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Multi-stage Screening in Early Intervention: A Critical Strategy for Improving ASD Identification and Addressing Disparities

  • S.I. : Early Detection In Autism Spectrum Disorder
  • Published:
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Abstract

Health disparities in ASD detection affect children’s access to subsequent interventions. We examined potential disparities in implementation of a multi-stage ASD screening and diagnostic evaluation protocol in Part C Early Intervention with 4943 children ages 14–36 months (mean 22.0 months; 62.9% boys, 73.3% children of color, 34.9% non-English-primary language, 64.5% publicly-insured). Participation and follow-through were high (64.9% and 65.3% at first- and second-stage screening, respectively, 84.6% at diagnostic evaluation). Logistic regressions identified predictors of screening participation and outcomes at each stage; demographic differences (race, language, public insurance) were observed only at first-stage screening and reflected higher participation for children of color and higher positive screens for publicly-insured children. Results suggest the multi-stage screening protocol shows promise in addressing disparities in early diagnosis.

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Acknowledgments

We thank Angel Fettig for her collaboration; the staff who served as liaisons to the participating community EI agencies (Sophie Brunt, Luisa Buitrago, Frances Dumont Reyes, Melanie Feldman, Elizabeth Frenette, Noah Hoch, Latisha Morant, Gillian Nolan, Sabrina Ozit, Nora Portillo, Juan Diego Vera); our partnering EI directors and key EI staff partners (Margaret Carreira, Candace Chang, Rachael Cracknell, Johan De Besche, Lorriane Facella, Liz Kern Ferreiro, Jennifer Greenberg, April Haefner, Amanda Kasica, Sharon Keleher, Lynne McLaughlin, Jacquelyn Murphy, Sarah Patane, and Katie Timmons); and partners at the Department of Public Health (Ron Denham, Patti Fougere, Tracy Osbahr, Joan Rafferty). We also extend our gratitude to the participating children and families, Early Intervention providers, graduate students, and study staff.

Funding

This research was supported by a Health Resources Services Administration grant to Drs. Eisenhower and Carter (R40MC26195), a National Institute of Mental Health grant to Drs. Sheldrick and Carter (R01MH104400), and an Autism Speaks Dennis Weatherstone Predoctoral Fellowship (AS #7415) to Dr. Martinez Pedraza. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS, NIMH, Autism Speaks, or the U.S. Government. Dr. Sheldrick is the co-creator of the POSI, which is one of the two first-stage screeners used in this study. He conducts research related to this instrument but receives no royalties. Dr. Carter is the co-creator of the POSI but receives no royalties. She is also co-creator of the BITSEA, which is one of the two first-stage screeners used in this study. Dr. Carter receives royalties on the sale of the BITSEA, which is distributed by MAPI Research Trust.

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Authors and Affiliations

  1. Department of Psychology, University of Massachusetts Boston, 100 Morrissey Blvd., Boston, MA, 02125, USA

    Abbey Eisenhower, Sophie Brunt & Alice S. Carter

  2. Center for Children and Families, Department of Psychology, Florida International University, Miami, FL, USA

    Frances Martinez Pedraza

  3. Department of Health Law, Policy and Management, School of Public Health, Boston University, One Silber Way, Boston, MA, 02215, USA

    R. Christopher Sheldrick

  4. Boston University, 715 Albany Street, Boston, MA, 02118, USA

    R. Christopher Sheldrick

  5. ZERO TO THREE, Washington, DC, USA

    Elizabeth Frenette

  6. Department of Psychology, Clark University, Worcester, MA, USA

    Noah Hoch

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Contributions

AE participated in the design of the study, directed and contributed to data collection, directed data analyses, drafted sections of the manuscript, and directed the editing process. FMP conceptualized the model on which the study is based, participated in the design of the study, directed and contributed to data collection, and performed revisions of the final manuscript. RCS participated in the design of the study, assisted with data analysis and interpretation, drafted sections of the paper, and contributed to revising the final manuscript. EF performed data processing and management, assisted with data collection, contributed to the initial conceptualization of the paper, and assisted with data analysis and interpretation. NH performed data processing and management, assisted with data collection, contributed to data analysis and interpretation, and edited the final manuscript. SB performed data processing and management, assisted with data collection, and contributed to data analyses and interpretation. ASC* conceptualized the model on which the study is based, participated in the design of the study, directed and contributed to data collection, assisted with data analysis and interpretation, and contributed to revising the final manuscript.

Corresponding author

Correspondence to Alice S. Carter.

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Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The current study was approved by the University of Massachusetts Boston Institutional Review Board.

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Informed consent was obtained from individual parent participants included in the study. Children did not provide assent due to their very young age.

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Eisenhower, A., Martinez Pedraza, F., Sheldrick, R.C. et al. Multi-stage Screening in Early Intervention: A Critical Strategy for Improving ASD Identification and Addressing Disparities. J Autism Dev Disord 51, 868–883 (2021). https://doi.org/10.1007/s10803-020-04429-z

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