Racial and Ethnic Disparities in the Identification of Children with Autism Spectrum Disorders

Background: Delayed and missed diagnosis of ASD may be exacerbated among medically underserved ethnic and racial minorities. Studies examining racial and ethnic differences in the age and accuracy of identification of ASD have produced mixed results, but are limited in that they relied on clinical samples in which subjects already had a putative diagnosis of ASD, rather than relying on population-based samples.

Objectives: to examine racial and ethnic disparities in the recognition of ASD in a population-based sample

Methods: Within a multi-site surveillance network, 2,568 8-year-old children were identified as meeting research criteria for ASD through screening and abstraction of evaluation records from multiple sources. Using logistic regression with random effects for site, we estimated the association between race/ethnicity and documented ASD, adjusting for sex, intelligence quotient (IQ), birth weight and maternal education.

Results: 58% of the sample had a documented ASD. In adjusted analyses, children who were black (odds ratio [OR] = 0.78; 95% confidence interval, 0.64 to 0.96), Hispanic (OR = 0.75; 0.55 to 0.99) or other ethnicity (OR = 0.65; 0.44 to 0.97) were less likely than white children to have a documented ASD. The extent of disparities varied as a function of the interaction of intellectual disability and race/ethnicity.

Conclusions: This study demonstrates racial and ethnic disparities in the recognition of ASD. The presence of intellectual disability among children wtih ASD may affect clinicians' and educators' further assessment. Our findings suggest the need for continued professional and caregiver education.