Multi-stage Screening in Early Intervention: A Critical Strategy for Improving ASD Identification and Addressing Disparities

• Published in: Journal of autism and developmental disorders 2021-03, Vol.51 (3), p.868-883
• Main Authors: Eisenhower, Abbey, Martinez Pedraza, Frances, Sheldrick, R. Christopher, Frenette, Elizabeth, Hoch, Noah, Brunt, Sophie, Carter, Alice S.
• Format: Article
• Language: English
• Subjects: Access to Health Care; At Risk Persons; Autism; Autism Spectrum Disorder - diagnosis; Autism Spectrum Disorder - ethnology; Autism Spectrum Disorder - therapy; Behavioral Science and Psychology; Child and School Psychology; Child, Preschool; Children; Clinical Diagnosis; Community Health Services - methods; Community Health Services - standards; Diagnosis; Disability Identification; Early Diagnosis; Early intervention; Early Intervention, Educational - methods; Early Intervention, Educational - standards; English Language Learners; Female; Health care disparities; Health disparities; Health Insurance; Healthcare Disparities - ethnology; Healthcare Disparities - standards; Humans; Infant; Language; Language Usage; Male; Mass Screening - methods; Mass Screening - standards; Medical diagnosis; Medical screening; Methods; Minority Group Children; Neurosciences; Participation; Pediatric research; Pediatrics; Pervasive Developmental Disorders; Predictor Variables; Preschool Children; Psychology; Public Health; Race; Racial Differences; S.I. : Early Detection In Autism Spectrum Disorder; Screening Tests; Toddlers
• ISSN: 0162-3257; 1573-3432
• DOI: 10.1007/s10803-020-04429-z

Health disparities in ASD detection affect children’s access to subsequent interventions. We examined potential disparities in implementation of a multi-stage ASD screening and diagnostic evaluation protocol in Part C Early Intervention with 4943 children ages 14–36 months (mean 22.0 months; 62.9% boys, 73.3% children of color, 34.9% non-English-primary language, 64.5% publicly-insured). Participation and follow-through were high (64.9% and 65.3% at first- and second-stage screening, respectively, 84.6% at diagnostic evaluation). Logistic regressions identified predictors of screening participation and outcomes at each stage; demographic differences (race, language, public insurance) were observed only at first-stage screening and reflected higher participation for children of color and higher positive screens for publicly-insured children. Results suggest the multi-stage screening protocol shows promise in addressing disparities in early diagnosis.