An Examination of Racial Bias in Scoring the Autism Diagnostic Observation Schedule (ADOS ) Module 3: An Item Response Theory Analysis

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Yu, Y. Y., Wyman, A., Faulk, C., Fulop, L., Greenberg, R. L., Benecke, R. M., Steinbeck, L. K., Foy, J., Kim, C., Emory, G. O., Storch, E. A., Zampella, C. J., Yerys, B., Schultz, R. T., Parish-Morris, J., Herrington, J., & Clements, C. C. (2025). An Examination of Racial Bias in Scoring the Autism Diagnostic Observation Schedule (ADOS ) Module 3: An Item Response Theory Analysis. Autism Research, 19(2), Article e70155. https://doi.org/10.1002/aur.70155

Publication date: 23 Dec 2025 Added to AutiHub: 4 Oct 2026 Type: Article Article language: English
Publisher source (DOI) Full text OpenAlex source

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Authors

Publication authors
17
Publication authors identified as autistic
1 / 17 (5.9%)
  1. Yuen Yvonne Yu
  2. Austin Wyman *
  3. Calliana Faulk
  4. Lizzy Fulop
  5. Rebecca L. Greenberg
  6. Rachel M. Benecke
  1. Lauren K. Steinbeck
  2. Jessica Foy
  3. Caitlyn Kim
  4. George O. Emory
  5. Eric A. Storch
  6. Casey J. Zampella
  1. Benjamin Yerys
  2. Robert T Schultz
  3. Julia Parish-Morris
  4. John Herrington
  5. Caitlin C Clements

Abstract

ABSTRACT Given the rising prevalence of autism among racial minority children in the United States, but persistent service use disparities, this study examines potential bias in specific items from the autism diagnostic observation schedule (ADOS), a highly regarded autism evaluation. We leveraged unidimensional item response theory graded response models and a sample of 735 children to analyze the differential item functioning (DIF) of items within ADOS Module 3. Three items showed significant signs of racial bias: A1 (overall language level), A5 (offers information), and D5 (compulsions and rituals). On these items, Black/African American and Asian children were usually more likely to be rated as showing autistic behaviors than White children with similar autism levels. The impact of racial bias on the item score was small, and the impact on the overall test score was even smaller: on a scale of 0–48 points, the effect of racial bias was estimated at 0.23 total points for Black/African American children and 0.16 points for Asian children. Furthermore, none of the items showing significant bias contribute to the autism classification algorithm. This analysis suggests a small but detectable amount of bias in several specific ADOS items, but not in items central to informing an autism diagnosis. Thus, bias appears statistically, but not clinically, significant. This contributes to examinations of racial bias in the ADOS as the first analysis of Asian children and the first in‐depth look at all items in the most commonly used version among school‐aged children.

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Cited bibliography overview

These indicators describe the bibliography cited by this publication. An author name is counted each time it appears in one cited reference, so the same person can be counted more than once. Names not yet linked to an author already present in AutiHub are treated as unknown, not as non-autistic. Last computed: 17 Oct 2026 01:01.

Cited references
30
With a DOI
22
Without a DOI, from raw bibliography text
8
3 / 30 (10.0%) cited references include at least one author identified as autistic.
References with data to complete
1 / 30 (3.3%)
References with detected author names
29 / 30 (96.7%)
Without detected author names
1
Without a structured title
1
Without a stable identifier
8
References with raw author names still to review
1
References with external metadata lookup issues
0
These indicators apply to cited references displayed on this page, after technical duplicates have been merged. A reference without a DOI can still support author statistics when a title and author names are available.
Author names detected in the cited bibliography
178
From DOI or external metadata
178
From validated raw bibliography text
0
Raw names already validated
0
Raw names still to review
1
31 / 178 (17.4%) names are linked to an author already present in AutiHub. 147 / 178 (82.6%) names are not yet linked.
Names linked to a person identified as autistic
4 / 178 (2.2%)
Calculated across all author names detected in the cited bibliography. Among names linked to an author already present in AutiHub: 4 / 31 (12.9%). Distinct people identified as autistic: 4 / 167 (2.4%).
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