Child Care Center Directors’ Knowledge and Perceptions of Early Screening for Developmental Disabilities and Autism Spectrum Disorder (ASD)

Background:

Early developmental and ASD screening has many benefits, including earlier diagnosis, access to early intervention (EI), and improved developmental outcomes. To benefit from EI, at-risk children must be identified, typically through screening by a primary healthcare provider, and referred for an evaluation. However, some healthcare providers do not screen for ASD, citing barriers such as lack of time, lack of knowledge, inadequate training, and hesitance to share difficult news with families. Alternatively, child care settings may be another avenue for early screening. Child care providers are in an optimal position to potentially identify at-risk children because they receive training in child development and have ongoing opportunities to monitor child development as well as build rapport with families. While recent studies show that early care professionals can be adept at screening for ASD, research has yet to provide insight as to whether Directors feel comfortable with their providers screening, talking with parents about concerns, or referring families to EI. Given their influence in decision making, examining Director’s knowledge, perceptions, and practices around screening for ASD would be an important step in determining whether screening in childcare settings is feasible.

Objectives:

The current study explored Directors’ knowledge, perceptions, practices, comfort level, and resources for:

1. recognizing characteristics of developmental disability including ASD,
2. screening for developmental disability and ASD,
3. communicating developmental concerns with parents and referring families to EI, and
4. continuing education in these areas.

Methods:

Twelve semi-structured interviews were conducted with Directors of child care centers serving children birth through age 5, stratified across settings (public, private, home based, faith based). Interviews were recorded, transcribed, checked for accuracy, and coded by the authors, who had established reliability on the codes. Using grounded theory, themes and axial codes (sub-themes within the data) were generated.

Results:

Director’s perceptions of their knowledge of recognizing ASD ranged from minimal to moderate with all Directors interested in more training in recognizing signs and symptoms of developmental disabilities and ASD. All Directors expressed that some type of developmental tracking process was present at their center, however, none had an ASD screening process, and few formally screened for developmental concerns. All Directors reported feeling very comfortable or somewhat comfortable in communicating developmental concerns with parents, however, knowledge of the referral process to EI varied among Directors. A common theme was difficulty when parents disagreed with professionals’ concerns. Most Directors expressed a need for training in recognizing signs and symptoms of ASD and communicating concerns to parents.

Conclusions:

This study examined the knowledge, perceptions, practices, comfort level and resources of childcare directors in identifying factors that influence formal screening, professional development, and communicating concerns with families. Directors reported that additional training is needed in screening, addressing early signs of ASD, and talking with families. Additional research investigating ASD specific screening in early care settings is warranted and identifying early care professionals’ knowledge of screening can help identify gaps in practice.