Relationship Between Ethnic and Socioeconomic Classification and Parents' Perception of Autism Symptoms In Their Toddlers

Background: The literature shows that children of ethnic minority backgrounds receive a diagnosis of autism later than do Caucasian children (Mandell et al., 2002). Yet the barriers to early detection of autism have not been well defined.  In this study, we examined issues related to barriers to early detection of autism by examining how parents from an ethnic minority background differed from American white Caucasian parents in perceptions of their toddlers’ developmental characteristics just prior to their enrollment in an early intervention study.

Objectives: To compare pre-diagnosis perception of presenting symptoms of developmental delay between parents of toddlers from ethnic-minority vs. non-minority backgrounds who volunteered for an early intervention study.

Methods: 14 toddlers with autism (mean age = 27.98 months) and their caregivers from an ethnic minority background participated, which included minorities of African-American (N = 10), Hispanic (N = 1), and Asian (N = 3) descent. The non-minority group included 54 American Caucasian toddlers with autism (mean age = 27.08 months) and parents. Children were diagnosed with an autism spectrum disorder by expert clinical researchers. Parents in both groups were administered the MacArthur Communicative Development Inventories (CDI; Fenson et al., 1994), which is a parent checklist that assesses language and communication skills in infants and toddlers; and  Communication and Symbolic Behavior Scales Caregiver Questionnaire (CSBS-CQ: Wetherby & Prizant, 2002), which is normed for children between 0-24 months of age, and provides information on sounds, words, gestures, and social-affective signaling, Children were also administered the Mullen Scales of Early Learning, (MSEL; Mullen, 1995) and the Autism Diagnostic Observation Schedule (ADOS; Lord et al., 2000). Moreover, in order to control for the socioeconomic status (SES) of the participants, Hollingshead (1975) four-factor index of SES was calculated.

Results: The SES of participants was mostly upper (53% non-minority and 64.7% minority) and upper-middle class (43% non-minority, 11.8% minority). All participating families in lower SES classes were minorities (17.7%). Minority parents reported fewer words (p < .001), sounds (p < .01), and gestures (p < .05) on the CSBS-CQ; and fewer gestures (p < .05) and sentences (p < .001) on the CDI compared to non-minority parents. Low-SES and high-SES parents did not differ on any scale of the CSBS-CQ or the CDI (ps > .10). Minority children scored lower on the communication subscale of ADOS compared to non-minority children (p < .05); however, no differences were detected between groups on any scales of the MSEL (ps > .50).

Conclusions: This preliminary study indicates that the majority of parents who initiate contact with an academic institution’s research program to determine whether their toddler might have autism are from upper to upper-middle class backgrounds, regardless of ethnic membership.  This phenomenon has been reported by Maenner at al (2009). Moreover, ethnic minority parents may require more substantial communication delay in their toddler prior to seeking evaluation by autism experts. This was independent of SES. Whether this reflects a genuine clinical difference between groups or cultural differences in interpretation of autism symptoms needs to be further investigated.