Racial and ethnic disparities in the co-occurrence of intellectual disability and autism: Impact of incorporating measures of adaptive functioning.
Sarah M Furnier, Ronald Gangnon, Julie L Daniels and 9 others
PMID 38415400WHAT IT FOUND
Adding adaptive behavior scores to IQ tests reduced the estimated prevalence of co-occurring intellectual disability in autistic preschoolers from 62.9% to 38.0%.
This change also reduced racial disparities, with no group showing significantly higher odds than White children when both criteria were used.
Key findings
01Using IQ scores alone classified 62.9% of children with autism as having co-occurring intellectual disability, but requiring low adaptive behavior scores as well reduced this estimate to 38.0%.
02When intellectual disability was defined by IQ alone, Black and Hispanic children had significantly higher odds of meeting criteria than White children, but these disparities were no longer statistically significant when adaptive behavior scores were included in the definition.
03The reduction in estimated intellectual disability prevalence after adding adaptive criteria was largest for Black children (30.1 percentage points) and smallest for White children (21.8 percentage points).
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
The study focused on preschool children (aged 2–5 years), a group for whom intellectual disability is not typically diagnosed due to instability in cognitive scores. Results may not apply to older children. The MSEL may underestimate cognitive ability in young children with autism due to testing difficulties, potentially inflating initial intellectual disability estimates. A floor effect was observed, with 31% of children scoring the minimum on the MSEL composite and 37% on the visual reception subscale. Hispanic children were assessed with translated but not normed measures, which may affect score validity. Socioeconomic confounders were adjusted for, but household income and parental education may not fully capture the impact of structural racism or environmental disadvantages. Sample sizes for Asian or Pacific Islander and multiracial children were small, limiting statistical power for these groups.
Declared interests
The authors declare no conflicts of interest. The study was supported by the CDC and NIH.
The easy way to misread this
Do not interpret the reduction in racial disparities as evidence that bias has been eliminated from diagnosis. The disparities in odds ratios became non-significant when adaptive scores were added, but point estimates remained elevated for Black and Hispanic children, suggesting underlying differences in access to services or testing validity may still exist.