B-55: Diagnostic Sensitivity of the ADOS-2 in Hispanic/Latino Children With Autism Spectrum Disorder: A Literature Review of Cultural Validity and Barriers
Abstract
Objective: The Autism Diagnostic Observation Schedule, Second Edition (ADOS-2) is the gold-standard ASD diagnostic instrument for children, yet its normative sample predominantly includes White, English-speaking participants. Hispanic/Latino children experience significant ASD identification disparities, yet no study has evaluated ADOS-2 sensitivity in this population. This review examines whether ADOS-2 sensitivity in detecting social communication deficits varies in Hispanic/Latino children and identifies cultural factors limiting its accuracy. Method/Data Selection: Data were selected from PubMed (MEDLINE) and EBSCOhost (PsycINFO, CINAHL, Academic Search Complete) using terms related to ADOS-2, ASD, Hispanic/Latino, pediatric, and diagnostic accuracy, and were restricted to peer-reviewed English-language studies from 2007 to 2025. Of 101 records identified (54 PubMed; 47 EBSCOhost), 26 duplicates were removed, 75 titles and abstracts screened, and 14 studies met full-text inclusion criteria. Results/Data Synthesis: No included study reported ADOS-2 sensitivity or specificity in Hispanic/Latino pediatric samples. ADI-R studies found reduced sensitivity in Latino children across communication domains, paralleling ADOS-2 Social Affect items. A differential item functioning analysis (n = 6,269) found racial bias in 11% of ADOS-2 Social Affect items, yet explicitly excluded Hispanic/Latino children. The sole ADOS algorithm study in Hispanic children (2008) found inconsistent module specificity. Conclusions: A critical ADOS-2 validation gap exists for Hispanic/Latino children. Structural and cultural barriers, including limited availability of Spanish-language appointments, provider distrust, and systemic inequities, further constrain diagnostic accuracy. Given that Hispanic/Latino children now represent one of the fastest-growing pediatric populations in the United States, culturally adapted protocols, bilingual evaluators, and prospective item-level validation studies are urgently needed to promote equitable ASD diagnosis.