While the prevalence of ASD is equivalent across racial demographics, there persists a significant difference in identifying developmental concerns and accurately diagnosing children from Black backgrounds as compared to their white peers. Research has identified a number of barriers to accurate diagnosis including inadequate screening, slow response to parent concerns, lack of awareness of symptoms, and misdiagnosis. This chapter will explore systematic factors such as socioeconomic inequities leading to lack of access to adequate clinical services, historical medical mistrust, racial bias within healthcare leading to improper diagnosis, and barriers to appropriate services and interventions for Black children with ASD. Additionally, a closer examination of the diagnostic criteria for ASD will be discussed alongside cultural factors that should be considered when interpreting the behavioral and developmental profile of the Black child.