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Children with Autism Spectrum Disorder (ASD) are known to experience performance and participation challenges, with early diagnosis being critical for improved outcomes. Children from ethnic minority backgrounds tend to receive their diagnoses later, even when symptomatology is similar. This mixed methods study explored symptom severity, functional difficulties, and age at diagnosis for ASD and to describe the functional challenges encountered by preschool-aged children with ASD of African American descent. The International Classification of Functioning, Disability, and Health along with the Model of Human Occupation were the theories used for this study to conceptualize functional challenges and other potential factors. Research questions addressed symptom severity, degree of functional challenges, and age of diagnosis, and to gather family perspectives regarding functional challenges for preschool-aged children of African American descent. Data consisted of subpopulation responses from the 2009-2010 National Survey for Children with Special Healthcare Needs (N = 224) and locally-conducted interviews with parents (N = 3). No significant relationships were found using general linear model between age at diagnosis and symptom severity or degree of functional challenges. Qualitative themes included the diagnosis process, routines and transitions, communication, family and home environment, and school and community environments. Educators and health care providers need to enhance screening for early signs of ASD and consider racial and cultural implications related to performance and participation challenges. Social change implications include the development of effective and targeted awareness campaigns and improved diagnostic and intervention services for children with ASD from minority backgrounds and their families.