Date of Completion

6-4-2014

Embargo Period

12-1-2014

Keywords

Autism, Developmental Screening, Race/ethnicity, Health Disparity

Major Advisor

Marianne Barton, Ph.D.

Associate Advisor

Chi-Ming Chen, Ph.D.

Associate Advisor

Diana L. Robins, Ph.D.

Field of Study

Psychology

Degree

Doctor of Philosophy

Open Access

Open Access

Abstract

Universal screening for autism spectrum disorder (ASD) is recommended to reduce disparities in timing of diagnosis. Early diagnosis of ASD has been associated with higher parent education and income in some studies, while others report that economically disadvantaged children and African American and Latino children are diagnosed later or not at all (Fombonne, 2003; Fountain, King, & Bearman, 2011; Liptak et al., 2008). A sample of 18,669 children was drawn from screening sites at the University of Connecticut (n = 9587, 51.4%) or Georgia State University (n = 9082, 48.6%). Socioeconomic status (SES) was estimated by Census Tract median income data. Participants included Majority group (White children; n= 6169) and the Minority group (all other racial/ethnic groups; n= 2789). There were small but significant disparities by race/ethnicity, controlling for income, in child age at M-CHAT screening, age at M-CHAT Follow-up Interview (FUI), and time from M-CHAT to FUI. African American and Latino children were older at screening and follow-up, but not evaluation, likely due to differential attrition. Minority and lower income children screened positive more frequently on certain screener items, including all reverse-scored items. Finally, positive predictive value (PPV) of the M-CHAT did not differ by race/ethnicity. In conclusion, standardized screening procedures employed in the current study largely eliminated disparities in screening, follow-up, and evaluation for ASD in toddlers. Item response patterns also differed by both race/ethnicity and SES, underscoring the need for support for parent understanding of M-CHAT items in pediatric practice.

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