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Autism Spectrum and Developmental Disorders

Association of Demographic Factors with an Autism-Specific Screener and Diagnostic Outcome in Young Children

(PS2-47) Association of Demographic Factors with an Autism-specific Screener and Diagnostic Outcome in Young Children

Friday, November 21, 2025
11:30 AM - 12:30 PM CST
Location: Elite Hall A, Level 1
Abstract Text: Autism is underdiagnosed in individuals of lower socioeconomic status, racial and ethnic minorities and females. A recent study (Lyall et al., 2025) using data from a US national consortium showed that Black and female children who demonstrate autistic traits on a parent-report questionnaire (Social Responsiveness Scale) have a lower likelihood of clinical diagnosis than White and male children. However, this finding has not yet been replicated in younger children using toddler screening. This study implemented a combined sample of 474 young children (ages 14-50 months) from two multi-site toddler screening studies (Study 1: Vivanti et al., 2024; Study 2: Wieckowski et al., 2021) that received autism screening with the Modified Checklist for Autism in Toddlers, Revised, with Follow-up (M-CHAT-R/F) during well-child visits and attended an autism diagnostic evaluation following positive screening on M-CHAT-R/F or another project screener, or primary care clinician concern (see Table 1). Logistic regressions were conducted to investigate associations between demographic factors (binary classifications of race [White/non-White], ethnicity [Latino/non-Latino], sex [male/female], and maternal education level [High School Education or less (or GED equivalent)/postsecondary education]) and autism-related outcomes (M-CHAT-R/F classification of low/high likelihood of autism, and diagnosis [autism/non-autism], determined by clinical best estimate). Chi-square analysis indicated significant study differences in M-CHAT-R/F likelihood and diagnostic outcome (both ps < .001), which warranted including study as a factor in the logistic regressions and cautious interpretation of findings. M-CHAT-R/F classification was significantly associated with diagnostic outcome, χ2 (1, N = 369) = 4.331, p = .037, with 53.4% concordance (49.6% of children having high likelihood of autism and an autism diagnosis, and 62.2% having low likelihood of autism and no autism diagnosis). Individuals with lower maternal education were 2.783 times more likely to screen positive on M-CHAT-R/F than individuals with higher maternal education (p = .007, 95% CI [1.318, 5.878]); no other factors were significantly related to screening classification (see Table 2). As the M-CHAT-R/F is a parent-report tool, maternal education may play a role in comprehension or interpretation of screener questions. It also is important to remember that as a brief screener, M-CHAT-R/F result should not be interpreted as definitive regarding final diagnosis. When considering diagnostic outcome, White participants were 1.876 times more likely to receive an autism diagnosis than non-White participants (p = .020, 95% CI [1.104, 3.188]). This racial difference in diagnostic rate is fairly consistent with the literature; however, it is interesting that there was not a corresponding race difference in the screen positive rate. This suggests a difference in parent and clinician impressions of autistic traits in association with race. These findings support prior evidence of inequities in the autism diagnostic process and suggests supports are needed for families of lower socioeconomic and minority backgrounds before, during, and after receiving an autism diagnosis.