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Journal of Autism and Developmental Disorders

, Volume 44, Issue 7, pp 1621–1632 | Cite as

Autism and Developmental Screening in a Public, Primary Care Setting Primarily Serving Hispanics: Challenges and Results

  • Gayle C. WindhamEmail author
  • Karen S. Smith
  • Nila Rosen
  • Meredith C. Anderson
  • Judith K. Grether
  • Richard B. Coolman
  • Stephen Harris
Original Paper

Abstract

We implemented screening of children 16–30 months of age (n = 1,760) from a typically under-served, primarily Hispanic, population, at routine pediatric appointments using the modified checklist for autism in toddlers (M-CHAT) and Ages and Stages Questionnaire. Screen positive rates of 26 and 39 %, respectively, were higher than previous reports. Hispanics were more likely to score M-CHAT positive than non-Hispanics (adjusted OR 1.7, 95 % CI 1.2–2.4), as were those screened in Spanish. About 30 % of screen-positive children were referred for further assessment, but only half were seen. Thus screening in this population is feasible, but may require additional resources. Attention to the cultural applicability of screening instruments, as well as to explaining the results or need for additional services to parents, is critical to serve the growing Hispanic population.

Keywords

Autism spectrum disorders Developmental screening M-CHAT ASQ Hispanics Children’s health 

Notes

Acknowledgments

This project was supported by funding from the Centers for Disease Control and Prevention (CDC) Grant number 5U01DD000305 and the California Department of Public Health (salary support for GW and JG). We acknowledge the work carried out by study staff, Zulma Flamenco-Conerly, Astrid Arretz, and Tim McLaughlin; the support and efforts of local program staff, Nancy Crowe from Santa Clara County Office of Education, Michelle Oliver of the Early Start Program, Drs. Howard Doi and Carrie Molho, and Rajni Madan of the San Andreas Regional Center; and the Department of Pediatrics managers, pediatricians and medical records staff at SCCHHS. Portions of this work have been presented at IMFAR.

