Comparing Parent-Report of Non-Intellectually Disabled Asian-American Youth with ASD and ADHD to Their White Peers

Background: Over the last few decades, there have been considerable advancements in the understanding of developmental disorders such as autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD). Yet, there is still a dearth of research evaluating differences in functioning in these disorders across ethnicity, particularly among those without intellectual disability (ID) (Morgan et al., 2013; Wallis & Pinto-Martin, 2008). Even less research exists on the manifestation of these disorders in Asian-American youth. Even CDC prevalence rates rarely include national averages for this group, due to wide variability across sites, with some reporting prevalence well below national averages, and others reporting much higher rates (CDC Community Report on Autism, 2018; Coker et al., 2016). Differences in parental perceptions and reporting of symptoms may contribute to differences in clinical ascertainment of ASD and ADHD in this population.

Objectives: This study investigated ethnic differences in parent-reported impairment in adaptive behavior and social-emotional functioning in non-intellectually disabled Asian and White youth with ASD and ADHD.

Methods: From a large clinic-referred and research database of over 2,000 individuals, a sample of White (N=502) and Asian (N=50) youth with ASD and/or ADHD without ID were selected. The case control matching procedure in SPSS v25 was used to generate a sample of White and Asian youth (n=96; ages 6-17), matched on age (within 1 year) and full-scale IQ (within 5 points). Both unmatched groups and matched groups were compared on parent-reported adaptive behavior and social-emotional functioning. A series of one-way ANOVAs was used to analyze differences between ethnic groups on subdomain scores of the Vineland-II (communication, daily living skills, socialization) and on selected subscales of the Child Behavior Checklist (CBCL; anxiety, withdrawn/depressed, social problems, thought problems, attention problems, internalizing, externalizing, anxiety).

Results: Both the unmatched and matched samples were comparable on age, full-scale IQ, and maternal education (Tables 1 & 2). Among the unmatched sample, Asian and White youth had significantly different levels of parent-reported impairment on the Thought Problems subscale of the CBCL. No other subscale of the CBCL or any subscale of the Vineland-II were significantly different in the unmatched sample (Table 1). Among the matched sample, Asian and White youth did not have significantly different levels of parent-reported impairment on any subdomain of the Vineland-II or subscale of the CBCL (Table 2).

Conclusions: Among a clinically-diagnosed sample of children with ASD and ADHD, overall daily functioning was comparable among Asian American and White youth, according to parent response to questionnaires. However, a significant difference in parent-reported thought problems highlights a discrepancy between groups. Overall, findings support the theory of cultural invariance of the manifestation of ASD, as a neurodevelopmental disorder. These data suggest families of each group are assessing their children’s functioning in similar ways. These results are particularly interesting in the context of research describing variable discrepancy rates of assessment and diagnoses among these ethnic groups. Further studies are needed to explore symptoms in undiagnosed Asian American youth, to determine if suspected under-diagnosis is attributable to parent perceptions versus clinician bias.