Sociodemographic Barriers to Early Detection of Autism: Screening and Evaluation Using the M-CHAT, M-CHAT-R, and Follow-Up

Abstract

Parents (n = 11,845) completed the Modified Checklist for Autism in Toddlers (or its latest revision) at pediatric visits. Using sociodemographic predictors of maternal education and race, binary logistic regressions were utilized to examine differences in autism screening, diagnostic evaluation participation rates and outcomes, and reasons for non-participation. Families of lower maternal education and racial minorities exhibited inflated initial screen positive rates and lower participation at Follow-Up, although not at evaluation. Economic challenges, such as invalid phone numbers, were identified as barriers to reaching these families. Families of higher education and White race were more likely to decline participation in evaluation. Results suggest the need for increased public education about childhood development to enhance awareness, reduce stigma, and streamline screening.

Testing two screening instruments for autism spectrum disorder

“…It is unfortunate that screening instruments do not generally work as well in such populations. 2 Our own data 3 suggest that specificity rather than sensitivity is more affected, with higher rates of false positives in families with lower education, and this is consistent with the Charman et al findings.…”

Hope, social relations, and depressive symptoms in mothers of children with autism spectrum disorder

“…In this population, it would be particularly interesting to examine the importance of agency thinking in parents of various ethnic/ racial minority groups (e.g., Latino parents) as they commonly encounter additional barriers (Zuckerman, Sinche, Mejia, Cobian, Becker, & Nicolaidis, 2014). Although research is limited, studies find that ethnic/racial minority families are less likely to attend follow-up evaluations after their child initially screens positive for ASD, possibly due to economic challenges (Khowaka, Hazzard, & Robins, 2015). In addition, certain racial/ethnic groups (e.g., Hispanic Americans, black Americans, and Alaskan Native/Native Americans) score at basic or below basic levels of health literacy (Kutner, Greenberg, Jin, & Paulsen, 2006).…”

Observed and Parent-Report Measures of Social Communication in Toddlers With and Without Autism Spectrum Disorder Across Race/Ethnicity

“…Follow-up testing was not completed, so information regarding the diagnostic classification of participants is not available, and thus conclusions regarding the utility of the M-CHAT as an ASD screener for this sample could not be drawn. Another study using the M-CHAT found higher rates of initial positive screens that would indicate the need for further testing for toddlers from non-White and low-SES families that were negated by the M-CHAT Follow-Up interview (Khowaja, Hazzard, & Robins, 2015). This finding is particularly concerning given that non-White and low-SES families in this study were also significantly less likely to participate in the M-CHAT Follow-Up interview (which was completed over the phone at a later date) than White, high-SES families, illustrating a critical limitation in a two-step screening measure for diverse populations.…”