Autism Spectrum Disorders and Race, Ethnicity, and Nativity: A Population-Based Study

Abstract

OBJECTIVE: Our understanding of the influence of maternal race/ethnicity and nativity and childhood autistic disorder (AD) in African Americans/blacks, Asians, and Hispanics in the United States is limited. Phenotypic differences in the presentation of childhood AD in minority groups may indicate etiologic heterogeneity or different thresholds for diagnosis. We investigated whether the risk of developing AD and AD phenotypes differed according to maternal race/ethnicity and nativity. METHODS: Children born in Los Angeles County with a primary AD diagnosis at ages 3 to 5 years during 1998–2009 were identified and linked to 1995–2006 California birth certificates (7540 children with AD from a cohort of 1 626 354 births). We identified a subgroup of children with AD and a secondary diagnosis of mental retardation and investigated heterogeneity in language and behavior. RESULTS: We found increased risks of being diagnosed with AD overall and specifically with comorbid mental retardation in children of foreign-born mothers who were black, Central/South American, Filipino, and Vietnamese, as well as among US-born Hispanic and African American/black mothers, compared with US-born whites. Children of US African American/black and foreign-born black, foreign-born Central/South American, and US-born Hispanic mothers were at higher risk of exhibiting an AD phenotype with both severe emotional outbursts and impaired expressive language than children of US-born whites. CONCLUSIONS: Maternal race/ethnicity and nativity are associated with offspring’s AD diagnosis and severity. Future studies need to examine factors related to nativity and migration that may play a role in the etiology as well as identification and diagnosis of AD in children.

Changes in Prevalence of Autism Spectrum Disorders in 2001–2011: Findings from the Stockholm Youth Cohort

“…Similarly, disparities in access to services and/ or ascertainment and diagnostic bias have been thought to contribute to lower prevalence of ASD without intellectual disability among individuals of migrant background from (Haglund and Kallen 2011;Magnusson et al 2012), a finding observed also in the current study. Our finding of ASD with intellectual disability being more prevalent among children born to migrant parents is in line with recent studies from the USA (Becerra et al 2014), and several European countries (Keen et al 2010;Haglund and Kallen 2011;Magnusson et al 2012;Lehti et al 2013;van der Ven et al 2013;Bolton et al 2014). However, further populationbased studies are needed to disentangle the mechanisms underlying associations between ethnic origin, migration and ASD.…”

Predictors of Age of Diagnosis for Children with Autism Spectrum Disorder: The Role of a Consistent Source of Medical Care, Race, and Condition Severity

“…Sell et al (2012) found that African American children had higher rates of object preoccupations and inflexible routines, while Caucasian children demonstrated more unusual sensory stimuli preoccupations and abnormal motor development. Becerra et al (2014) found that ethnic minority children were more likely to display ASD phenotypes with severe emotional outbursts and impaired expressive language than Caucasian children. Consequently, primary care physicians trained to identify typical or common ASD presentations may overlook minority children displaying phenotypic differences.…”

“…Besides those variables studied, physician training has been identified as an important variable in ASD diagnosis (Fiscella et al 2014;Fountain et al 2011;Heidgerken et al 2005). Differences in training of physicians serving primarily Caucasian versus African American populations may elucidate group differences, especially given different phenotypic expressions of ASD seen in the literature (Becerra et al 2014;Sell et al 2012). Implicit and explicit bias of physicians serving minority patients would also be worthwhile to study.…”

‘You are labelled by your children’s disability’ – A community-based, participatory study of stigma among Somali parents of children with autism living in the United Kingdom

“…Children of migrant parents living in western countries are more likely to have an autism diagnosis than the general population, particularly autism with intellectual disability (Becerra et al 2014;Bolton et al 2014). …”