Research Paper
A comparison of Autism Spectrum Disorder DSM-IV criteria and associated features among African American and white children in Philadelphia County

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Abstract

Background

Racial differences are documented in the timing and type of autism spectrum disorder (ASD) diagnosis among white and African American children. Differences in clinical presentation by race may contribute to these disparities. This study explores documented differences in core ASD symptoms and associated behavioral features among African American and white children.

Methods

This project is a secondary data analysis from the Pennsylvania Autism and Developmental Disabilities Surveillance Program and utilized methodology that evaluates existing records, reviews, and codes for DSM-IV criteria for ASD and 12 associated behavioral features. The sample comprised 343 children meeting surveillance case definition for ASD, from 3 population-based cohorts of children in Philadelphia County.

Results

A higher frequency of white children compared to African American children with ASD have documented DSM-IV criteria of inflexible adherence to nonfunctional routines/rituals (92% vs 81%; p = .005) and persistent preoccupation with parts of objects (67% vs 50%; p = .002). A higher frequency of white children with ASD compared to African American children with ASD have documented abnormal motor development (74% vs 60%; p = .008) and odd responses to sensory stimuli (76% vs 51%; p < .001). There were no significant differences in externalizing behaviors or reciprocal social interaction.

Conclusions

This study suggests differences in the types of ASD symptoms and associated behavioral features exhibited by African American as compared to white children with ASD. Further research is needed to determine if these differences contribute to disparities in the timing or type of ASD diagnosis.

Section snippets

Background

Some previous studies reported that the prevalence of ASD does not vary by race [6], [7], [8], [9], but these studies are in conflict with a more recent study by the CDC that did report differences in prevalence by race and/or ethnicity in the latest surveillance data among whites, African Americans, and Hispanics. In this study, the overall average prevalence of ASDs was higher among whites than African American or Hispanic children. According to these data for ASDs in Philadelphia County, for

Methods

This study was conducted on 3 cohorts of children living in Philadelphia County. This geographic region is well suited to explore the question of differences in reported characteristics among white and African American children with ASD. According to data from the US Census Bureau, the proportion of children in the 5- to 9-year age range in Philadelphia County corresponds to the national average of approximately 12% to 13% of the total population [26]. In Philadelphia County, there are almost

Sample (Table 2)

Data from 3 study years were combined for analysis. The 2002, 2006, and 2008 study years were combined for a sample size of 343 surveillance cases of ASD (see Table 2).

The racial distribution is 59% (n = 202) African American and 41% (n = 141) white. The African American group was composed of 82% males (n = 166) compared to 87% (n = 123) white males. In our sample, there were no more African American than white children diagnosed with autistic disorder vs other ASDs. This is noted because

Discussion

This study investigated differences in core ASD symptoms and associated behavioral characteristics among African American and white children in a population-based cohort. Specifically, we found that compared to African American children with ASD, white children with ASD had more documented DSM-IV criteria of Restricted Interests and Repetitive/Stereotyped Behaviors including inflexible adherence to nonfunctional routines and preoccupation with parts. Compared to African American children with

Conclusions

In conclusion, this study suggests that race may have become less of a factor over time in accessing diagnostics services, at least in Philadelphia County, as age of diagnosis and type of diagnosis were similar in our 2 groups. There are some interesting differences in DSM-IV criteria and behavioral features that relate to atypical behaviors and motor skills that may suggest these are present at a higher frequency in white children with ASD compared to African American children with ASD. It may

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    This work was supported in part by the Project #T77 MC 0012 from the Maternal and Child Health Bureau (Title V, Social Security Act), Health Resources and Services Administration, Department of Health and Human Services. The data represented in this report were collected by the Autism and Developmental Disabilities Monitoring (ADDM) Network Surveillance years 2002, 2006, and 2008 supported by the Centers for Disease Control and Prevention (CDC). The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the CDC. The Principal Investigator of the Pennsylvania Autism and Developmental Disabilities Surveillance Program is Ellen Giarelli, Ed.D., R.N., C.R.N.P. The authors have no additional financial disclosures or conflicts of interest to report.

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