,” CCSS, Child Developmental and Behavioral UnitSan JoséCosta Rica
  3. 3.University of Costa RicaSan JoséCosta Rica

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