Differences In Items and Summary Scales of the Autism Diagnostic Interview-Revised Between Latino and Non-Latino White Adolescents and Adults with ASD

Background: Recent research documents that Latinos are less likely to be diagnosed with autism than their non-Latino counterparts.  One factor that may contribute to these differences in diagnostic rates is that autism diagnostic instruments have not been adapted for the Latino population; therefore, whether these instruments measure the same constructs across cultures has not been determined. The focus of this study is on the use of the Autism Diagnostic Interview-Revised (ADI-R) among Latinos with an ASD diagnosis compared to non-Latino Whites.  Because the ADI-R is based on parent report, cultural perceptions about normative language, social, and behavioral development may influence parental responses.  Some research shows that Latina mothers place more emphasis on social development and may have a lower threshold for behavioral presentations in their children. 

Objectives: The goal of this analysis was to compare ADI item and summary scores between Latino and non-Latino White children with an ASD.  We hypothesized that: 1) Latina mothers will report more social impairments in their children with ASD, 2) similar levels of impairment in nonverbal communication, and 3) fewer restrictive and repetitive behaviors than non-Latina White mothers.

Methods: We created a matched sample consisting of 48 Latina mothers and 96 non-Latina White mothers of adolescents and adults with an ASD from a larger study of adolescents and adults with autism across the lifespan.  The sample was matched on verbal fluency, whether the person with ASD had an intellectual disability and age of person with ASD. In the Latino sample, 85% of the mothers were foreign born and 69% were interviewed in Spanish. All participants were interviewed in their homes by interviewers trained by researchers certified in the use of the ADI-R.  The interviews included the 37 ADI-R items that comprise the diagnostic algorithm.  Separate analyses of variance (ANOVA) were conducted for individual items and summary scores in the three domains of the ADI-R: impairments in social reciprocity, nonverbal communication and repetitive behaviors and restrictive interests.

Results: There were no differences in level of total social reciprocity impairments between the two groups; However, Latina mothers reported a higher level of impairment in direct gaze among their children than non-Latina white mothers. Both groups reported similar levels of impairments in nonverbal communication. The Latina mothers reported lower levels of restrictive and repetitive behaviors among their children than non-Latina White mothers.  Specific items that were significantly different in this category included circumscribed interests, unusual preoccupations and compulsions or rituals.

Conclusions: Findings suggest that social and communication items may work similarly across the two groups; however, whether there is cultural equivalency for the restrictive and repetitive behavior items warrants further exploration.