A comparison of autism spectrum disorder DSM-IV criteria and associated features among African-American and White children in Philadelphia county

Background: Racial differences have been 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. Objectives: This study explores documented differences in core features of ASD and associated behavioral features including externalizing behaviors among African American and White children with ASD. Methods: This project is a secondary analysis of data from the Pennsylvania Autism and Developmental Disabilities Surveillance Program (PADDSP). The sample comprised 343 children meeting surveillance case definition for ASD, from three birth-cohorts of children 8-years-old in years 2002, 2006 and 2008 in Philadelphia County. Results: This study found differences in impairment in spoken language and restricted behaviors among the two groups. There were also differences in some associated behavioral features. In this sample, White children with ASD were found to have more frequent documentation of abnormal motor development, sensory issues and seizures. African American children with ASD were found to have more frequent documentation of abnormal level of fear. There were no significant differences in documented externalizing behaviors, nor reciprocal social interaction (according to the DSM IV-TR criteria for qualitative impairments) in this population-based cohort. Conclusions: This pilot study finds differences in frequency of documentation of some DSM criteria and associated behavioral features among White and African American children with ASD. Further research is needed to clarify whether this is an observation or recording bias or a clinical difference that may affect symptom presentation and referral for services.