A comparison of autism spectrum disorder DSM-IV criteria and associated features among African American and white children in Philadelphia County.
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.
The Children's Hospital of Philadelphia, Division of Child Development, Rehabilitation and Metabolic Disease, Philadelphia, PA 19104, USA. nsell@barnabashealth.org
Neelam Kharod
NK
Sell
Ellen
E
Giarelli
Nathan
N
Blum
Alexandra L
AL
Hanlon
Susan E
SE
Levy
D001741:Black or African American; D001526:Behavioral Symptoms / Q000175:diagnosis / Q000208:ethnology*; D002648:Child; D002652:Child Behavior / Q000208:ethnology; D002657:Child Development; D002659:Child Development Disorders, Pervasive / Q000175:diagnosis / Q000208:ethnology*; D003192:Compulsive Behavior / Q000175:diagnosis / Q000208:ethnology; D002658:Developmental Disabilities; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D008297:Male; D009048:Motor Skills; D009770:Obsessive Behavior / Q000175:diagnosis / Q000208:ethnology; D010414:Pennsylvania; D015143:Philadelphia; D015995:Prevalence; D012677:Sensation; D044465:White People