Screening may overcome ethnicity barriers to timely autism diagnosis
By Eleanor McDermid, medwireNews Reporter
Introduction of a screening protocol for autism spectrum disorder (ASD) increases the rate of diagnosis, with Spanish-speaking families being the greatest beneficiaries, report researchers.
R Christopher Sheldrick (Boston University, Massachusetts, USA) and study co-authors say that their multistage screening protocol “emphasizes ASD screening as a process that includes clinician and parent decision-making”, rather than focusing “on the psychometric properties of screening instruments”, and could be delivered in English or Spanish.
As reported in JAMA Pediatrics, the study included data from 33,326 children seen at 12 early intervention sites. The ASD screening protocol was implemented in three of these sites, in 2013, 2014 and 2016. The authors say that all test sites had “high levels of poverty and health disparities”.
The other nine sites functioned as controls, selected because they served similar populations to the test sites. Nevertheless, the test sites had a smaller proportion of White people than the control sites (52.8 vs 83.1%), as well as more Spanish speakers (28.9 vs 12.5%), families on public insurance (75.4 vs 60.4%) and families classed as living in poverty (66.9 vs 54.2%). The researchers used propensity scores to account for these differences.
Between 2012 and 2018, the rate of ASD diagnoses per 1000 children per quarter at the control sites rose from 12.9 to 17.0, equating to a small but significant increase, at an incidence rate ratio (IRR) of 1.02.
There was a larger rise at the intervention sites, however, from 12.7 to 21.8 per 1000 children per quarter, representing an additional 8.1 ASD diagnoses per 1000 children per quarter and a significant IRR of 1.60.
Spanish-speaking families derived the greatest benefit from the screening intervention, with an IRR of 2.6, equating to an additional 15.4 diagnoses per 1000 children per quarter. The increase in diagnosis was smaller for other families, with an IRR of 1.5, which equated to an additional 6.9 diagnoses per 1000 children per quarter.
In addition, boys benefitted significantly more than girls, at IRRs of 1.8 and 1.1, respectively, and an additional 14.8 and 0.5 diagnoses per 1000 children per quarter.
In a linked editorial, Kate Wallis (Children’s Hospital of Philadelphia, Pennsylvania, USA) and co-authors describe the increased benefit for Spanish-speaking families as “remarkable given that these interventions do not directly address key structural barriers to ASD diagnosis such as disparities in [payer] type, transportation, and/or childcare that might be thought determine access to care.”
They outline several factors that could play a part for these families, including a high need for information, hesitancy to seek a diagnosis because of stigma and an increased likelihood of having their concerns dismissed by clinicians.
“However, as this study suggests, such barriers can be overcome with culturally tailored intervention, and [early intervention] therapists are in a prime position to address and help mitigate these barriers”, write the editorialists.
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JAMA Pediatr 2022; doi:10.1001/jamapediatrics.2021.5380
JAMA Pediatr 2022; doi:10.1001/jamapediatrics.2021.5377