We compared preschool diagnostic eligibility categories in the U.S. and Puerto Rico for speech/ language impairment (SI), autism spectrum disorder (ASD), developmental delay (DD), and intellectual disability (ID) across three years (2016–2018). We observed higher reporting of ASD & SI in Puerto Rico as compared to the U.S., suggesting increased awareness and education towards these diagnoses. While there was higher identification for SI and ASD, there was lower identification for DD and ID in Puerto Rico, suggesting that cultural differences impact how these disabilities are defined and assessed. (author abstract)