Autism Spectrum Disorders

Abstract

A review of the literature supports that there are barriers to the diagnosis and treatment of Autism Spectrum Disorder (ASD) for African American children. The barriers may lead to poorer physical and mental health outcomes for this population. Some research data suggest an increased prevalence of ASD among African American children while other studies yield prevalence rates that do not differ across race and ethnicity groups. Investigating disparities in ASD prevalence is complicated and result differ depending, in part, on whether surveillance samples or clinical populations were used. Possible prevalence differences aside, African American children are at greater risk of receiving a later diagnosis or having a missed diagnosis of ASD due to the disproportionality of poverty and other factors. Socioeconomic status is a predictor of receiving an ASD diagnosis, as children with a higher SES are more likely to receive a more timely diagnosis of ASD. Other factors that may explain disparity in diagnosis of ASD in African American children are cultural; some families may be less likely to seek or receive an ASD diagnosis for a child. Heightened stigma associated with developmental disability diagnosis may cause families in the African American community to be cautious in pursuing an ASD diagnosis. Clinician bias, and institutionalized racism may affect whether an African American child is identified with ASD. Many African American children do not have a usual source of primary care where screening and diagnostic assessments often begin, and as a child ages, mental health or behavioral concerns may take precedence over or mask ASD, further delaying a diagnosis. The literature also suggests disparities in utilization and access to healthcare and educational interventions for African American children. Disparities in access and utilization may be due to the lack of cultural competency of providers, perceived low quality of care, or the lack of the family centered care among other factors. Cultural competency training for providers, as well as aggressive developmental screening may help to eliminate disparities in the diagnosis of ASD among African American children, as well as disparities in the access and utilization of services. Additional research is needed to clarify barriers to diagnosis and access to services for African American children. Further research may also clarify any differences in ASD phenotypes across race; increasing the representation of minority children in research samples will help ensure that findings adequately reflect the clinical presentation and response to intervention for all children.