An Examination of Racial Bias in Scoring the Autism Diagnostic Observation Schedule (ADOS) Module 3: An Item Response Theory Analysis.
Yuen Yvonne Yu, Austin Wyman, Calliana J Faulk and 14 others
PMID 41437726WHAT IT FOUND
Clinicians rated Black/African American and Asian children as showing slightly more autistic behaviors than White children with similar autism levels on three ADOS items.
However, these items do not affect the final autism classification score, so the bias had negligible impact on diagnosis.
Key findings
01Three ADOS Module 3 items showed statistically significant differential item functioning by race, where Black/African American and Asian children were more likely to be rated as showing autistic behaviors than White children with equivalent latent autism levels.
02None of the items showing racial bias are included in the ADOS algorithm used to classify autism, resulting in little or no impact on the classification score.
03The overall impact of these biases on the total hypothetical ADOS score was very small, estimated at 0.23 points for Black/African American children and 0.16 points for Asian children on a 0–48 scale.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
The sample size for Asian children was very small (21 participants), which limited the statistical power to detect bias in this group. The study did not have data on participant dialect, bilingualism, or co-occurring language disorders, which could explain some of the scoring differences on language items. Clinician demographics (race and cultural background) were not available, so it is unclear if the bias stems from the raters' perspectives. Data were combined from 14 different studies over 15 years, using both the original ADOS and ADOS-2, which may introduce systematic differences in administration.
Declared interests
Funding was provided by multiple National Institutes of Health (NIH) grants. One author, Storch, reported receiving research funding from the Ream Foundation and International OCD Foundation, consulting for Brainsway and Biohaven Pharmaceuticals, owning stock in NView, and receiving book royalties from various publishers. Other authors reported no conflicts of interest.
The easy way to misread this
Do not assume this study proves the ADOS is culturally neutral or free of bias. It found that bias exists in how clinicians rate specific behaviors for Black/African American and Asian children, even though these specific items do not change the final diagnostic algorithm score. The bias still affects the clinical picture and report.
Summarised by AI from the full paper, without a clinician reviewing it. Check it against the source before it changes what you do. Read it on PubMed →