Autism spectrum disorder (ASD) typically develops in children before age 3, but less than half of children are accurately diagnosed with ASD before age 4.
Although paediatric advocates recommend that children at risk of ASD receive screening through early intervention (EI) services provided by states, the program often lacks effective screening tools to detect and diagnose this disorder. Now, a new study led by a Boston University School of Public Health (BUSPH) researcher found that implementing a multi-stage screening protocol for ASD in early intervention services may lead to a 60 per cent increase in ASD detection, compared to standard screening.
The study also underscored the importance of monitoring for disparities in ASD. The increased rate of ASD detection was nearly twice as high for Spanish-speaking families as for non-Spanish-speaking families, helping to reduce a well-documented health disparity.
The study is the first comprehensive evaluation of ASD screening in EI settings and includes comparison with non-screened EI settings. Unlike standard approaches to screening, which are often limited to providing questionnaires for parents, the multi-component screening protocol in this study includes input from parents and EI providers in the decision-making process for a child’s ASD diagnosis, as well as training for EI providers and ongoing collaboration between the EI providers and the EI sites’ program directors and research assistants.
“When implemented with appropriate supports and access to diagnostic services, screening can really move the needle on the early detection of autism,” says Dr. Radley Chris Sheldrick, study lead author and research associate professor of health law, policy and management at BUSPH. “If implemented in a culturally sensitive way, it can also reduce health disparities in autism diagnoses, which have been well-documented in the literature.” For the study, Dr. Sheldrick and colleagues analyzed administrative data that was collected by the Massachusetts Department of Public Health and included records for 33,326 children aged 14 to 26 months who were enrolled in services at 12 EI agencies in the greater Boston area from 2012 to 2018. The ASD screening was implemented at three of the EI sites, and the researchers used records from the nine non-screened sites for comparison. Parents or caregivers began the multi-stage screening protocol by completing questionnaires about their children’s social and emotional behaviour. If indicated, they and their children then completed an observational assessment known as the Screening Tool for ASD in Toddlers and Young Children (STAT) with their EI providers, who received specialized training to administer the STAT. EI providers were also encouraged to participate in the ASD diagnostic and feedback evaluations, which occurred in the final stage of the process.