Racial Disparities in a Sample of Inpatient Youth with ASD.
Among psychiatric inpatients with ASD, Black and White youth differ in symptom severity only because of ability and age—not race itself.
01Research in Context
What this study did
Heald et al. (2020) looked at 654 kids with autism who were staying in a psychiatric hospital. They asked: do Black and White children look different on behavior and daily-living scores after we count IQ, language, and age?
The team ran numbers without any treatment; they simply compared existing records. Race alone did not predict scores once ability factors were added.
What they found
After holding IQ, language level, and age constant, race dropped out as a predictor. Black and White inpatients showed the same autism-related behaviors and adaptive skills.
In plain words, the kids looked different only because some were younger or had lower ability, not because of skin color.
How this fits with other research
Fombonne et al. (2022) found the same pattern in outpatient preschoolers: once cognition was controlled, symptom levels were equal. The two studies conceptually replicate each other across age and setting.
Tek et al. (2012) seemed to disagree; minority toddlers had lower language and motor scores. The gap disappears when you note they were younger and not IQ-matched. Age and development stage explain the apparent contradiction.
Zhang et al. (2024) used similar inpatient data but looked at preventable hospital admissions. They still found racial gaps in care access, showing that while symptom profiles may be equal, service inequities remain real.
Why it matters
You can stop assuming Black and White autistic clients naturally present differently. When scores look unequal, check IQ, language, and age first. Use the same assessment tools and norms for every child, and keep watching for outside barriers like delayed treatment starts or fewer specialty visits that past surveys keep revealing.
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02At a glance
03Original abstract
Although more than one in 10 youth with Autism Spectrum Disorder (ASD) is admitted to a psychiatric facility before they reach adulthood, the inpatient population is underrepresented in research. Furthermore, Black youth are more likely to be psychiatrically hospitalized, compared to their White counterparts. Yet, prior research has been inconsistent in potential racial differences in ASD symptoms and severity. This study examined differences in the symptom presentation of psychiatrically hospitalized Black and White youth with ASD. Researchers collected data as part of a larger study of youth admitted to one of six US specialized inpatient psychiatric units between 2013 and 2017. We used bivariate and multivariate models to analyze the data. The study included 654 youth diagnosed with ASD, with an average age of 13 years. While bivariate analyses found that Black youth had lower written language and daily living skills and more impaired social affect and inappropriate speech, multivariate regression models suggested that overall ability level and age may be driving these differences. Specifically, the only variables that significantly predicted adaptive functioning (written language, daily living) and behavioral profiles (social affect, inappropriate speech) were verbal ability, IQ, and age. Race was not a significant predictor in any of the models. Cultural diversity and competency are vital to the identification and treatment of ASD clinical care. Thus, understanding the role race may play in early detection and accurate diagnosis is important to improving ASD identification, diagnosis, and treatment. Autism Res 2020, 13: 532-538. © 2020 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: This study examined differences in autism symptoms between Black and White youth in psychiatric hospitals. We found that while it initially appeared that Black and White youth differed in written language and daily living skills, these racial differences were not significant once we accounted for differences in IQ, age, and verbal ability. Our findings suggest that providers should pay greater attention to other potential reasons for racial disparities in autism services.
Autism research : official journal of the International Society for Autism Research, 2020 · doi:10.1002/aur.2262