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Cited by 946Autism Spectrum Disorder ResearchChild Nutrition and Feeding IssuesDown syndrome and intellectual disability research

Racial/Ethnic Disparities in the Identification of Children With Autism Spectrum Disorders

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Mandell, David S., Wiggins, Lisa D., Carpenter, Laura Arnstein, Daniels, Julie, DiGuiseppi, Carolyn, Durkin, Maureen S., Giarelli, Ellen, Morrier, Michael J. +6 more·2009·American Journal of Public Health
DOI 10.2105/ajph.2007.131243PMC PMC2661453
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Abstract

Objectives. We sought to examine racial and ethnic disparities in the recognition of autism spectrum disorders (ASDs). Methods. Within a multisite network, 2568 children aged 8 years were identified as meeting surveillance criteria for ASD through abstraction of evaluation records from multiple sources. Through logistic regression with random effects for site, we estimated the association between race/ethnicity and documented ASD, adjusting for gender, IQ, birthweight, and maternal education. Results. Fifty-eight percent of children had a documented autism spectrum disorder. In adjusted analyses, children who were Black (odds ratio [OR] = 0.79; 95% confidence interval [CI] = 0.64, 0.96), Hispanic (OR = 0.76; CI = 0.56, 0.99), or of other race/ethnicity (OR = 0.65; CI = 0.43, 0.97) were less likely than were White children to have a documented ASD. This disparity persisted for Black children, regardless of IQ, and was concentrated for children of other ethnicities when IQ was lower than 70. Conclusions. Significant racial/ethnic dispatrities exist in the recognition of ASD. For some children in some racial/ethnic groups, the presence of intellectual disability may affect professionals' further assessment of developmental delay. Our findings suggest the need for continued professional education related to the heterogeneity of the presentation of ASD.

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  • In the U.S., African American, Hispanic, and Asian children are more likely to receive a diagnosis at a later age than Caucasian children.

    “In the U.S., African American, Hispanic, and Asian children are more likely to receive a diagnosis at a later age than Caucasian children (Maenner et al. 2020; Mandell et al. 2009; Palmer et al. 2010).”

    From The Diagnosis of Autism: From Kanner to DSM-III to DSM-5 and Beyond (2021) · cites this paper as Mandell et al. 2009

    The Discussion (page unavailable) reports prior research finding that Black children with ASD were diagnosed at older ages than White children. For Hispanic and Asian children, the paper finds lower odds of a documented ASD classification in certain groups, not a later age at diagnosis; it therefore does not support that part of the claim. (LLM, conf=0.88)

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  • There are continued disparities in the number of children identified with ASD across race, ethnicity, states, and neighborhoods within cities, with children of color and from less advantaged backgrounds being diagnosed less often and later than other children.

    “there are continued disparities in the number of children identified with ASD across race, ethnicity, states, and even neighborhoods within cities, with children of color and from less advantaged backgrounds being diagnosed less often and later than other children (Mandell et al. 2009, Mandell & Palmer 2005).”

    From Recent Advances in Autism Research as Reflected in DSM-5 Criteria for Autism Spectrum Disorder (2015) · cites this paper as Mandell et al. 2009

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  • Many factors, both internal and external to a child, affect when he or she first receives a diagnosis of ASD.

    “Furthermore, many factors, both internal and external to a child, affect when he or she first receives a diagnosis. These include ethnicity and race, access to appropriate services, bilingual status and region of the country, as well as whether the child has delays besides those that characterize autism, such as in motor coordination or cognitive development (e.g., Mandell et al. 2009, Shattuck et”

    From Recent Advances in Autism Research as Reflected in DSM-5 Criteria for Autism Spectrum Disorder (2015) · cites this paper as Mandell et al. 2009

  • Disadvantaged racial/ethnic or sociodemographic groups have lower rates of autism diagnosis, and up to 20% of children are not diagnosed by 8 years of age.

    “disadvantaged racial/ethnic or sociodemographic groups have been shown to have lower rates of diagnosis1,29 and up to 20% of children are not diagnosed by 8 years of age,1”

    From Environmental Chemical Exposures and Autism Spectrum Disorders: A Review of the Epidemiological Evidence (2014) · cites this paper as [29]

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Research works printed but not linked: 2

  1. [23]Institute of Medcine Unequal Treatment 2002 National Academies Press Washington, DC
  2. [32]Diagnostic and Statistical Manual of Mental Disorders 1994 American Psychiatric Association Washington, DC Fourth Edition

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Authors
Mandell, D. S., Wiggins, L. D., Carpenter, L. A., Daniels, J., DiGuiseppi, C., Durkin, M. S., Giarelli, E., Morrier, M. J., Nicholas, J. S., Pinto-Martin, J. A., Shattuck, P. T., Thomas, K. C., Yeargin-Allsopp, M., & Kirby, R. S.
Affiliations
  • Centers for Disease Control and Prevention (US)
  • David S. Mandell is with the Departments of Psychiatry and Pediatrics, University of Pennsylvania School of Medicine, Philadelphia. Lisa D. Wiggins and Marshalyn Yeargin-Allsopp are with the National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA. Laura Arnstein Carpenter is with the Division of Genetics and Developmental Pediatrics, Medical University of South Carolina, Charleston. Julie Daniels and Kathleen C. Thomas are with the Cecil G....
ORCID
Venue
American Journal of Public Health
Publisher
American Public Health Association
Published
2009-03
Volume
99
Issue
3
Pages
493-498
ISSN
  • 0090-0036 (ISSN-L)
  • 1541-0048
DOI
10.2105/ajph.2007.131243
PMC
PMC2661453
OpenAlex
W1969090439
Semantic Scholar
59cba7f725dca5ce2740257c42e605de326368e3
Cited by
946
References
48
Citations by year
2026: 109 · 2025: 43 · 2024: 77 · 2023: 58 · 2022: 60 · 2021: 71 · 2020: 72 · 2019: 65 · 2018: 49 · 2017: 67 · 2016: 48 · 2015: 54 · 2014: 42 · 2013: 35 · 2012: 35
FWCI
10.20
Type
journal article
Language
en
Open access
Locations
  • American Journal of Public Health (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • RePEc: Research Papers in Economics (submittedVersion)
Funders
National Institute of Mental Health (K01MH067628)
Topics
  • Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
  • Health Sciences › Medicine › Psychiatry and Mental health › Child Nutrition and Feeding Issues
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Down syndrome and intellectual disability research
Keywords
autism spectrum disorder, racial and ethnic disparities, underdiagnosis, children, Black children, Hispanic children, intellectual disability, developmental delay, IQ, professional education
MeSH terms
Autistic Disorder, Child, Cross-Sectional Studies, Ethnicity, Female, Humans, Male, Population Surveillance, United States, Confidence Intervals, Logistic Models, Odds Ratio, Risk Assessment, Racial Groups, Health Status Disparities

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