Racial Differences in a Sample of Inpatient Youth with Autism Spectrum Disorder

Background: Research in atypically developing Black youth has found significant disparities in symptoms/behavioral profiles. However, there is limited research examining symptom profile differences between Black youth with ASD and youth with ASD from other racial groups. Furthermore, results have been inconsistent across the few studies that have looked at symptom profile differences by race and none of these studies have examined the inpatient population of youth with ASD.

Objective: The current study evaluated differences between Black and White inpatient youth with ASD, regarding: demographic & health-related characteristics; problem behaviors; communication; and, social functioning.

Methods: Participants were recruited as part of the Autism Inpatient Collection – a multi-site study enrolling youth diagnosed with ASD between the ages of 4 and 20 from six specialized inpatient psychiatry units in the US. Research-reliable Autism Diagnostic Observation Schedule (ADOS) testers administered the ADOS to confirm ASD diagnosis. Nonverbal IQ was assessed using the Leiter-3.  Problem behaviors were measured using the Aberrant Behavior Checklist – Community; adaptive functioning was assessed using the Vineland-II; and, social functioning using the ADOS-2 social affect summary score. Data were analyzed with chi-square difference tests, independent samples t-tests, and linear regression.

Results: Of the 654 youth in the sample, the majority were male (79%) and the mean age was 13.1 years (SD = 3.4). Approximately 88% of youth were White and 12% were Black. Black youth were more likely to be non-verbal or minimally verbal (70%), compared to White youth (50%; p = .001). Black youth had significantly lower mean nonverbal IQ scores (M = 61.0, SD = 24.0) in comparison to White youth (M = 74.1, SD = 28.5; p = .002). Black youth with ASD had significantly lower written communication scores (p = .019) and had greater impairment regarding community daily living skills (p = .016) in comparison to White youth. Black youth also had significantly greater impairment regarding social functioning, compared to White youth (p = .044). Lastly, Black youth had greater levels of inappropriate speech (p = .039), although there were no other differences in behavioral symptomology between races.

Conclusion: This study highlighted significant racial disparities in psychiatric inpatient care among youth with ASD. Black psychiatric inpatient youth with ASD had overall lower functioning than White youth, as evidenced by lower nonverbal IQs and a higher proportion who are minimally verbal, as well as more impaired social functioning. The results pertaining to nonverbal IQ are consistent with previous research in other settings. However, few other differences in specific skill deficits or problem behaviors emerged between Black and White inpatients. Given that all participants had marked problem behaviors that necessitated inpatient hospitalization, future research should investigate this association in a broader sample.