References

  1. Albores-Gallo, L., Roldan-Ceballos, O., Villarreal-Valdes, G., Betanos-Cruz, B. X., Lemus-Espinosa, I., & Hilton, C. L. (2012). I-CHAT Mexican version validity and reliability and some cultural considerations. ISRN Neurology, 2012, 408694. doi: 10.5402/2012/408694.PubMedCentralPubMedCrossRefGoogle Scholar
  2. American Academy of Pediatrics (AAP). Council on Children with Disabilities, Section on Developmental Behavioral Pediatrics. Bright Futures Steering Committee, Medical Home Initiatives for Children with Special Needs Project Advisory Committee. (2006). Identifying infants and young children with developmental disorders in the medical home: an algorithm for developmental surveillance and screening. Pediatrics, 118(1), 405–420.Google Scholar
  3. Baron-Cohen, S., Cox, A., Baird, G., Swettenham, J., Nightingale, N., Morgan, K., et al. (1996). Psychological markers in the detection of autism in infancy in a large population. British Journal of Psychiatry, 168, 158–163.PubMedCrossRefGoogle Scholar
  4. Bryson, S. E., Rogers, S. J., & Fombonne, E. (2003). Autism spectrum disorders: Early detection, intervention, education, and psychopharmacological management. Canadian Journal of Psychiatry, 48(8), 506–516.Google Scholar
  5. California Department of Developmental Services (CA DDS). (2003). Autistic spectrum disorders changes in the California caseload: An update: 1999 through 2002. Sacramento, CA: Dept. of Developmental Services.Google Scholar
  6. Canal-Bedia, R., Garcia-Primo, P., Martin-Cilleros, M. V., Santos-Borbujo, J., Guisuraga-Fernandez, Z., Herraez-Garcia, L., et al. (2011). Modified checklist for autism in toddlers: Cross-cultural adaptation and validation in Spain. Journal of Autism and Developmental Disorders, 41(10), 1342–1351.PubMedCrossRefGoogle Scholar
  7. Centers for Disease Control and Prevention (CDC). (2007). Prevalence of autism spectrum disorders—Autism and developmental disabilities monitoring network, 14 sites, United States, 2002. MMWR Surveillance Summary, 56(1), 12–28.Google Scholar
  8. Centers for Disease Control and Prevention (CDC). (2012). Prevalence of autism spectrum disorders—autism and developmental disabilities monitoring network, 14 sites, United States, 2008. MMWR Surveillance Summary, 61(3), 1–19.Google Scholar
  9. Chlebowski, C., Robins, D. L., Barton, M., & Fein, D. (2013). Large-scale use of the modified checklist for autism in low-risk toddlers. Pediatrics, 131(4), e1121–e1127.PubMedCentralPubMedCrossRefGoogle Scholar
  10. Croen, L. A., Grether, J. K., Hoogstrate, J., & Selvin, S. (2002). The changing prevalence of autism in California. Journal of Autism and Developmental Disorders, 32(3), 207–215.PubMedCrossRefGoogle Scholar
  11. Dawson, G., & Osterling, J. (1997). Early intervention in autism: Effectiveness and common elements of current approaches. In M. J. Guralnick (Ed.), The effectiveness of early intervention (pp. 307–326). Baltimore, MD: Paul H. Brookes Publishing Co.Google Scholar
  12. Dobrez, D., Sasso, A. L., Holl, J., Shalowitz, M., Leon, S., & Budetti, P. (2001). Estimating the cost of developmental and behavioral screening of preschool children in general pediatric practice. Pediatrics, 108(4), 913–922.PubMedCrossRefGoogle Scholar
  13. Durkin, M. S., Maenner, M. J., Meaney, F. J., Levy, S. E., DiGuiseppi, C., Nicholas, J. S., et al. (2010). Socioeconomic inequality in the prevalence of autism spectrum disorder: Evidence from a U.S. cross-sectional study. PLoS ONE, 5(7), e11551.PubMedCentralPubMedCrossRefGoogle Scholar
  14. Fujiwara, T. (2013). Socioeconomic status and the risk of suspected autism spectrum disorders among 18-month-old-toddlers in Japan: A population-based study. Journal of Autism and Developmental Disorders,. doi: 10.1007/s10803-013-1988-3.Google Scholar
  15. Glascoe, F. P. (2010). Parents’ evaluation of developmental status (PEDS). http://www.pedstest.com. Nolensville, Tennessee: PEDSTest.com, LLC.
  16. Guzman, B. (2001). Census 2000 brief: The Hispanic population (C2KBR/01-3). Washington, DC: U.S. Census Bureau.Google Scholar
  17. Kakooza-Mwesige, A., Ssebyala, K., Karamagi, C., Kiguli, S., Smith, K., Anderson, M. C., et al. (2013). Adaptation of the ‘ten questions’ to screen for autism and other neuro-developmental disorders in Uganda. Autism. doi: 10.1177/1362361313475848.
  18. King, T. M., Tandon, S. D., Macias, M. M., Healy, J. A., Duncan, P. M., Swigonski, N. L., et al. (2010). Implementing developmental screening and referrals: Lessons learned from a national project. Pediatrics, 125(2), 350–360.PubMedCrossRefGoogle Scholar
  19. Krug, D. A., Arick, J., & Almond, P. (1980). Behavior checklist for identifying severely handicapped individuals with high levels of autistic behavior. Journal of Child Psychology and Psychiatry, 21(3), 221–229.PubMedCrossRefGoogle Scholar
  20. Lord, C. (1995). Follow-up of two-year-olds referred for possible autism. Journal of Child Psychology and Psychiatry, 36(8), 1365–1382.PubMedCrossRefGoogle Scholar
  21. Mandell, D. S., & Novak, M. (2005). The role of culture in families’ treatment decisions for children with autism spectrum disorders. Mental Retardation and Developmental Disabilities Research Reviews, 11(2), 110–115.PubMedCrossRefGoogle Scholar
  22. Mandell, D. S., Novak, M. M., & Zubritsky, C. D. (2005). Factors associated with age of diagnosis among children with autism spectrum disorders. Pediatrics, 116(6), 1480–1486.PubMedCentralPubMedCrossRefGoogle Scholar
