Autism Assessment with English-Spanish Bilingual Individuals in the United States

There is limited clinical guidance on best autism assessment practices for bilingual individuals. This study aimed to examine whether Spanish-English bilingual participants display varying levels of autism symptoms on the Autism Diagnostic Observation Schedule, Second Edition (ADOS-2) when it is administered in English compared to Spanish, and whether these differences are associated with participants' dominant language. Furthermore, we explored how often participants met the ADOS-2 autism cutoff scores on both the Spanish and English administrations and compared percentages. We then used generalized linear models with random effects to examine whether the language of ADOS-2 administration (English or Spanish) predicted autism severity scores, depending on participants' Spanish exposure or usage [1-99%], while controlling for sex, verbal IQ, and autism diagnosis.

A total of 94 community-referred English-Spanish bilingual participants (age range = 1.5 years- 44.6 years) from predominantly low-income households were included, all with existing diagnoses of autism or other neurodevelopmental or mental health conditions.

We found that, on average, the ADOS-2 yields similar severity scores when it is administered in Spanish and English with bilingual individuals. Additionally, language of the ADOS-2 administration does not predict severity scores regardless of percentage of Spanish use or exposure.

We discuss how findings from this study can inform clinical practice in autism assessment for bilingual individuals, while acknowledging that language is only one aspect of culturally sensitive assessment and must be considered when working with bilingual families.