It is well established that early intervention is a critical determinant in the course and outcome of autism spectrum disorder (ASD). The earlier the child is identified and intensive intervention can begin, the better the outcomes tend to be for children with ASD. However, many children meeting ASD diagnostic criteria may be missed or diagnosed years after onset of symptoms. Moreover, studies have shown racial and ethnic differences in ASD diagnostic trends. For example, there is evidence to suggest that Latino children are diagnosed with ASD 2.5 years later than white children and have more severe symptoms at time of diagnosis.
The reasons for low rates of ASD diagnosis and diagnostic delay among Latino children are poorly understood. Delays may reflect family factors, including ethnic differences in parent knowledge, beliefs, and concerns about overall child development and developmental delay. A study published in the journal Pediatrics sought to examine why Latino children are diagnosed with ASD less often and later than white children. Researchers mailed a self-administered survey to a random sample of California pediatricians to assess rates of bilingual general developmental and ASD screening, perceptions of parent ASD knowledge in Latino and white families, reports of difficulty assessing for ASD in Latino and white children, and perceptions of barriers to early ASD identification for Latinos.
The results indicated that although 81% of respondents offered some form of developmental screening, 29% of pediatricians offered Spanish ASD screening per American Academy of Pediatrics guidelines, and only 10% offered both Spanish general developmental and Spanish ASD screening per American Academy of Pediatrics guidelines. Most practitioners thought that Latino (English and Spanish primary family language) parents were less knowledgeable about ASD than other parents. They also had more difficulty assessing ASD risk for Latino children with Spanish primary family language than for white children. The most frequent barrier to ASD identification in Latinos was access to developmental specialists.
These findings have important practice and policy implications. For example, rates of Spanish language developmental and ASD screening need targeted improvement. Developing and promoting free or low-cost screening resources could improve early identification and reduce language-based disparities. Pediatricians may also need information about bilingualism and language development, accurate interpretation of screening results in Latino children, and strategies for discussing this difficult topic with parents from a different culture. In sum, promoting language appropriate screening, disseminating culturally appropriate ASD materials to Latino families, improving the specialist workforce, and providing practitioner support in screening and referral of Latino children may be important ways to reduce racial and ethnic differences in care.
Pediatrician Identification of Latino Children at Risk for Autism Spectrum Disorder Katharine E. Zuckerman, Kimber Mattox, Karen Donelan, Oyundari Batbayar, Anita Baghaee and Christina Bethell. Pediatrics; originally published online August 19, 2013 DOI: 10.1542/peds.2013-0383
Lee A. Wilkinson, PhD, CCBT, NCSP is author of the award-winning book, A Best Practice Guide to Assessment and Intervention for Autism and Asperger Syndrome in Schools, published by Jessica Kingsley Publishers.
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