Differences in Parental Reports of Behavior: a Possible Factor in Disparities of Age at Diagnosis of Autism Spectrum Disorders in African Americans

Background:

Earlier detection and subsequent implementation of intervention services yields the best outcome for children with autism spectrum disorders. Accordingly, measures are being taken to reduce the overall age at which ASDs are detected. However, recent research has found that African-Americans are diagnosed an average of 1.5 years later than Caucasian children and are more likely to receive a misdiagnosis of adjustment disorder or conduct disorder prior to their ASD diagnosis than other children (Mandell et. al., 2002, 2007).

Objectives:

This study examined the impact that varied racial and educational backgrounds may have on the diagnostic process of young children with autism. It is possible that differences in initial diagnoses may be related to differences in frequency of reports or specific nature of concerns that parents of particular racial or educational backgrounds report to health care professionals. This study tested the hypotheses that 1) African-American parents report fewer concerns corresponding to specific symptoms of ASDs and place more emphasis on disruptive behaviors than other racial groups, and 2) Parents with fewer years of formal education report fewer ASD-specific concerns and place more emphasis on disruptive behavior than more highly educated parents.

Methods:

As a part of a diagnostic evaluation, developmental history questionnaires were administered to parents of toddlers who screened as ‘at risk’ for autism (mean age at evaluation= 26.11 months, SD= 4.47 months) as a part of a larger ongoing study for the early detection of autism. Parents' (N = 300) free responses to specific open-ended items on a history questionnaire, such as ‘What concerns you most about your child’s development?’ and ‘What made you initially concerned about your child’s behavior?’, were compared based on race and maternal education reporting differences. Open-ended responses were classified according to whether the parent noted a behavioral characteristic specific to children with ASDs and/or if they emphasized the child’s disruptive behaviors.

Results:

Analyses revealed a significant main effect of race on frequency of ASD-specific concerns, p= .03. Specifically, it was found that African-Americans (M= .93, SD= .18) reported significantly fewer ASD-specific concerns than Hispanic/Latinos (M= 1.7, SD= .20), p= .05. Results also revealed a significant main effect of race on frequency of reports emphasizing non-compliant behaviors p=.001. Specifically, Hispanic/Latinos reported significantly more disruptive concerns (M= .55, SD= .10) than both Caucasians (M= .29, SD= .04) and African-Americans (M= .10, SD= .10), p < .01. There were no significant maternal educational differences.

Conclusions:

Hypothesized differences between African-Americans and other races in terms of ASD-specific reports were only partially supported by the data; differences in age at diagnosis for African-Americans may be due to other factors such as continuity of health care. Similarly, it is possible that there is a disconnection between parental expression of concern and referral for evaluative services. Because African-Americans actually reported fewer concerns of disruption, misdiagnoses of African-Americans with conduct and adjustment disorder may not be directly related to parental misattribution of symptoms. It is possible that underlying expectations about African-American behavior in general may lead to misattribution of any observations of disruption.