Veronica Nolden sensed her toddler wasn't like other kids.
At 15 months old, Branden wouldn't look her in the eye.
He wouldn't say "Mama" or "Hi" or "Bye."
He wouldn't say anything.
But Nolden, of Milwaukee, refused to let herself think there might be something really wrong.
And her harried pediatrician didn't notice anything amiss.
So, it wasn't until Branden was 3 that he was finally diagnosed with an autism spectrum disorder.
Nolden's story is not uncommon. According to the Centers for Disease Control and Prevention, autism is diagnosed in 55 to 66 per 10,000 children.
Children such as Branden living in areas considered economically disadvantaged are generally diagnosed later than those who live in more affluent communities. There is concern that these children may be missing a critical window for therapy, when the brain is its most elastic and new behaviors and skills can be ingrained.
It's this concern that sparked a recent gathering of state, city, county and private health experts to meet at Milwaukee's first Autism Summit.
"There are many children who do not receive a diagnosis until they go to school," said Emily Levine, executive director of the Autism Society of Southeastern Wisconsin.
Levine was instrumental in pulling together researchers and officials from the state Department of Health Services, the Milwaukee Health Department, 16th Street Clinic, Easter Seals, Children's House, the Medical College of Wisconsin, the University of Wisconsin-Milwaukee and the state Department of Public Instruction, among others.
The group would like to consider strategies such as universal screening for the disease and outreach to families and physicians in underserved communities.
Improving access to help
In 2008, researchers from New York found that not only were there disparities in the access to care among underserved populations, but that children from these groups also seemed to receive diagnoses later than advantaged groups.
"The resources are hard to chase down for all of us," said Levine. "But in the suburbs, there is a sense of entitlement. They won't take no for an answer."
In the 2008 article, which was published in the Journal of Developmental and Behavioral Pediatrics, the researchers pointed to many reasons why autistic children from underserved populations might not receive early diagnoses.
Parents might not recognize the early signs and symptoms of autism, and their health care providers may be less likely to recognize the signs of autism than health care providers who serve other populations.
In addition, the interactions between doctors and families may also be different. For example, language barriers might hamper communication between some families and their physicians.
Using data collected from the National Survey of Children's Health, the researchers found that the prevalence of autism was lower for Latinos - at 26 per 10,000 - than for non-Latinos (51 per 10,000).
They also found that the lowest preschool rate of autism occurred in poor children, at a rate of 16 per 10,000.
Parents in denial
Nolden, the mother of Branden, said part of the problem - which she sees as universal - is also a parent's unwillingness to see, or admit, there is something wrong.
Nolden now works as a specialized teaching assistant at the K-3 program at the School for Early Development & Achievement at the Milwaukee Center for Independence. She sees now that it wasn't just her: It takes time for most parents to accept that something is wrong.
She tries to be as sensitive and accepting of that as she can, while still pressing the parents to get the help they need.
Branden, who is now 5, receives therapy six days a week, from 9 in the morning to 5:30 p.m., and she says it's made a world of difference.
"He can now say 'Good morning,' 'Mama' and 'Daddy,' " she said. "At this point, I really didn't think he'd have this much."
She's now doing her best to educate those in her community about autism - not only by talking with parents and working at the Center for Independence, but also handing out notes in restaurants to people who appear perplexed at her son's behavior.
The note says: "My child is not misbehaving. My child has autism. He may swing his arms or scream with joy. He may cry out loud or throw his food."
She hopes efforts such as her fliers, and the Milwaukee summit, will be the start of an educational campaign to make autism diagnoses and access to care the same for all communities.