Racial Disparities in an Inpatient Sample of Youth with ASD: Nonverbal IQ, Problem Behaviors, Verbal Ability, and Social Functioning

Background: Research in atypically developing Black youth has found significant disparities in symptoms/behavioral profiles. However, there is limited research examining symptom profile differences between Black youth with ASD and youth with ASD from other racial groups. Furthermore, results have been inconsistent across the few studies that have looked at symptom profile differences by race and none of these studies have examined the inpatient population of youth with ASD.

Objectives: The current study evaluated differences between Black inpatient youth with ASD and inpatient youth with ASD from other racial groups, regarding: demographic & health-related characteristics; problem behaviors; communication; and, social functioning.

Methods: Participants were recruited as part of the Autism Inpatient Collection – a multi-site study enrolling youth diagnosed with ASD between the ages of 4 and 20 from six specialized inpatient psychiatry units in the US. Research-reliable Autism Diagnostic Observation Schedule (ADOS) testers administered the ADOS to confirm ASD diagnosis. Nonverbal IQ was assessed using the Leiter-3. Problem behaviors were measured using the Aberrant Behavior Checklist – Community; communication using the Vineland-II; and, social functioning using the ADOS-2 social affect summary score. Data were analyzed with chi-square difference tests, one-way ANOVAs, and basic descriptive statistical procedures using Stata.

Results: Of the 605 youth in the sample, the majority were male (78%) and the mean age was 13.1 years (SD = 3.4). Approximately 81% of youth were White, 9% were Black, and 10% identified as another race and/or multiple races. Black youth were admitted to psychiatric hospitals significantly more often over their lifetime than White youth (p = .021). Black youth were more likely to be non-verbal or minimally verbal (72%), compared to White youth (49%) and youth who identified as another race (52%; p = .006).

Black youth had significantly lower mean nonverbal IQ scores (M = 61.0, SD = 24.7) in comparison to White youth (M = 73.6, SD = 28.7; p = .026). Black youth with ASD had significantly lower written communication scores (F (2, 485) = 3.66, p = .026) in comparison to youth who identified as White or another race, but there was no difference between groups in parent-reported receptive and expressive communication skills. Black youth had significantly greater impairment regarding social functioning, compared to White youth (F (2, 567) = 3.98, p = .019).

Conclusions: This study highlighted significant racial disparities in psychiatric inpatient care among youth with ASD. Black psychiatric inpatient youth with ASD had overall lower functioning than inpatients of other races, as evidenced by lower nonverbal IQs and a higher proportion who are minimally verbal, as well as more impaired social functioning. The results pertaining to nonverbal IQ are consistent with previous research in other settings. However, few other differences in specific skill deficits or problem behaviors emerged between Black and non-Black inpatients. Given that all participants had marked problem behaviors that necessitated inpatient hospitalization, future research should investigate this association in a broader sample.