Distinctive Autism Diagnostic Profiles of Latino Chidren in Puerto Rico

Background:   There is scarce information about Latino children with autism that can be used in the clinical diagnosis process for this population, particularly those residing in the USA and Puerto Rico. Latinos with autism are the largest group of children in the USA minority population, and clinicians are seeking to differentiate individuals with autism validly from those of typical development. The DSM-V emphasis on social-communication will require autism diagnosticians to distinguish communication interactions between these groups in order to assure that children with authentic disabilities are those enrolled in clinical and special education programs.  This investigation aimed at identifying which observable behaviors can be used in the differential diagnosis process.

Objectives:  Our objectives were: 1) to identify social & communication skills that distinguish between severe and moderate autism; 2) to identify social-communication skills that distinguish between mild autism and typical development; and 3) to recommend simplified algorithms for autism diagnosis in the population of USA and Puerto Rico Latino children.

Methods:  The method consisted of an IRB-approved record-review investigation of 260 children seen at our Autism Diagnostic Clinic. We analyzed gender, DSM-IV traits, social skills, communication profiles, CARS scores, and diagnostic impressions for this sample. Based on this analysis we conducted statistical calculations to describe the traits that assist in the above-distinctions and provide arguments for a simplified algorithm that can be used validly with the population of Latino children with suspected autism. 

Results:  Data from the investigation indicates that most children with autism were males, with social interaction disorders as the most frequent DSM-IV trait, followed by repetitive behaviors and, finally, communication impairments, 42.40% were diagnosed with autism and the rest had other developmental disablities and no-disorders.  The most distinguishing CARS characteristics between severe and moderate autism dealt with emphatic behaviors and pragmatic functions. Other distinctive features included mesaage conveyance, detailed story telling, and sustained attention. High-functioning autism represented 15.70%, moderate autism  was 15.70%, and low autism was 22.80%.  

Conclusions:  Our findings revealed that three CARS items are the most distinguishing items for an autism diagnosis, i.e., relationships with other persons (item #1), imitation (#2), and non-verbal communication (#12).  These items need to be used in improved diagnostic protocols that are culturally and linguistically appropriate for the population of Latino chiuldren with autism-risk.