Past research indicates Non-Hispanic black (NHB) children are less likely than Non-Hispanic white (NHW) children to have an autism spectrum disorder (ASD) diagnosis, even if they appear to meet the DSM-IV criteria for the disorder.
This study examined differences between NHB and NHW children according to ASD diagnoses and ASD educational eligibility noted in health and educational records.
Participants were 1273 8-year-old children included in the Metropolitan Atlanta Developmental Disabilities Surveillance Program (MADDSP) who were classified as an ASD surveillance case based on standardized record-review of health and education records during four surveillance years (2000, 2002, 2004, and 2006). Children were placed in one of six mutually exclusive categories based on specificity of diagnoses and placements noted in health and educational records: (1) children with autistic disorder, (2) children with Asperger’s disorder without autistic disorder, (3) children with Pervasive Developmental Disorder- Not Otherwise Specified (PDD-NOS) without autistic or Asperger’s disorder, (4) children with non-specific ASD only (5) children with ASD educational eligibility without documented ASD diagnosis, and (6) children without any of the aforementioned ASD diagnoses/eligibilities specified in surveillance records, but with enough documented ASD behavioral symptoms to warrant inclusion as an ASD surveillance case.
Total ASD prevalence was higher for NHW than NHB children each surveillance year (12 and 9.5 per 1,000 in 2006, respectively). NHB children were more likely than NHW children to have autistic disorder documented in a record (p<.05 in 2002, 2004, and 2006) and to have met public school criteria for autism eligibility (p<0.05 in 2002 and 2006). NHB children were consistently less likely than NHW children to have the more general ASDs – PDD-NOS (p<0.05 in 2002 and 2006) and Asperger’s disorder (p<0.05 in all years) – documented in surveillance records. In all years, NHB children with an ASD were significantly more likely than NHW children to have co-occurring intellectual disability (ID). From 2000-2006, the percentage of children with documented autism eligibility decreased significantly for NHW children (from 26%-14%) and diagnosis of autistic disorder increased for NHB children (23%-35%). Documented Asperger’s disorder consistently increased for NHW (from 8%-11%) only, although this was not significant in all years. The proportions of NHW and NHB children without documented ASD classification in their records were similar; while there was an overall decrease from 2000-2002, from 2002 onward the proportions overall and by racial/ethnic subgroups were stable (22% and 20% for NHW and NHB, respectively).
While cases of ASD are increasing for both NHW and NHB children, the types of ASD classifications received by NHW and NHW are consistently different with NHB children less likely to receive an ASD clinical diagnosis on the milder end of the spectrum. Consequently, lack of recognition and diagnosis of ASD symptoms in NHB children with milder ASD could prevent or delay enrollment into intervention services designed to meet the needs of children with ASD. This study illustrates the need for continued professional education on the presentation of milder forms of ASD, especially as it pertains to minority groups.