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Racial/Ethnic Disparities in the Identification of Children With Autism Spectrum Disorders
Open accessAbstract
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 (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
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“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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“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
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“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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Trends in documented co-occurring conditions in children with autism spectrum disorder, 2002–2010
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Self-citation
Metadata
- 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
- 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
- green
- www.ncbi.nlm.nih.gov
- 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
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
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