Racial/Ethnic Disparities in the Identification of Children With Autism Spectrum Disorders

Abstract

Objectives We sought to examine racial and ethnic disparities in the recognition of autism spectrum disorders (ASDs). Methods Within a multisite network, 2568 children aged 8 years were identified as meeting surveillance criteria for ASD through abstraction of evaluation records from multiple sources. Through logistic regression with random effects for site, we estimated the association between race/ethnicity and documented ASD, adjusting for gender, IQ, birthweight, and maternal education. Results Fifty-eight percent of children had a documented autism spectrum disorder. In adjusted analyses, children who were Black (odds ratio [OR] = 0.79; 95% confidence interval [CI] = 0.64, 0.96), Hispanic (OR = 0.76; CI = 0.56, 0.99), or of other race/ethnicity (OR = 0.65; CI = 0.43, 0.97) were less likely than were White children to have a documented ASD. This disparity persisted for Black children, regardless of IQ, and was concentrated for children of other ethnicities when IQ was lower than 70. Conclusions Significant racial/ethnic dispatrities exist in the recognition of ASD. For some children in some racial/ethnic groups, the presence of intellectual disability may affect professionals’ further assessment of developmental delay. Our findings suggest the need for continued professional education related to the heterogeneity of the presentation of ASD.

Childhood Autism Spectrum Disorder and Epilepsy Co-occurrence: Sub-population Prevalence Variances and Risk Modeling

“…This current finding supports several previously published data that examine ASD among children stratified by race and ethnicity [18,19]. The observed higher prevalence of ASD among white children relative to blacks may be explained in part by appropriate diagnoses of ASD in whites, in contrast to blacks who may rather be diagnosed with attention deficit disorder (ADD) [20,19]. Additionally, black children may have less access to the healthcare system and may therefore be under-diagnosed with ASD [20].…”

“…The observed higher prevalence of ASD among white children relative to blacks may be explained in part by appropriate diagnoses of ASD in whites, in contrast to blacks who may rather be diagnosed with attention deficit disorder (ADD) [20,19]. Additionally, black children may have less access to the healthcare system and may therefore be under-diagnosed with ASD [20]. We also surmised that the increasing prevalence of congenital anomalies among white children may contribute to the higher prevalence of ASD in whites, given the possibility of uterine environmental insult [3,11].…”

Parental Age and Cognitive Disability among Children in the United States

“…Potential parents seeking guidance for their reproductive decisions understandably may have difficulty comparing risks associated with age for different conditions, some of which carry considerable ambiguity in their diagnosis (Mandell et al 2009). The use of all-condition cognitive disability in this study, based on a large, population-based sample, contributes to our understanding of the overall risks.…”

Reporting of Cultural Factors in Autism Research Publications in Sweden: Application of the GAP-REACH Checklist

“…The concerns of the WHO are well justified as studies have shown that cultural factors can potentially lead to health disparities in recognition, diagnostic assessment, and treatment for children with ASD especially regarding ethnic minority communities (Interagency Autism Coordinating Committee (IACC) 2014; Mandell et al 2002Mandell et al , 2009; National Autism Center 2015; Pierce et al 2014). Mandell and Novak (2005) argue that investigation of cultural factors in ASD research should focus on studying families' cultural views and beliefs about causes of their child's disability, existing barriers to ASD diagnosis as well as parents' treatment preferences.…”