Wednesday, October 21, 2015

Identification of Latino Children At-Risk for Autism

It is well established that early intervention is a critical determinant in the course and outcome of autism spectrum disorder (ASD). The earlier the child is identified and intensive intervention can begin, the better the outcomes tend to be for children with ASD. In fact, numerous studies have described the benefits of early identification and intervention for children with developmental disabilities and, particularly, for children on the autistic spectrum. However, many children meeting ASD diagnostic criteria may be missed or diagnosed years after onset of symptoms. Moreover, studies have shown racial and ethnic differences in ASD diagnostic trends. For example, there is evidence to suggest that Latino children are diagnosed with ASD 2.5 years later than white children and have more severe symptoms at time of diagnosis.
The reasons for low rates of ASD diagnosis and diagnostic delay among Latino children are poorly understood. Delays may reflect family factors, including ethnic differences in parent knowledge, beliefs, and concerns about overall child development and developmental delay. A study published in the journal Pediatrics sought to examine why Latino children are diagnosed with ASD less often and later than white children. Researchers mailed a self-administered survey to a random sample of California pediatricians to assess rates of bilingual general developmental and ASD screening, perceptions of parent ASD knowledge in Latino and white families, reports of difficulty assessing for ASD in Latino and white children, and perceptions of barriers to early ASD identification for Latinos.
The results indicated that although 81% of respondents offered some form of developmental screening, 29% of pediatricians offered Spanish ASD screening per American Academy of Pediatrics guidelines, and only 10% offered both Spanish general developmental and Spanish ASD screening per American Academy of Pediatrics guidelines. Most practitioners thought that Latino (English and Spanish primary family language) parents were less knowledgeable about ASD than other parents. They also had more difficulty assessing ASD risk for Latino children with Spanish primary family language than for white children. The most frequent barrier to ASD identification in Latinos was access to developmental specialists.
These findings have important practice and policy implications. For example, rates of Spanish language developmental and ASD screening need targeted improvement. Developing and promoting free or low-cost screening resources could improve early identification and reduce language-based disparities. Pediatricians may also need information about bilingualism and language development, accurate interpretation of screening results in Latino children, and strategies for discussing this difficult topic with parents from a different culture.  In sum, promoting language appropriate screening, disseminating culturally appropriate ASD materials to Latino families, improving the specialist workforce, and providing practitioner support in screening and referral of Latino children may be important ways to reduce racial and ethnic differences in care.
Pediatrician Identification of Latino Children at Risk for Autism Spectrum Disorder Katharine E. Zuckerman, Kimber Mattox, Karen Donelan, Oyundari Batbayar, Anita Baghaee and Christina Bethell. Pediatrics; originally published online August 19, 2013 DOI: 10.1542/peds.2013-0383

Lee A. Wilkinson, PhD, NCSP is author of the award-winning book, A Best Practice Guide to Assessment and Intervention for Autism and Asperger Syndrome in Schools, published by Jessica Kingsley Publishers. He is also editor of a best-selling text in the American Psychological Association (APA) School Psychology Book Series, Autism Spectrum Disorder in Children and Adolescents: Evidence-Based Assessment and Intervention in Schools and author of the book, Overcoming Anxiety and Depression on the Autism Spectrum: A Self-Help Guide Using CBTHis latest book is A Best Practice Guide to Assessment and Intervention for Autism Spectrum Disorder in Schools (2nd Edition).

1 comment:

Debbie Ahrns said...

Hello I believe that Early Intervention is key for intervention for the child and the family. This article intrigues me in that I have worked with two Hispanic children diagnosed to be on the spectrum before the age of two by a special team at a Children's Hospital. Having spent 35 + years working with children with differing abilities and their families age birth to age three. I watched these young boys play both in their homes as well as in center play groups. Their play and interaction were more repressitive of a child who was hearing impaired . So I built an unconditional relationship with the took two months two times a week with one young boy and our relationship changed. I meet with his parent and asked more about family history. Mother spoke Englissh very well, Dad struggled but understood and the one young boy was cared for by his Grandmother while the parents ran their restaurant . As it turned out Grandmother only spoke Spanish, she was willing to use sign language . Then I asked the family while at home during meals or in the kitchen to ONLY use sign language and speak English as food and meal time create many wonderful opportunities to build vocabulary . I am pleased to share that this young man by the time of the next evaluation tested out and was speaking both in English and Spanish as well as using sign language. At age three he had progressed so well he was no longer eligible for services for children with differing abilities. it is with pleasure that I share his Grandmother also learned to speak English in a short period of time. The second young man I did have an interpreter join the classroom and some home intervention sessions this helped build a foundation of trust from the entire family . He did well and made great progress using a picture communication system first as it turns out he was hearing impaired and responded better to female individuals voices then that of men. This young man at three continues to receive speech intervention. I realize this is not the norm but having experienced this first will always been an intervention strategy for all very young children whom live in multi lingual environments. Learning to communicate is a multi layer process and essential to social engagement/interaction success. Communication is like Ping Pong I take a turn you take a turn it is a TURN BALANCED interaction and everyone needs to understand this and build interactions based on this concept . Just my thoughts to add to the value of your article . I enjoy your post. Peace be with you. Debbie

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