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David S. Mandell, ScD, Lisa D. Wiggins, MS, Laura Arnstein Carpenter, PhD, BCBA, Julie Daniels, PhD, Carolyn DiGuiseppi, MD, PhD, Maureen S. Durkin, PhD, DrPH, Ellen Giarelli, EdD, Michael J. Morrier, MA, BCBA, Joyce S. Nicholas, PhD, Jennifer A. Pinto-Martin, PhD, Paul T. Shattuck, PhD, Kathleen C. Thomas, PhD, Marshalyn Yeargin-Allsopp, MD and Russell S. Kirby, PhD

David S. Mandell is with the Departments of Psychiatry and Pediatrics, University of Pennsylvania School of Medicine, Philadelphia. Lisa D. Wiggins and Marshalyn Yeargin-Allsopp are with the National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA. Laura Arnstein Carpenter is with the Division of Genetics and Developmental Pediatrics, Medical University of South Carolina, Charleston. Julie Daniels and Kathleen C. Thomas are with the Cecil G. Sheps Center for Health Services Research, Chapel Hill, NC. Carolyn DiGuiseppi is with the Department of Epidemiology, Colorado School of Public Health, University of Colorado, Denver. Maureen S. Durkin is with the Departments of Population Health Sciences and Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison. Ellen Giarelli and Jennifer A. Pinto-Martin are with the University of Pennsylvania School of Nursing, Philadelphia. Michael J. Morrier is with the Emory Autism Center, Emory University School of Medicine, Atlanta, GA. Joyce S. Nicholas is with the Departments of Biostatistics, Bioinformatics, and Epidemiology and Neurosciences, Medical University of South Carolina, Charleston. Paul T. Shattuck is with the George Warren Brown School of Social Work, Washington University, St Louis, MO. Russell S. Kirby is with the Department of Community and Family Health, University of South Florida, Tampa.

Correspondence: Requests for reprints should be sent to David S. Mandell, University of Pennsylvania School of Medicine, Center for Mental Health Policy and Services Research, 3535 Market Street, 3rd Floor, Philadelphia, PA 19104 (e-mail: mandelld{at}mail.med.upenn.edu).

Objectives. We sought to examine racial and ethnic disparities in the recognition of autism spectrum disorders (ASDs).

Methods. Within a multisite network, 2568 children aged 8 years were identified as meeting surveillance criteria for ASD through abstraction of evaluation records from multiple sources. Through logistic regression with random effects for site, we estimated the association between race/ethnicity and documented ASD, adjusting for gender, IQ, birthweight, and maternal education.

Results. Fifty-eight percent of children had a documented autism spectrum disorder. In adjusted analyses, children who were Black (odds ratio [OR] = 0.79; 95% confidence interval [CI] = 0.64, 0.96), Hispanic (OR = 0.76; CI = 0.56, 0.99), or of other race/ethnicity (OR = 0.65; CI = 0.43, 0.97) were less likely than were White children to have a documented ASD. This disparity persisted for Black children, regardless of IQ, and was concentrated for children of other ethnicities when IQ was lower than 70.

Conclusions. Significant racial/ethnic dispatrities exist in the recognition of ASD. For some children in some racial/ethnic groups, the presence of intellectual disability may affect professionals' further assessment of developmental delay. Our findings suggest the need for continued professional education related to the heterogeneity of the presentation of ASD.

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