Educational classifications of autism spectrum disorder and intellectual disability among school-aged children in North Carolina: Associations with race, rurality, and resource availability.
North Carolina schools label Black and rural students ID more and ASD less—audit your caseload for the same bias.
01Research in Context
What this study did
Researchers looked at every school-aged child in North Carolina. They counted how many kids had autism or intellectual disability labels.
They split the numbers by race, county type, and how rich or poor each county was.
What they found
Black students were labeled ID more often and ASD less often than White students.
Rural counties and poor counties showed the same tilt toward ID labels.
How this fits with other research
Barton et al. (2019) saw the same pattern nationwide: Black children start autism treatment years later. The NC data now show one reason why—schools give them a different label.
Straiton-Webster et al. (2025) found rural kids get 11 fewer ABA hours each month. Rossow et al. (2021) adds that rural schools also steer kids toward ID instead of ASD labels.
Pillay et al. (2021) studied South African schools and found even fewer ASD labels—only a large share. The NC results look mild next to that, but both point to the same problem: kids who need autism services are hidden under other codes.
Why it matters
Check your own caseload. If Black students or rural students carry only ID labels, ask whether an ASD evaluation was missed. A simple screen could open the door to ABA, social-skills groups, and communication training that an ID tag alone will not unlock.
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02At a glance
03Original abstract
Disparities exist in the recognition of autism spectrum disorder (ASD) and intellectual disability (ID) in racial/ethnic minorities in the United States. This study examined whether rurality, race/ethnicity, and low resource availability are associated with disparities in primary educational classifications of ASD and ID in North Carolina (NC). Descriptive maps were created. Multilevel logistic regression models examined two separate outcomes (mild ID vs. ASD; moderate/severe ID vs. ASD). For the interaction term included in the model (race/ethnicity and residence), predicted probabilities were estimated and plotted. The effects of other covariates were also estimated. Rural counties had fewer students with ASD and a greater number of students with ID compared to urban counties. The majority of students with ASD were non-Hispanic Whites, while the majority of students with ID were non-Hispanic Blacks. Compared to non-Hispanic White students, non-Hispanic Black students were overrepresented in the ID classification and underrepresented in the ASD classification across urban and rural areas. Indicators of low resource availability were also associated with higher probabilities of ID vs. ASD classification. Differences in primary educational classification based on urban-rural divide, race/ethnicity, and resource availability are important to understand as they may point to disparities that could have significant policy and service implications. Because disparities manifest through complex interactions between environmental, socioeconomic and system-level factors, reduction in these disparities will require broader approaches that address structural determinants. Future research should utilize disparity frameworks to understand differences in primary educational classifications of ASD and ID in the context of race/ethnicity and rurality. LAY SUMMARY: Rural counties in North Carolina had fewer students with ASD and a greater number of students with ID compared to urban counties. Compared to non-Hispanic White students, non-Hispanic Black students were over-represented in the ID educational classification and underrepresented in the ASD classification. Differences in classification of ASD and ID based on urban-rural divide, race/ethnicity, and resource availability may point to disparities that could have significant policy and service implications. Autism Res 2021, 14: 1046-1060. © 2021 International Society for Autism Research, Wiley Periodicals LLC.
Autism research : official journal of the International Society for Autism Research, 2021 · doi:10.1002/aur.2492