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Differences in Autism Symptoms Between Minority and Non-Minority Toddlers


Little is known about whether early symptom presentation differs in toddlers with ASD from ethnic minority versus non-minority backgrounds. Within a treatment study for toddlers with ASD, we compared 19 minority to 65 Caucasian children and their parents on variables obtained from the Mullen Scales of Early Learning, Autism Diagnostic Observation Schedule, and Communication and Symbolic Behavior Scales Caregiver Questionnaire. The majority of parents were from the upper classes irrespective of ethnic membership. Minority children had lower scores in language, communication, and gross motor than non-minority children. Findings indicate that subtle communication delays may be undetected or presumed unremarkable by parents of minority toddlers, and that more significant delays are needed to prompt the search for intervention services.

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Fig. 1



Autism spectrum disorders


Diagnostic and statistical manual IV, text revision


Communication and Symbolic Behavior Scales Developmental Profile


Autism Diagnostic Observation Schedule


Socio-economic status


  • American Psychological Association. (2000). Diagnostic and statistical manual of mental disorders; volume IV-TR. Washington, DC: American Psychological Association.

    Google Scholar 

  • Begeer, S., Bouk, S. E., Boussaid, W., Terwogt, M. M., & Koot, H. M. (2009). Underdiagnosis and referral bias of autism in ethnic minorities. Journal of Autism Developmental Disorders, 39, 142–148.

    Article  Google Scholar 

  • Centers for Disease Control and Prevention (CDC). (2006). Mental health in the United States: Parental report of diagnosed autism in children aged 417 yearsUnited States, 20032004. Retrieved from

  • Centers for Disease Control and Prevention (CDC). (2010). Autism spectrum disorders (ASDs): What should you know? Retrieved from

  • Costello, E. J., Keeler, G. P., & Angold, A. (2001). Poverty, race/ethnicity and psychiatric disorder: A study of rural children. American Journal of Public Health, 91, 1494–1498.

    PubMed  Article  Google Scholar 

  • Cuccaro, M. L., Brinkley, J. S., Abramson, R. K., Hall, A., Wright, H. H., Gilbert, J. R., et al. (2007). Autism in African–American families: Clinical-phenotypic findings. American Journal of Medical Genetics Part B: Neuropsychiatry Genetics, 144, 1022–1026.

    Article  Google Scholar 

  • Danesco, E. R. (1997). Parental belief on childhood disability: Insights on culture, child development and intervention. International Journal of Disability, Development and Education, 44, 41–52.

    Article  Google Scholar 

  • Desai, P. P., Hendrie, H. C., & Evans, R. M. (2003). Genetic variation in apolipoprotein D affects the risk of Alzheimer disease in African–Americans. American Journal of Medical Genetics Part B: Neuropsychiatry Genetics, 116, 98–101.

    Article  Google Scholar 

  • Durkin, M. S., Maenner, M. J., Meaney, F. J., Levy, S. E., DiGuiseppi, S., Nicholas, J. S., et al. (2010). Socioeconomic inequality in the prevalence of autism spectrum disorder: Evidence from a U.S. cross-sectional study. PLoS ONE, 5(7), e11551. doi:10.1371/journal.pone.0011551.

    PubMed  Article  Google Scholar 

  • Fombonne, E. (2003). Epidemiological surveys of autism and other pervasive developmental disorders: An update. Journal of Autism and Developmental Disorders, 33, 365–382.

    PubMed  Article  Google Scholar 

  • Fountain, C., King, M. D., & Bearman, P. S. (2010). Age of diagnosis for autism: individual and community factors across 10 birth cohorts. Journal of Epidemiology and Community Health, 65, 503–510. doi:10.1136/jech.2009.104588.

    Google Scholar 

  • Gradin, C. (2008). Poverty among minorities in the United States: Explaining the racial poverty gap for Blacks and Latinos, Working Papers 96, Society for the Study of Economic Inequality. Retrieved from

  • Hilton, C. L., Fitzgerald, R. T., Jackson, K. M., Maxim, R. A., Bosworth, C. C., Shattuck, P. T., et al. (2009). Brief report: Under-representation of African Americans in autism genetic research: A rationale for inclusion of subjects representing diverse family structures. Journal of Autism and Developmental Disorders, 40, 633–639.

    Article  Google Scholar 

  • Hollingshead, A. B. (1975). Four factor index of social status. Working Paper, Department of Sociology, Yale University, New Haven.

  • Landa, R., Holman, K., & Garrett-Mayer, E. (2007). Social and communication development in toddlers with early and later diagnosis of autism spectrum disorders. Archives of General Psychiatry, 64, 853–864.

