Differences in Neuropsychological and Behavioral Profiles of White and Asian Children with Autism Spectrum Disorder (ASD)

Background: Asian-American children are less likely to be identified with Autism Spectrum Disorder (ASD) relative to White children (CDC, 2014). Understanding the impact of cultural differences on symptom presentation, as well as symptom identification, is important for closing this gap and for guiding appropriate treatment planning. Although researchers have found that cultural factors can account for differences in the neuropsychological profiles of typically developing racial minorities relative to their White peers (e.g., Ardila, Rosselli, Matute & Guajardo, 2005; Kelkar, Hough & Fang, 2013; see also Ponton & Corona-LoMonaco, 2007), no known research studies have compared neuropsychological outcomes of Asian and White children with ASD. 

Objectives: This study aims to address the gap in cross-cultural ASD research by comparing executive function (EF) and behavioral profiles of Asian-American and White-American children with ASD.  

Methods: Data from participants evaluated at an outpatient neuropsychology clinic between 2014-2015 were drawn from an IRB-approved clinical database. 19 Asian and 19 Caucasian children with ASD were matched by age (M=7.97, SD=3.80), gender (89.5% male), and nonverbal IQ (M=101.53, SD=22.35). Parents and teachers completed the ADHD Rating Scale, Behavior Rating Inventory of Executive Function (BRIEF) and Child Behavior Checklist (CBCL). Performance tests included various Wechsler intelligence scales, the Differential Ability Scales, Second Edition (DAS-II), the Test of Everyday Attention for Children (TEA-Ch), and the Tower of London (TOL). 

Results: Independent samples t-tests indicated that teachers of students with ASD reported more problems with inattention (t(21)=-2.961,p<.01) and hyperactivity (t(21)=-2.729,p<.01) in White children than in Asian children on the ADHD Rating Scale. Parents of Asian children endorsed fewer problems with inhibition, shifting, emotional control, and planning/organization on the BRIEF, while parents of White children rated them to have clinically significant deficits in the same areas. Similarly, teacher responses to the BRIEF identified fewer problems with planning/organization in Asian students. No differences were found on performance tests of EF. Teachers and parents reported greater concerns for aggression and externalizing behaviors in White children on behavioral checklists. Parents of Asian children additionally reported significantly less concerns for internalizing behaviors. 

Conclusions: There are clear differences in parent/teacher reports of executive dysfunction and behavioral problems between Asian and White children, while performance test results are similar between groups. In general, White children are perceived to have more (and clinically significant) difficulties in behavior regulation relative to Asian children. This could be related to referral bias, differences in cultural perception/attribution of problems, or cultural differences in the manifestation of problems. This could also represent problems in the cultural sensitivity of parent/teacher report tools. Further research and analysis is needed to confirm these findings.