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Poster #42 - Parent-report of Child Social Behaviors Drives Diagnostic Status in a Diverse Low-income Research Sample

Thu, March 21, 12:30 to 1:45pm, Baltimore Convention Center, Floor: Level 1, Exhibit Hall B

Integrative Statement

Background: Gold-standard evaluation for Autism Spectrum Disorders (ASD) includes multi-informant report and clinician-trained observation of child behavior (Ozonoff, Goodlin-Jones, & Solomon, 2005). Discrepancies between caregiver-clinician report are more likely in ASD samples of young children of color and samples with higher IQs (Neuhaus, Beauchaine, Bernier, & Webb, 2018). ASD in particular may be at risk for such discrepancy due to its shared features with other childhood disorders like Attention-Deficit Hyperactivity Disorder (ADHD) (Miodovnik, Harstad, Sideridis, &Huntington, 2015). The present study examined patterns of diagnosis based on parent-reported concerns as part of referral for participation in a clinical research trial.
Method: This community sample (n=131) included caregivers of children with ASD or ADHD, ages 7-11, enrolled in Title I schools that were participating in a clinical trial of two executive function interventions. Caregiver response to a brief screening measure gauging for social and repetitive behaviors was used to determine if a child would be assessed for ADHD or ASD. After screening, parents of children suspected of ASD completed the Social Communication Questionnaire (SCQ) and clinicians administered Module 3 of the Autism Diagnostic Schedule, Second Edition (ADOS-2). Parents of children suspected of ADHD completed the ADHD Rating Scale and clinicians administered the ADHD module of the Mini International Neuropsychiatric Interview MINI (Mini): Kid. We examined ethnic-racial differences in parent-report of child behavior in relation to clinician-reported diagnosis.
Results: Clinician-reported diagnosis differed significantly between ethnic-racial groups F(2,128)=5.902, p=0.004. Post-hoc Tukey comparisons revealed significant differences between the African-American and White (p=0.02) and White and Latino (p=0.01) child sample, but not between African-American and Latino children (p=0.10). The relationship between research diagnostic group and ethno-racial group was significant, X2(2, N=131)=11.06, p=0.004, where African-American and Latino children were less likely than White children to meet for ASD criteria than ADHD criteria. However, one-way ANOVAs indicated no significant differences between groups on the ADOS-2, SCQ, MINI Kid, and ADHD Rating Scale, the measures on which research diagnoses were based. Parent-report of prior clinical diagnosis also did not differ significantly between ethno-racial groups overall.
Conclusion: Minority children were less likely to be diagnosed for autism than their White counterparts, despite minimal reported differences on gold-standard diagnostic tools. This gap in diagnosis is likely driven by the initial parent-report of child social behaviors, which was used as the determining factor for which diagnostic (ADHD or ASD) procedure would be followed. This research suggests that screening procedures may benefit from integrated parent-report and trained clinical observation to assess for social behaviors that would elicit concern for ASD. Efforts are needed to raise parents' awareness of typical social development and warning signs for ASD in older, non-intellectually disabled children, particularly in communities of color.

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