    PubMed  Article  Google Scholar 

  • Liptak, G. S., Benzoni, L. B., Mruzek, D. W., Nolan, K. W., Thingvoll, M. A., Wade, C. M., et al. (2008). Disparities in diagnosis and utilization of health services for children with autism: Data from the national survey of children’s health. Journal of Developmental and Behavioral Pediatrics, 29, 152–160.

    PubMed  Article  Google Scholar 

  • Lord, C., Rutter, M., DiLavore, P., & Risi, S. (1999). Autism diagnostic observation schedule. Los Angeles, CA: Western Psychological Services.

    Google Scholar 

  • Mandell, D. S., Ittenbach, R. F., Levy, S. E., & Pinto-Martin, J. A. (2007). Disparities in diagnoses received prior to a diagnosis of autism spectrum disorder. Journal of Autism and Developmental Disorders, 37, 1795–1802.

    PubMed  Article  Google Scholar 

  • Mandell, D. S., Listerud, J., Levy, S. E., & Pinto-Martin, J. A. (2002). Race differences in the age at diagnosis among Medicaid-eligible children with autism. Journal of the American Academy of Child and Adolescent Psychiatry, 4, 1447–1453.

    Article  Google Scholar 

  • Mandell, D., & Novak, M. (2005). The role of culture in families’ treatment decisions for children with autism spectrum disorders. Mental Retardation and Developmental Disabilities Research Reviews, 11, 110–115.

    PubMed  Article  Google Scholar 

  • Mandell, D. S., Novak, M. M., & Zubritsky, C. D. (2005). Factors associated with the age of diagnosis among children with autism spectrum disorders. Pediatrics, 116, 1480–1486.

    PubMed  Article  Google Scholar 

  • Mandell, D. S., Wiggins, L. D., Carpenter, L. A., Daniels, J., DiGuiseppi, C., Durkin, M. S., et al. (2009). Racial/ethnic disparities in the identification of children with autism spectrum disorders. American Journal of Public Health, 99, 493–498.

    PubMed  Article  Google Scholar 

  • Mullen, E. M. (1995). Mullen scales of early learning (AGS ed.). Circle Pines, MN: American Guidance Service.

    Google Scholar 

  • Pachter, L. M., & Dworkin, P. H. (1997). Maternal expectations about normal child development in 4 cultural groups. Archives of Pediatrics and Adolescent Medicine, 151, 1144–1150.

    PubMed  Article  Google Scholar 

  • Post, D. M., Cegala, D. J., & Marinelli, T. M. (2001). Teaching patients to communicate with physicians: The impact of race. Journal of the National Medical Association, 93, 6–12.

    PubMed  Google Scholar 

  • Rogers-Adkinson, D. L., Ochoa, T. A., & Delgado, B. (2003). Developing cross-cultural competence: Serving families of children with significant developmental needs. Focus on Autism and Other Developmental Disabilities, 18, 4–8.

    Article  Google Scholar 

  • Schopler, E., Andrews, C., & Strupp, K. (1979). Do autistic children come from upper middle class parents? Journal of Autism and Developmental Disorders, 9, 139–152.

    PubMed  Article  Google Scholar 

  • Veling, W., Susser, E., Van Os, J., Mackenbach, J. P., Selten, J. P., & Hoek, H. W. (2008). Ethnic density of neighborhoods and incidence of psychotic disorders among immigrants. American Journal of Psychiatry, 165, 66–73.

    PubMed  Article  Google Scholar 

  • Wetherby, A., & Prizant, B. (2002). CSBS DP manual: Communication and symbolic behavior scales developmental profile. Baltimore, MD: Paul H. Brookes.

    Google Scholar 

  • Zhang, J., Wheeler, J. J., & Richey, D. (2006). Cultural validity in assessment instruments for children with autism from a Chinese cultural perspective. International Journal of Special Education, 21, 109–114.

    Google Scholar 

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We would like to thank the toddlers and families who participated in this study. We also thank the research staff at the Kennedy Krieger REACH laboratory in the Center for Autism and Related Disorders who contributed to this project through scheduling, data organization, data collection, and data processing. Rebecca Landa, principal investigator, thanks the National Institute of Mental Health for support of her research through grant #154MH066417, the Maternal and Child Health Research Program—Maternal and Child Health Bureau (Combatting Autism Act), Health Resources and Services Administration, Department of Health and Human Services the Health Resources and Services Administration grant R40 MC 15594, and the Krieger Foundation for their funding.

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Correspondence to Rebecca J. Landa.

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Tek, S., Landa, R.J. Differences in Autism Symptoms Between Minority and Non-Minority Toddlers. J Autism Dev Disord 42, 1967–1973 (2012).

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  • Autism spectrum disorder
  • Toddlers
  • Early symptoms
  • Minority