  23. Mandell, D. S., Wiggins, L. D., Carpenter, L. A., Daniels, J., DiGuiseppi, C., Durkin, M. S., et al. (2009). Racial/ethnic disparities in the identification of children with autism spectrum disorders. American Journal of Public Health, 99(3), 493–498.PubMedCentralPubMedCrossRefGoogle Scholar
  24. Miller, J. S., Gabrielsen, T., Villalobos, M., Alleman, R., Wahmhoff, N., Carbone, P. S., et al. (2011). The each child study: Systematic screening for autism spectrum disorders in a pediatric setting. Pediatrics, 127(5), 866–871.PubMedCrossRefGoogle Scholar
  25. Pandey, J., Verbalis, A., Robins, D. L., Boorstein, H., Klin, A. M., Babitz, T., et al. (2008). Screening for autism in older and younger toddlers with the modified checklist for autism in toddlers. Autism, 12(5), 513–535.PubMedCrossRefGoogle Scholar
  26. Pedersen, A., Pettygrove, S., Meaney, F. J., Mancilla, K., Gotschall, K., Kessler, D. B., et al. (2012). Prevalence of autism spectrum disorders in Hispanic and non-Hispanic white children. Pediatrics, 129(3), e629–e635.PubMedCrossRefGoogle Scholar
  27. Perera, H., Wijewardena, K., & Aluthwelage, R. (2009). Screening of 18–24-month-old children for autism in a semi-urban community in Sri Lanka. Journal of Tropical Pediatrics, 55(6), 402–405.PubMedCrossRefGoogle Scholar
  28. Pinto-Martin, J. A., Young, L. M., Mandell, D. S., Poghosyan, L., Giarelli, E., Levy, S. E., et al. (2008). Screening strategies for autism spectrum disorders in pediatric primary care. Journal of Developmental and Behavioral Pediatrics, 29(5), 345–350.PubMedCrossRefGoogle Scholar
  29. Robins, D. L. (2008). Screening for autism spectrum disorders in primary care settings. Autism, 12(5), 537–556.PubMedCrossRefGoogle Scholar
  30. Robins, D. L., Fein, D., & Barton, M. L. (1999). Follow-up interview for the modified checklist for autism in toddlers (M-CHAT FUI). Storrs, CT: Self-Published.Google Scholar
  31. Robins, D. L., Fein, D., Barton, M. L., & Green, J. A. (2001). The modified checklist for autism in toddlers: An initial study investigating the early detection of autism and pervasive developmental disorders. Journal of Autism and Developmental Disorders, 31(2), 131–144.PubMedCrossRefGoogle Scholar
  32. Rogers, S. J., & Vismara, L. A. (2008). Evidence-based comprehensive treatments for early autism. Journal of Clinical Child and Adolescent Psychology, 37(1), 8–38.PubMedCentralPubMedCrossRefGoogle Scholar
  33. Rydz, D., Srour, M., Oskoui, M., Marget, N., Shiller, M., Birnbaum, R., et al. (2006). Screening for developmental delay in the setting of a community pediatric clinic: A prospective assessment of parent-report questionnaires. Pediatrics, 118(4), e1178–e1186.PubMedCrossRefGoogle Scholar
  34. Sand, N., Siverstein, M., Glascoe, F. P., Gupta, V. B., Tonniges, T. P., & O’Connor, K. G. (2005). Pediatricians’ reported practices regarding developmental screening: Do guidelines work? Do they help? Pediatrics, 116(1), 174–179.PubMedCrossRefGoogle Scholar
  35. Scarpa, A., Reyes, N. M., Patriquin, M. A., Lorenzi, J., Hassenfeldt, T. A., Desai, V. J., et al. (2013). The modified checklist for autism in toddlers: Reliability in a diverse rural American sample. Journal of Autism and Developmental Disorders, 43, 2269–2279.PubMedCrossRefGoogle Scholar
  36. Sices, L., Feudtner, C., McLauglin, J., Drotar, D., & Williams, M. (2003). How do primary care physicians identify young children with developmental delays? A national survey. Journal of Developmental and Behavioral Pediatrics, 24(6), 409–417.PubMedCrossRefGoogle Scholar
  37. Squires, J., Bricker, D., & Potter, L. (1997). Revision of a parent-completed development screening tool: Ages and stages questionnaires. Journal of Pediatric Psychology, 22(3), 313–328.PubMedCrossRefGoogle Scholar
  38. Tek, S., & Landa, R. J. (2012). Differences in autism symptoms between minority and non-minority toddlers. Journal of Autism and Developmental Disorders, 42(9), 1967–1973.PubMedCentralPubMedCrossRefGoogle Scholar
  39. U.S. Census Bureau. (2012). The Hispanic population in the U.S. 2012. www.census.gov/population/hispanic/data/2012.html. Accessed 7 Jan 2014.
  40. Wetherby, A. M., & Prizant, B. M. (2002). CSBS DP manual: Communication and symbolic behavior scales: Developmental profile. Baltimore, MD: Paul H. Brookes Pub.Google Scholar
  41. Windham, G. C., Anderson, M. C., Croen, L. A., Smith, K. S., Collins, J., & Grether, J. K. (2011). Birth prevalence of autism spectrum disorders in the San Francisco Bay area by demographic and ascertainment source characteristics. Journal of Autism and Developmental Disorders, 41(10), 1362–1372.PubMedCrossRefGoogle Scholar
  42. Yama, B., Freemen, T., Graves, E., Yuan, S., & Karen Campbell, M. (2012). Examination of the properties of the Modified Checklist for Autism in Toddlers (M-CHAT) in a population sample. Journal of Autism and Developmental Disorders, 42(1), 23–34.PubMedCrossRefGoogle Scholar
  43. Zuckerman, K. E., Mattox, B. S., Donelan, K., Batbayar, O., Baghaee, A., & Bethell, C. (2013). Pediatrician identification of Latino children at risk for autism spectrum disorder. Pediatrics, 132, 445–453.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Gayle C. Windham
    • 1
    Email author
  • Karen S. Smith
    • 2
  • Nila Rosen
    • 2
    • 4
  • Meredith C. Anderson
    • 2
  • Judith K. Grether
    • 1
  • Richard B. Coolman
    • 3
  • Stephen Harris
    • 3
  1. 1.Division of Environmental and Occupational Disease ControlCalifornia Department of Public HealthRichmondUSA
  2. 2.Impact Assessment, Inc.La JollaUSA
  3. 3.Santa Clara County Health and Hospital SystemSan JoseUSA
  4. 4.University of CaliforniaBerkeleyUSA

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