Observed Social Communication Profiles and Parent-Reported Red Flags of ASD in Toddlers with and without Autism Spectrum Disorder from Three Racial/Ethnic Groups

Background: Racial and ethnic diversity is rapidly growing in the United States, leading to heightened concerns about racial/ethnic disparities in the provision of services for young toddlers with autism spectrum disorder (ASD).  Studies have demonstrated that non-Hispanic White students with ASD are approximately two times more likely to be diagnosed with ASD than their Black or Hispanic peers (e.g., Kogan et al., 2009; Travers, Tincani, & Krezmien, 2011) and children from non-White minority groups were less likely than White children to have a diagnosis of ASD in their records (Mandell et al., 2009).  Despite these findings, only one study to date has explored potential differences in early symptom presentation among minority and non–minority toddlers with ASD (Tek & Landa, 2012).   

Objectives: This investigation of the FIRST WORDS^® Project studied a sample of 364 toddlers between the ages of 18 and 36 months with (n = 195) and without (n = 169) a diagnosis of ASD from three racial/ethnic categories: non-Hispanic White (n = 226), non-Hispanic Black (n = 74), and Hispanic White (n = 64).   

Methods: Differences across the groups were examined using scores from an observational measure of social communication, the Communication and Symbolic Behavior Scales (CSBS; Wetherby & Prizant, 2002) Behavior Sample, and a parent-report measure of autism red flags, the Early Screening for Autism and Communication Disorders (ESAC; Wetherby, Woods, & Lord, 2007).  The seven cluster scores of the CSBS Behavior Sample include emotion and eye gaze, communication, gestures, sounds, words, understanding, and object use.  The ESAC provides a total score based on 30 items.  

Results: After controlling for maternal education, findings revealed differences between children with and without ASD for both the CSBS and the ESAC.  Non-Hispanic White toddlers were observed to score higher than non-Hispanic Black and Hispanic White toddlers on the understanding cluster of the CSBS, but racial/ethnic groups did not differ on the other six clusters.  There were no significant interactions between diagnostic classification and race/ethnicity on either the CSBS or the ESAC.  A large, negative correlation was observed between the CSBS and the ESAC such that children with lower social communication scores based on observation during the CSBS had higher parent report of autism red flags.   

Conclusions:

These findings indicate good agreement between observed social communication and parent report of autism red flags in a diverse sample of toddlers.  There were no significant differences across race/ethnicity for six of the seven clusters of the CSBS. Results from this study suggest that both measures could be instrumental in identifying young toddlers with ASD from these racial/ethnic categories and may contribute to improving early detection and access to early intervention for toddlers with ASD.