08/18/13  Portland, Ore.

Survey finds pediatrician beliefs, practices play a significant role in early identification

Clinicians have long known that early identification of an autism spectrum disorder (ASD) improves a child’s long-term health outcome as well as the family’s ability to cope with disease. But Latino children are diagnosed with ASDs less often and later — an average of 2.5 years later — than white children and have more severe symptoms at the time of diagnosis. The reasons behind these disparities have been poorly understood, and no studies have investigated pediatricians’ perspectives on this inequity — until now.

A new study published online in the journal Pediatrics reveals that multiple factors in the primary care setting may contribute to delayed autism spectrum diagnosis for Latinos, including the perception that Latino parents are less knowledgeable about ASDs than white parents.

The study’s lead investigator, Katherine E. Zuckerman, M.D., M.P.H., an assistant professor of pediatrics at Doernbecher Children’s Hospital, Oregon Health & Science University, surmised that given their regular and early contact with families, primary care pediatricians play a critical role in early ASD identification. To test her theory, Zuckerman and colleagues surveyed 297 California primary care pediatricians — California is home to the highest population of Latino children in the United Sates — and their results were surprising:

• Only 1 in 10 pediatricians surveyed was performing the recommended (American Academy of Pediatrics) developmental screenings in Spanish.
• The majority of pediatricians reported that identifying ASD risk in Spanish-speaking families was difficult.
• 3 in 4 of the pediatricians cited access, communication or cultural barriers as obstacles to early identification of ASDs.

The most common barrier, according to the surveyed pediatricians, was a lack of access to ASD specialists.

Zuckerman and colleagues concluded that promoting language-appropriate screening, distributing culturally appropriate materials to Latino families, improving the availability of specialists, and providing physicians with support in screening and referral for Latino children could help improve early diagnosis for Latino children.

“We were surprised to learn how low the screening rates are among Latino children and how difficult primary care pediatricians report it is to screen Latino children for ASDs,” said Zuckerman. “We hope this data will help inform future interventions to reduce racial and ethnic differences in ASD care.”

The study was funded by an Academic Pediatric Association Commonwealth Fund Young Investigator Award and a grant from the National Institute of Mental Health (1K23MH095828), a branch of the National Institutes of Health.

Contributors to the study include: Zuckerman, Christina Bethell, Ph.D., M.B.A., M.P.H., Oyundari Batbayar, Kimber Mattox, Anita Baghaee, Child and Adolescent Health Measurement Initiative, Department of Pediatrics, Doernbecher Children’s Hospital at Oregon Health & Science University; and Karen Donelan, Ed.M., Sc.D., Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, Massachusetts.