Advancing Hózhó in Autism Assessment (AHAA) for Diné Families

2026

Indigenous children, including those who identify as Diné (Navajo, meaning "The People"), have inequitable access to autism spectrum disorder (ASD) diagnosis and treatment services. Inequitable service access for Indigenous children and their parents/guardians theoretically stems from the sociocultural factors embedded and intersecting at various ecological levels. Cultural values held by Indigenous parents/guardians of children with ASD influence their perceptions of and responses to their children's needs. Some Diné parents/guardians may view autistic behaviors as an expression of their child's uniqueness rather than a problem anchored to the term "disability." Differences in how ASD is perceived may also affect its assessment. For instance, an assessment conducted by a practitioner unfamiliar with the child's culture may be interpreted differently from one conducted by a practitioner familiar with the child's culture. Differences in the cultural responsiveness of assessment may ultimately contribute to disparities in diagnosis and access to other ASD services. Limited research has, however, been conducted on the cultural responsiveness of ASD assessment practices with Indigenous children and their parents/guardians. The objective of Advancing Hózhó in Autism Assessment (AHAA) for Diné Families is to develop recommendations to ensure that ASD assessment practices and the context in which assessments occur are culturally responsive. Hózhó is a wellness philosophy that guides thoughts, speech, and behavior in Diné culture. Through a Hózhó lens, this study will advance knowledge on ASD assessment that is congruent with Diné culture. Our central hypothesis, substantiated through research examining practitioner confidence and expertise in working with diverse children and families, is that a lack of culturally responsive ASD assessment practices used with Diné children and parents/guardians, as well as the contexts in which assessments occur, contributes to inaccurate ASD diagnosis and inequitable ASD services access. Our long-term goal is to ensure that ASD services are culturally responsive for Diné families and reduce persistent Indigenous ASD inequities. This community-engaged, mixed methods study will employ a convergent design and will build upon the National Institute on Minority Health and Health Disparities-funded Diné Parents Taking Action to Improve Services Access for Children with Autism pilot project (MPI: Lindly/Henderson). This study's methods will be informed by the engagement of a community advisory panel that includes ASD practitioners in the Navajo Nation, Diné parents/guardians of children with ASD, and autistic self-advocates. Our interdisciplinary team is uniquely positioned to conduct this work due to more than 30 years of combined clinical and research experience with Diné children with ASD and their parents/guardians on the Navajo Nation. Research team members span disciplines from speech and language pathology, special education, public health, and clinical psychology.

Adolescent Health, Mental/Behavioral Health – Autism, Early Childhood – Developmental Health (including developmental screening), Early Childhood – General, Health Equity, Mental/Behavioral Health – General , Children, Adolescents, and Young Adults with Special Health Care Needs

Performing Research or Evaluation

Quality Assurance, Child Care-Related Activities, Health-Related Activities

Professionals and Para-Professionals, Family Members/Caregivers, Children/Adolescents with Disabilities/SHCN

Racial or Ethnic Minorities, Geographic Areas, Reservation, Specific Groups

Regional

Federal

N/A