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Thursday, May 19, 2016

Pathways to Early Diagnosis and Intervention

In The Politics of Autism, I discuss evaluation and diagnosis of young children.

At IMFAR 2016, Maria Martinez had a paper titled: "Pathways to Early Autism Diagnosis and Intervention." The abstract:

Families of children with an ASD have more difficulty accessing and using services compared to families with children with other mental health care needs (Vohra, Madhavan, Sambamoorthi & St. Peter, 2014). The Autism CARES Act of 2014 introduced legislation to reduce barriers to screening, diagnosis and treatment however little is known about pathways that lead to earlier diagnosis and intervention. The Anderson model of health care utilization (Aday & Anderson, 1975) provides a framework to organize and examine factors associated with earlier access to autism services.


The purpose of this study is to identify pathways associated with early screening, assessment and intervention that can be utilized to develop a system of service that provides early intervention for autism spectrum disorders (ASD) and other developmental disabilities in order to facilitate children’s ability to reach their maximum potential. The target audience includes researchers, stakeholders and policy makers.


Data from the 2014-2015 North Carolina Needs of Young Children with Autism Survey are presented that represent over 450 families with a child diagnosed with an ASD. Descriptive statistics and logit modeling analyzed de-identified demographic, diagnostic and service use information using the Anderson health care utilization framework. Pathways to early intervention as well as models predicting early parent recognition of concerns, who first recognized concerns, time to diagnosis, and early intervention are presented.


Early parent recognition is associated with parents sharing concerns with more providers prior to a child’s initial ASD diagnosis (p < .005), ASD presentations with lower levels of functioning (p < .005), parents (vs. providers) first recognizing a concern (p < .005), and type of providers conducting initial autism assessment (p < .05). Who first recognized developmental concerns was associated with parent completion of an autism screener at their doctor’s office (p < .01) and minority child race/ethnicity (p <.05). Early diagnosis was associated with ASD presentations with lower functioning (p < .001), type of provider (p < .05) conducting ASD assessment, and autism screening (p < .05). Early intervention was associated with ASD presentations with lower functioning (p < .05) and type of providers conducting initial autism assessment (p < .05).


Parents who recognized concerns early were more likely to enter a pathway to earlier child diagnosis and intervention, particularly in cases of prompt initial diagnosis. This appears to be associated with type of provider conducting initial autism assessment and severity of child functioning, reflecting quicker pathway entry for families who are swiftly connected with specialists as well as autism presentations with greater functional impairment that may be easier to identify. When providers initially recognized developmental concerns, families were more likely to enter a pathway to quicker diagnosis and earlier intervention.
It is important for policy makers to support and increase autism awareness among parents and providers, routine autism screening and follow-up, strategies to improve provider recognition for minority and higher functioning children, and availability of specialists trained to conduct early diagnostic assessments