Clinicians have long known that early identification of an autism spectrum disorder (ASD) improves a child’s long-term health outcome as well as the family’s ability to cope with disease. But Latino children are diagnosed with ASDs less often and later — an average of 2.5 years later — than white children and have more severe symptoms at the time of diagnosis. The reasons behind these disparities have been poorly understood, and no studies have investigated pediatricians’ perspectives on this inequity — until now.
A new study published online in the journal Pediatrics reveals that multiple factors in the primary care setting may contribute to delayed autism spectrum diagnosis for Latinos, including the perception that Latino parents are less knowledgeable about ASDs than white parents.
The study’s lead investigator, Katherine E. Zuckerman, M.D., M.P.H., an assistant professor of pediatrics at Doernbecher Children’s Hospital, Oregon Health & Science University, surmised that given their regular and early contact with families, primary care pediatricians play a critical role in early ASD identification. To test her theory, Zuckerman and colleagues surveyed 297 California primary care pediatricians — California is home to the highest population of Latino children in the United Sates — and their results were surprising:
Note that most screening and diagnostic tools are proprietary, so there is a fee for using them.
Zuckerman and colleagues concluded that promoting language-appropriate screening, distributing culturally appropriate materials to Latino families, improving the availability of specialists, and providing physicians with support in screening and referral for Latino children could help improve early diagnosis for Latino children.
- Only 1 in 10 pediatricians surveyed was performing the recommended (American Academy of Pediatrics) developmental screenings in Spanish.
- The majority of pediatricians reported that identifying ASD risk in Spanish-speaking families was difficult.
- 3 in 4 of the pediatricians cited access, communication or cultural barriers as obstacles to early identification of ASDs.
- The most common barrier, according to the surveyed pediatricians, was a lack of access to ASD specialists.
Cyrstal Phend writes at MedPage Today:
Overall, 81% offered some kind of developmental screening at any routine visit for their patients. But only 30% did the general screening and 43% did autism spectrum disorder screening on the American Academy of Pediatrics-recommended schedule.
Doing both types of screening in Spanish following the guidelines was reported by only 10%.
The survey did not attempt to determine why so many providers didn't offer Spanish-language screening, but 25% of them cited limited availability of screening tools as a barrier to autism spectrum disorder diagnosis in Latino children.
"Although the Modified Checklist for Autism in Toddlers is publicly available in Spanish, most recommended developmental screening tools are not publicly available, and Spanish materials cost more," Zuckerman's group pointed out.
"Developing and promoting free or low-cost screening resources could improve early identification and reduce language-based disparities," they suggested.