Comparison of Symptom Profiles in a Minority Sample of Preschool Children Referred for ASD

Background:

ASD diagnosis varies according to race/ethnicity; minority children less likely receive a diagnosis, are diagnosed later, and are more likely to be misdiagnosed with or conduct disorder (Mandell et al. 2002; Mandell et al., 2007). Further, findings regarding variability in symptom presentation and developmental profiles across cultural groups are inconsistent. Minority children have been shown to have lower cognitive and language scores, and higher severity of ASD symptoms including unusual eye contact, stereotyped language, echolalia, and nonfunctional routines/rituals (Chaidez et al. 2012; Cuccaro et al., 2005; Harrison et al.,2017; Landa & Garrett-Mayer 2006; Sell et al. 2012). However, other studies have found relatively little difference between White and Hispanic groups on ASD symptoms, cognitive or adaptive functioning (Chaidez et al., 2012).

Objectives: To compare differences in symptom presentation within a minority sample of Hispanic and Black/African American preschool-age children referred for diagnostic evaluations.

Methods: The sample is comprised of 103 children between the ages of 2 and 5 who were evaluated at an University-based specialty diagnostic clinic as part of a services grant for children suspected of having an autism spectrum disorder. Children were referred directly through local Part C and Child Find services based on the following criteria: (1) at risk for ASD based on screening (2) Medicaid eligible or lacking private insurance (3) Head Start or Early Head Start eligible, or (4) zoned for a Title 1 school based on address. IRB approval for retrospective data analyses was obtained. Participants included those children who received diagnoses of ASD (n=83, 80% of initial sample), with a mean age of 45.57 months (SD=10.54) and nonverbal IQ of 72.76 (SD =24.44). The sample consists of 21 females (25%) and 62 males (75%). Ethnicity/race breakdown is as follows: White Non-Hispanic (1.2%), Asian (1.2%, Hispanic (72.3%), Black/African American (25%). Subsequent analyses will be based on Black (n=21) and Hispanic (n=60) subjects only.

Results: Preliminary results suggest that Hispanic children were significantly older at referral (47.88 vs 39.71 months), t=2.75(27.211), p=.011. There were no group differences in nonverbal IQ, receptive or expressive language. Nonverbal IQ scores below 70 were seen in 52% of each sample; however, Black children had higher rates of speech/articulation disorder (57% vs.35%). Black children had higher ADOS total severity scores (M=7.37, SD=1.832) than Hispanics (M=5.55, SD=1.832), t(77)= -3.14, p=.002. In contrast, Hispanic children were rated as more severe by parents on the ASRS with respect to Atypical Language (M_H=63.38; SD=8.96 vs. M_B=53.67; SD=11.89), t(38)=-2.334, p=.025 and Self-Regulation (M_H=60.84; SD=10.60 vs. M_B=52.68; SD=12.94), t(38)=-2.756, p=.007. Hispanics were rated as more severe on the BASC on the following subscales: aggression (M_H=51.78; SD=10.26 vs. M_B=46.33; SD=9.78), t(79)=2.12, p=.037 and anxiety (M_H=49.62; SD=9.65 vs. M_B=45.95; SD=5.72), t(59.596)=2.08, p=.042.

Conclusions:

Hispanic and Black children were more similar than different on the majority of measures, including cognitive, language and adaptive behavior. However, differences were found with respect to age of referral, clinician ratings of ASD symptom severity, and parent reported symptoms. Implications of these findings for the diagnostic and treatment process will be discussed.