Measures of ASD Severity in Children with Autism and Other Developmental Delays Are Related to Sociodemographic Factors

Poster Presentation
Friday, May 3, 2019: 5:30 PM-7:00 PM
Room: 710 (Palais des congres de Montreal)
S. Rosenberg1, L. Wiggins2, B. Barger3, C. DiGuiseppi4, G. N. Soke2, R. Landa5, L. Schieve2, L. C. Lee6, E. Moody7, E. Rubenstein8, K. Kaparich9, L. Stewart10, A. McKenzie9, C. Colbert11, D. Magnusson12 and C. Robinson Rosenberg13, (1)University of Colorado Anschutz Medical Campus, Aurora, CO, (2)Centers for Disease Control and Prevention, Atlanta, GA, (3)Georgia State University, Atlanta, GA, (4)Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, (5)Center for Autism and Related Disorders, Kennedy Krieger Institute, Baltimore, MD, (6)Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, (7)University of Colorado, Denver, Aurora, CO, (8)Waisman Center at UW Madison, Madison, WI, (9)Department of Psychiatry, University of Colorado Denver, Aurora, CO, (10)Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, (11)Colorado School of Public Health, Aurora, CO, (12)Physical Therapy, University of Colorado School of Medicine, Aurora, CO, (13)University of Colorado / JFK Partners, Aurora, CO

Previously we reported that family income, maternal education, and maternal race decreased the specificity of standardized parent-report autism spectrum disorder (ASD) screening instruments. Additional study is needed to examine how both maternal and clinician reports of ASD symptom severity are related to sociodemographic factors, as well as the correspondence between maternal and clinician reports of ASD symptom severity.


To examine associations between sociodemographic characteristics and scores on instruments that rated child ASD severity completed by mothers and study clinicians, as well as to assess the correspondence between ASD severity scores obtained from mothers and clinicians.


We used data from the Study to Explore Early Development (SEED), a multi-site case-control study exploring the phenotypes and determinants of ASD. Participants for this analysis were aged 2-5 years in 2007-2016 and were recruited through educational and healthcare organizations providing services to children with ASD and other developmental delays (DD). Analyses were limited to children whose birth mothers were the reporters. Demographic data were collected in a standardized maternal phone interview. Perspectives on child ASD severity were collected from the mother via the Social Responsiveness Scale (SRS) and from the study clinician using the Ohio State University Autism Rating Scale (OARS). The OARS was completed after a direct observation of the child, as well as a review of all other information available on the child.

We used analysis of variance to examine the relationship between each measure of symptom severity and the sociodemographic factors. Both models, one for the SRS, another for the OARS, included the following independent variables: family income, maternal age, maternal education, maternal race, maternal ethnicity, language spoken in the home, and child sex. To assess the correspondence of maternal and clinician ASD severity estimates, Pearson correlations were obtained for the OARS with the SRS. Tests for collinearity indicated this was not a concern for these models.


Lower education (F=6.04, p<.00), lower income (F=6.26, p<.00) and non-white race (F=7.84, p<.00) were associated with higher severity scores on the SRS. Lower education (F=7.62, p<.00), non-white race (F=11.04, p<.00), male sex (F=50.74, p<.00) and younger child age (F=7.53, p<.00) were associated with higher scores on the OARS. The OARS and SRS were strongly correlated (r=.71).


These results indicate that non-white mothers and those with low education and income report elevated levels of ASD severity in their children with ASD or DD. The strong agreement between maternal and clinician reports of severity of child symptoms suggests the reports of symptom severity reflect true differences in child behaviors. Nevertheless cultural and educational impacts on maternal reporting on self-administered questionnaires cannot be entirely ruled out. Future research is needed to determine the impact of different maternal severity thresholds on access to services.

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.