Objectives: Using a mail-based survey of California primary care pediatricians, we assessed (1) whether pediatricians offer standardized ASD and developmental screening to Latino children (2) pediatricians’ perceived ability to assess ASD risk among Latino children, and (3) pediatricians’ perceived barriers to ASD diagnosis for Latino children.
Methods: We surveyed a random sample of board-certified, clinic-based primary care pediatricians in California, using contact information from the American Medical Association Masterfile. The survey asked pediatricians if they offered ASD and general developmental screening tools per American Academy of Pediatrics (AAP) Bright Futures periodicity guidelines, and whether screening tools were offered in Spanish for families with a Spanish language preference. Pediatricians were also asked to compare how difficult it was to “identify signs and symptoms of an ASD” among children from white, Latino English primary language, and Latino Spanish primary language families. Finally, pediatricians were asked to report the frequency with which they experienced 10 possible barriers to ASD care. We used chi-square tests to compare developmental screening rates among the pediatricians who treated >25% Latino patients (49.2% of sample) versus all other pediatricians. We used McNemar’s test of proportions to compare difficulty of recognizing ASD signs/symptoms among children from Latino English language, Latino Spanish language, and white families.
Results: 266 Pediatricians responded to the survey (response rate: 62.6%). 28.1% of pediatricians offered both ASD and general developmental screening per AAP Bright Futures periodicity guidelines. However, only 8.5% of pediatricians with ≤25% Latino patients and 16.1% of pediatricians with >25% Latino patients offered both screenings in Spanish (p = 0.06). California pediatricians felt that it was more difficult to assess ASD risk among Latino children in Spanish primary language families (60.4% stating somewhat or very difficult) than among white children (33.2% stating somewhat or very difficult; p <0.001) or than among Latino children in English primary language families (34.8% somewhat or very difficult; p<0.001). Pediatricians felt that assessing ASD risk among Latino children in English primary language families was similarly difficult as assessing risk among white children (p = 0.06). Even among pediatricians with >25% Latino patients, assessing ASD risk in Latino children with Spanish primary language was perceived to be particularly difficult (46.0% stating somewhat or very difficult; p<0.001 compared to white children). Providers cited “language differences” and “access to ASD or developmental specialists” as the greatest barriers to ASD diagnosis.
Conclusions: Pediatricians find it difficult to identify ASD risk among Latino children in Spanish primary language families. Few pediatricians are offering appropriate developmental and ASD screening to families with Spanish language preference, despite availability of public-domain tools in Spanish. Promoting language-appropriate screening practices, providing Spanish-language materials about ASD, and improving access to ASD specialty services may be important ways to reduce ethnic differences in ASD diagnosis.