Addressing bias in gold-standard autism assessments to improve the early identification of young Black and Latinx children - Abstract
For children with autism spectrum disorder (ASD), receipt of early intervention (EI) requires accurate early
identification via provision of high quality ASD assessment tools that inform clinicians ability to provide accurate
and timely diagnoses.1--11 Timely receipt of EI for ASD is critical for ensuring optimal long term developmental
outcomes.12-21 Critically, missed or later identification of Black and Hispanic children are commonly reported with
those identified often having higher rates of intellectual disability and more severe developmental delays.22-29 A
small body of literature suggests that ASD assessments may misclassify Black or Hispanic children;
misclassification could result in families of children with ASD taking on the costs of unnecessary assessments
or missing vital EI services.20,30-34 Critically, there are few research studies showing that the two most widely
recommended and researched ASD assessment tools, the Autism Diagnostic Schedule (ADOS) and the Autism
Diagnostic Interview-Revised (ADI-R), are equally valid and reliable for use with Black or Hispanic populations
as they are for White populations.35-122 The majority of ADOS and ADI-R studies do not even provide descriptive
race or ethnicity data42-67,110-121; even when reported these are not usually analyzed.68-90,100-109 Further, while there
is a reasonably robust factor analytic literature on these tools, most studies include a wide range of age groups,
and none have sought to establish whether these tools are psychometrically equivalent for use with White, Black,
and Hispanic children.100-121 To date, a few smaller clinical studies have investigated ADOS and ADI-R scoring
in Hispanic and Black children91-98; two single well powered studies identified ADOS item level differences
between White, Black and Hispanic children, with some items displaying large effects.122,123 There is a clear need
for psychometric studies establishing that the ADOS and ADI-R’s factor structure, diagnostic accuracy, reliability,
and convergent and divergent validity are equitable for identifying ASD in young Black and Hispanic children.
The literature is largely silent on the psychometric equivalence of the ADOS and ADI-R in terms of the factor
structure, convergent and divergent validity, reliability, and diagnostic accuracy for identifying young Black and
Hispanic children. To address these limitations, the current study aims to: 1) determine if the factor structures of
the ADOS and ADI-R are equal for White, Black, and Hispanic children between the age of 3 and 5; 2) create
adapted scales displaying equal factor structures, convergent validity, divergent validity, and internal reliability
across groups; 3) compare the diagnostic accuracy, of established and adapted ADOS and ADI-R scales across
White, Black and Hispanic children; and 4) conduct sensitivity analyses to determine if other relevant variables
(e.g., child sex, maternal education) impact identified outcomes. All analyses will be conducted on data from the
Study to Explore Early Development (SEED) dataset, a large, demographically diverse, multi-state case control
study of children with ASD and DD between 3 and 5 years old with excellent phenotypic characterization.
