The influence of race on parental beliefs and concerns during an autism diagnosis: A mixed-method analysis.
Gazi Azad, Calliope Holingue, Danika Pfeiffer and 6 others
PMID 34519568WHAT IT FOUND
Parents' belief that a child had ASD before diagnosis differed by race, from 80.3% of White parents to 40.8% of Asian parents.
Communication concerns were common, but their relation to clinician-rated severity varied by race.
Key findings
01Before diagnosis, parent belief that their child had ASD differed by race, with the highest proportion among White parents (80.3%) and the lowest among Asian parents (40.8%).
02The most common parent concerns were communication (61%), social (51%), and emotional/behavioral (48%).
03Parent belief that a child had ASD was associated with lower clinician-rated severity only in White children (β = -0.8). Concern about social communication was associated with higher severity only in Hispanic children (β = 5.26).
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
Race and ethnicity were combined into electronic health record categories, and the study did not capture more detailed culture or ethnicity information. The Hispanic group was 6% of the sample, and multiracial/other parents were 13% of the sample. Multiracial and other categories were collapsed because those groups were sparse. The study did not have child IQ or adaptive functioning data. ADOS-2 was administered by clinically trained providers, not research-reliable clinicians, and inter-rater reliability was not available. Clinician demographic data were not available, so possible provider factors were not examined. First evaluation status was based on parent report and could not be confirmed. Parent belief was measured with one yes/no question, and concerns were measured with one open-ended response. Some cultural groups may be reluctant to disagree with professional judgments, which could affect how concerns are stated. Data were collected through an online system, so families without web portal access may be underrepresented.
Declared interests
No conflicts of interest declaration is supplied. The article metadata indicates NIH extramural research support.
The easy way to misread this
Do not read parent concern wording as equally reliable for identifying ASD severity across all racial groups. The association between parent belief and lower clinician-rated severity was found only in White children, and some race differences in concerns changed after adjusting for child age.