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Autism and developmental screening in a public, primary care setting primarily serving Hispanics: challenges and
Gayle C Windham1, Karen S Smith, Nila Rosen
1Division of Environmental and Occupational Disease Control, California Department of Public Health, 850 Marina Bay Parkway, Building P, Richmond, CA, 94804, USA, gayle.windham@cdph.ca.gov.
Insights
Autism screening in underserved Hispanic children using the M-CHAT is feasible but shows higher positive rates. Cultural sensitivity and resources are crucial for effective early detection and intervention.
Area of Science:
- Pediatric screening
- Developmental pediatrics
- Autism spectrum disorder research
Background:
- Early identification of developmental delays is crucial for intervention outcomes.
- Underserved populations, including Hispanic communities, often face barriers to developmental screening.
- The Modified Checklist for Autism in Toddlers (M-CHAT) is a widely used screening tool.
Purpose of the Study:
- To assess the feasibility and outcomes of autism screening in a primarily Hispanic, underserved population.
- To evaluate the performance of the M-CHAT and Ages and Stages Questionnaire in this demographic.
- To identify potential disparities and challenges in screening and referral processes.
Main Methods:
- Screening of 1,760 children aged 16-30 months at routine pediatric visits.
- Utilized the Modified Checklist for Autism in Toddlers (M-CHAT) and Ages and Stages Questionnaire.
- Analyzed screen-positive rates and referral completion by ethnicity and language of screening.
Main Results:
- Screen-positive rates were 26% (M-CHAT) and 39% (ASQ), exceeding previous reports.
- Hispanic children and those screened in Spanish had higher M-CHAT positive rates (aOR 1.7).
- Only 30% of screen-positive children were referred, and half of those completed assessment.
Conclusions:
- Autism screening is feasible in this underserved, primarily Hispanic population.
- Higher screen-positive rates suggest potential cultural factors or increased prevalence.
- Addressing cultural applicability and improving referral completion are critical for effective service delivery.
Abstract:
We implemented screening of children 16-30 months of age (n = 1,760) from a typically under-served, primarily Hispanic, population, at routine pediatric appointments using the modified checklist for autism in toddlers (M-CHAT) and Ages and Stages Questionnaire. Screen positive rates of 26 and 39%, respectively, were higher than previous reports. Hispanics were more likely to score M-CHAT positive than non-Hispanics (adjusted OR 1.7, 95% CI 1.2-2.4), as were those screened in Spanish. About 30% of screen-positive children were referred for further assessment, but only half were seen. Thus screening in this population is feasible, but may require additional resources. Attention to the cultural applicability of screening instruments, as well as to explaining the results or need for additional services to parents, is critical to serve the growing Hispanic population.
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