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Lesson 1: Overview of Autism Spectrum Disorders

Missing the Diagnosis

One of the other challenges with diagnosing ASD relates to 1) stereotypes, biases, and perceptions, as well as 2) the manner in which the assessment and screeners were created. The article by Bradshaw and colleagues (2021) also describes how despite so much improved knowledge about ASD, a great deal of misinformation and stereotyping remains. Because of this stereotyping, some people may miss the ASD diagnosis. 

 

Girls and ASD 

Despite the common perception that the greater prevalence of ASD in boys rather than girls is due to some biological difference, research has revealed that girls may be underdiagnosed with ASD. This may be due to two phenomena. One is that most of the ASD assessments and screeners were created based on boys and children without ASD. This may misrepresent the range of presentations among children with ASD (e.g., preferences, behaviors, dispositions). The second issue relates to a phenomenon called masking or camouflaging. Masking and camouflaging relate to the person’s hiding of their presentations, support needs, and behaviors associated with ASD to appear as a person without ASD. Research has supported that girls may in fact engage in this behavior, which leads to their underdiagnoses. 

Check out this TikTok from Paige Layle who talked about masking in girls and how this relates to the low-functioning/high-functioning presumption. 

 

ASD and the Black Community: Racial and Ethnic Inequities

Picture of a Black child looking at a picture book in pre-school

Another source of missed diagnosis is due to racial and ethnic inequities in assessment, screening, and access to care. Despite how rates of ASD identification have increased, research has shown how Black children with ASD continue to be underdiagnosed for ASD, leading to delays in services and interventions. Much of these relates to racialized perceptions and stereotypes held by practitioners who are conducting assessments, which impact children and their families.

 In a research study on parents’ racialized experiences by Culver and colleagues (2024), one mother, Deborah, described what she was told by her child’s provider, “Each time when I requested autism testing, I was told that he didn’t look like he had autism and so they didn’t see it as being necessary” (p. 5). 

For this reason, providers need to have cultural competence and engage in self-reflection to assess their own perceptions, assumptions, or lack of familiarity with the range of presentations of ASD across social identities. For more information on this topic, check out this resource from the Child Mind Institute which describes some of the issues and the implications. 


Self Check Activity 1

 

Self Check Activity 2

Match the name of each assessment tool with its correct description or purpose. Type A, B, C, etc. in each text box, then select Submit at the bottom.
 
  • A. The Autism Diagnostic Interview (Revised)
  • B. The Autism Diagnostic Observation Schedule (Generic)
  • C. The Social Communication Questionnaire
  • D. The Social Responsiveness Scale
  • E. Vineland Adaptive Behavior Scale

 

Solution
The Autism Diagnostic Interview (Revised)
A comprehensive interview with a parent or caregiver that is designed to assess the extent of autistic symptoms in an individual with a mental age of two and above
The Autism Diagnostic Observation Schedule (Generic)
A semi-structured assessment that assesses the three areas of impairment from the DSM-IV
The Social Communication Questionnaire
Presented in a yes/no format and intended to either investigate a child’s behavior over the past three months or assess ASD symptoms across an individual’s lifetime
The Social Responsiveness Scale
A rating scale completed by a parent or teacher that measures the severity of autism symptoms
Vineland Adaptive Behavior Scale
Assesses a child’s ability to care for him/herself

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