Autism Screening In Under-Served Populations

Background:  Although no evidence of racial or ethnic differences exist in the epidemiology or phenotype of autistic disorder (Bertrand et al., 2001), research suggests that both racial and income disparities are present in the early detection and treatment of autism.  African-American and Latino children have been found to receive their first diagnosis at later ages than white children (Mandell, Listerud, Levy, and Pinto-Martin, 2002), and poor children have been found to receive a diagnosis later than non-poor children (Goin-Kochel, Mackintosh, & Myers, 2006; Mandell et al., 2002; Mandell, Novak, & Zubritsky, 2005). In addition, minority children have been found to be more likely than white children to be without health insurance coverage, to be without a usual source of care, and to report an inability to get needed medical care (Newacheck, Hung, & Wright, 2002).

Primary healthcare providers are unlikely to adopt mental health screening or early intervention methods already developed in child psychology or psychiatry, even though such knowledge may be critical to child mental health promotion and early intervention efforts (NIMH, 2001). This implies the need for targeted education among healthcare professionals regarding the diagnosis and treatment of autism and ASD within diverse populations, as well as among parents, caregivers, educators, and other community members who have regular contact with minority children to facilitate early recognition of in their children that might signal a developmental delay and a possible autism spectrum disorder. It also indicates the need for much greater accessibility to diagnostic services among poor and minority children.

Objectives: Screen at least 1,000 children for ASD in a community setting using the MCHAT or SCQ, in six cities in New Jersey with large, low income, minority populations.  This will in turn facilitate access to appropriate services resulting in early entry into appropriate early intervention services for a large number of underserved children who traditionally would not have been identified until after they entered elementary school.

Methods: Health care providers in diverse settings within these cities were offered developmental screening training; culturally-sensitive autism education materials for use in community outreach were created; outreach was conducted to caregivers of children in these cities and other community members regarding normative child development, behavioral signs of possible developmental delay, and resources; community autism screening of children 18-60 months old within daycares/preschools was provided; and autism screening clinics in easily accessible locations throughout these cities will be established. In addition, children will be screened with the MCHAT or SCQ and children failing the MCHAT will complete the MCHAT interview.  Children failing the MCHAT interview and SCQ will undergo further evaluation with the ESAC, Mullen visual reception component, and ADOS.

Results: Preliminary data based on screening with a homeless population in one underserved area indicates a higher failure rate on ASD screening than expected based on existing research.  Necessary components of a successful screening will be discussed along with challenges faced. Additional data will be discussed.

Conclusions:  Our initial experiences suggest potential barriers to use of traditional parent report measures in this population.