Discrepancies in Parent Vs. Clinician Reporting of Autism Specific Language Patterns across Racial and Ethnic Groups

Background: Previous research has shown differences in parent and clinician reporting of symptoms of Autism Spectrum Disorder (ASD) (Lemler, 2012) and that symptom recognition, diagnosis, and treatment can be heavily influenced by culture (Donohue et al., 2017; Tek & Landa, 2012; Daley, 2004). In previous analyses, we found differences in non-minority parent reports compared to clinician reports of ASD complex mannerisms but not in minority parent reports compared to clinician reports.

Objectives: This study aims to examine differences in parent versus clinician reporting of language related symptoms of ASD by first analyzing discrepancy between parent and clinician ratings for two language related symptoms: stereotyped speech and echolalia (SSE). Second, we explored whether these discrepancies differed across racial and ethnic groups.

Methods: Data on individuals with ASD was used from Boston Children’s Hospital and the Boston Autism Consortium Phenotypic and Genetic Factors in ASD study. 119 participants met inclusion criteria, including: 1) Demographics form, 2) Behavior and Sensory Interest Questionnaire (BSIQ, Hanson et al., 2016), and 3) Autism Diagnostic Observation Schedule-Second Edition (ADOS, Lord et al., 2012). Participants were grouped according to NIH minority status (NIH, 2017). Clinician-reported SSE (CSSE) was measured using an average of the ADOS A3 and A4 codes “Immediate Echolalia,” and “Stereotyped Speech”, scored 0-3. Parent-reported SSE (PSSE) was measured using BSIQ-F1 category of “Language Preservations,” using an average of two individual codes: F1.a. Immediate echolalia and F1.b. delayed echolalia (i.e. stereotyped speech), scored 0-3). First, a one-way ANOVA was used to compare the CSSE and PSSE scores. Next, Tukey post-hoc tests were performed to analyze between-group comparisons for CSSECaucasian, CSSEMinority, PSSECaucasian, and PSSEMinority, to explore whether there were significant differences based on minority status of the child.

Results: Of 119 participants, 87 (73%) were identified by their parents as “White/Caucasian” and 32 (27%) as one of the listed racial and/or ethnic minority descent categories. Categories endorsed by parents included 9 (7.6%) “Asian,” 4 (3.4%) “Black/African-American,” 6 (5%) “More than one race,” 11 (9.2%) “Hispanic,” and 5 (4.2%) who identified as “Other.” Due to low numbers in each minority group, these groups were combined together for the current analysis. Results from a one-way ANOVA showed significant differences in reporting between PSSE and CSSE (p=0.005). Tukey post-hoc contrasts showed significant differences in CSSEMinority and PSSEMinority (p=.014) but no significant differences in CSSECaucasian and PSSECaucasian (p=.476). All other findings were not significant (CSSEMinority and PSSECaucasian, CSSECaucasian and PSSMinority, PSSMinority and PSSCaucasian).

Conclusions: Preliminary analyses showed significant differences in reporting of SSE between parent and clinicians, suggesting that parents and clinicians are recognizing evidence and/or levels of echolalia and stereotyped speech differently. Between-groups analyses resulted in a statistically significant difference between parent and clinician report of SSE for the minority group, but not for any other group. Differences in the reporting of behaviors can impact diagnosis and treatment, and illuminates the need for more research in this area. Inconsistencies in reporting could possibly be attributed to parents having different knowledge about ASD symptomology across cultural groups.