Autism Spectrum Disorder Administrative Prevalence in Texas School Children of Immigrant Parents

Background:  Texas is the second most populated state in the US and has the third highest foreign-born population. Although the etiology of autism spectrum disorder (ASD) is not well understood, migration and ethnicity have been implicated as possible risk factors. However, results from studies on associations between immigration and ASD diagnosis and prevalence have been conflicting.

Objectives:  To (1) calculate administrative estimates of children from homes speaking 128 different languages enrolled in Texas schools systems (2) investigate differences in ASD administrative prevalence by comparing estimates for immigrant populations to that of English-speaking children with ASD in Texas school systems.

Methods:  We conducted a cross-sectional study using data from educational records of children from pre-K to 12th grade ranging from age 3 to 22 years provided by the Texas Education Agency (TEA). Through a Public Information Request, the total number of children meeting eligibility to receive autism services from TEA was provided in aggregate form from the TEA Special Education Data Book. Additionally, TEA was able to provide cross referenced data on students who met autism eligibility criteria within 128 specific language groups based on reports from Home Language Surveys (HLS). ASD administrative prevalence estimates for Texas students were derived using the total number of children with an educational autism designation stratified by reported home language. Additionally, languages were grouped by primary geographic region and administrative prevalence estimates for geographic regions were calculated. Lastly, using 2 by 2 tables, relative risks and 95% confidence intervals were calculated for administrative estimates of these languages with English language as a reference.

Results:  Data for 1225 Local Education Agencies (LAEs), showed that 100% of schools provided services to English-speaking children. Of these 89% also reported serving children whose home language was Spanish. There were approximately 35,555 children of from English-speaking households with an ASD educational designation, accounting for 81% of all children with an ASD designation. Of the 11,524 children from homes speaking Chinese languages, 129 had a TEA autism educational designation, making the estimated risk of ASD 37% higher for these children compared to children from English speaking households (RR=1.37; 95% CI: 1.19, 1.54). Furthermore, although risk of ASD education designation was significantly higher in children of families from West Africa (RR=3.53; 95% CI: 3.26, 3.80), East Africa (RR=2.05; 95% CI: 1.72, 2.37), and South Africa (RR=3.72; 95% CI: 2.76, 4.69), results were not significant for those from Central Africa (RR=1.33; 95% CI: 0.79, 1.87).

Conclusions:  Studies of differences based on ethnicity and country of origin could yield results that will contribute to more knowledge on factors associated with receiving an ASD diagnosis. Additionally, social stigma and language barriers may reduce diagnosis and identification of immigrant children with ASD, suggesting that the increased administrative prevalence seen in our study may only be a small indicator of a potentially larger prevalence. The views expressed in this abstract are those of the author and do not necessarily represent the views or policies of the U.S. Environmental Protection Agency.