Autism Spectrum Disorders: Racial Disparities and Treatment
How ethnicity impacts Autism Spectrum Disorders diagnosis & treatment
Posted March 1, 2013
Autism is a group of developmental brain disorders, commonly called autism spectrum disorder (ASD). The term "spectrum" refers to the wide range of symptoms, skills, and levels of impairment, or disability, that children with ASD can have. ASD is diagnosed according to guidelines listed in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition - Text Revision (DSM-IV-TR). Symptoms of autism spectrum disorder (ASD) vary from one child to the next, but these children typically have difficulties in three areas: social impairments (e.g., lack of interest in peer relationships, impaired non-verbal behavior), communication difficulties (e.g., delayed speech, repetitive language), and stereotyped behaviors or restricted interest (e.g., hand flapping, preoccupied interest). The NIMH provides a guide for parents on understanding autism that is helpful for understanding the disorder and its treatment.
According to the CDC, about 1 in 88 children are identified with an autism spectrum disorder; and autism is reported to occur in all racial, ethnic, and socioeconomic groups. However, the research consistently notes that children of African American, Hispanic, and Asian decent are more likely to be identified later. The delay in identification seems to be two-fold, based on professionals’ impressions and parents’ recognition. For example, one study reported that African American children with ASD were often first diagnosed with ADHD, conduct disorder, or adjustment disorder (see Mandell et al., 2007). Additional reasons that ethnic minority children are diagnosed later include factors such as financial (e.g., inability to pay for specialty services), educational resources, and cultural/language barriers. More recently, research has found that ethnic minority children may have subtle communication delays compared to non-minority children that may be undetected or presumed unremarkable by parents of minority toddlers (Tek & Landa, 2012). As a result, for ethnic minority children more significant delays are needed to prompt early identification and the search for intervention services.
How is ASD treated?
While there's no proven cure yet for autism spectrum disorder (ASD), treating ASD early, can greatly reduce symptoms and increase your child's ability to grow and learn new skills. According to the NIMH, research has shown that intensive behavioral therapy during the toddler or preschool years can significantly improve cognitive and language skills in young children with ASD. There is no single best treatment for all children with ASD, but the American Academy of Pediatrics recently noted common features of effective early intervention programs. These may include:
• Starting as soon as a child has been diagnosed with ASD
• Having small classes to allow each child to have one-on-one time with the therapist or teacher and small group learning activities
• Encouraging activities that include typically developing children, as long as such activities help meet a specific learning goal
• Providing a high degree of structure, routine, and visual cues, such as posted activity schedules and clearly defined boundaries, to reduce distractions
• Guiding the child in adapting learned skills to new situations and settings and maintaining learned skills
• Social skills, such as joint attention (looking at other people to draw attention to something interesting and share in experiencing it)
• Self-help and daily living skills, such as dressing and grooming
• Cognitive skills, such as pretend play or seeing someone else's point of view
One type of a widely accepted treatment is applied behavior analysis (ABA). The goals of ABA are to shape and reinforce new behaviors, such as learning to speak and play, and reduce undesirable ones. ABA, which can involve intensive, one-on-one child-teacher interaction for up to 40 hours a week, has inspired the development of similar interventions that aim to help those with ASD reach their full potential. ABA-based interventions include: Verbal Behavior, Pivotal Response Training, and TEACCH (Treatment and Education of Autistic and related Communication handicapped Children), and Interpersonal Synchrony. For children younger than age 3, these interventions usually take place at home or in a child care center. Because parents are a child's earliest teachers, more programs are beginning to train parents to continue the therapy at home. Students with ASD may benefit from some type of social skills training program. While these programs need more research, they generally seek to increase and improve skills necessary for creating positive social interactions and avoiding negative responses.
Helpful links on autism spectrum disorders:
• All about Autism Spectrum Disorders http://www.nimh.nih.gov/health/topics/autism-spectrum-disorders-pervasive-developmental-disorders/index.shtml
• Facts on screening and diagnosis http://www.cdc.gov/ncbddd/autism/screening.html
• Autism Speaks http://www.autismspeaks.org
Copyright 2013 Erlanger A. Turner, Ph.D.
You can follow Dr. Turner on Twitter @DrEarlTurner for daily post on psychology, mental health, and parenting. Feel free to join his Facebook group, “Get Psych’d with Dr. T” to discuss today's blog, or to ask further questions about this posting.
Autism. National Institute of Mental Health. Retrieved February 2013 from http://www.nimh.nih.gov/health/publications/a-parents-guide-to-autism-s…
Autism Spectrum Disorders, Data and Statistics. Center for Disease Control (CDC). Retrieved February 2013 from http://www.cdc.gov/NCBDDD/autism/data.html
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.
Tek, S., & Landa R. J (2012). Differences in Autism Symptoms Between Minority and Non-Minority Toddlers, Journal of Autism and Developmental Disorders, 42, 9, 1967–1973. DOI 10.1007/s10803-012-1445-8