Racial and Ethnic Inequities in Autism Treatment Effects: : A Meta-Analysis Using the National Database for Autism Research

In the long-term Black people Indigeneous people and people of color (BIPOC) with autism spectrum disorder (ASD) experience more severe ASD symptoms relative to their White peers. The ASD field is faced with a key question of whether these disparities are driven by inequitable treatment access and implementation alone or whether differential treatment efficacy also contributes. The question of differential treatment efficacy represents a large evidence gap because ASD treatment trial investigators often struggle to enroll sufficiently diverse samples to test treatment efficacy for specific subgroups based on race and ethnicity. Consequentially there is extremely limited evidence to show that evidence-based treatments as designed and tested are equitably efficacious for BIPOC. In this study we will address this evidence gap by combining data from multiple ASD treatment trials and employing innovative individual participant data (IPD) meta-analysis and meta-regression methods. We have selected and accessed nine ASD treatment trial datasets archived in the NIMH's National Database for Autism Research (NDAR). Together these form our combined trial database which has a total of 691 participants and sufficient representation of BIPOC to detect heterogeneity of treatment effects by race and ethnicity. To minimize the selection bias that would otherwise arise from only including NDAR-archived trials in our study we will supplement these NDAR data with data from additional trials identified through an existing relevant systematic review that members of our study team are currently conducting for the U.S. Preventive Services Task Force. Our study findings will demonstrate the extent to which ASD evidence-based treatment effects vary by race and ethnicity while also exploring other potential child and family participant-level variables (e.g. child gender) and trial-level variables (e.g. treatment dosage) that may also influence treatment effects. If non-significant our main findings will support the notion that the evidence-based treatments examined are equitably efficacious across racial and ethnic populations. This would signal the need to further focus on efforts to improve equity in the access to and implementation of evidence-based treatments. Alternatively significant mainfindings would imply inequitable treatment effects that must be addressed through further development refinement and testing of treatments. In either case this study will build neededknowledge to support the use of ASD treatments that are equitably efficacious for BIPOC and White children