Autism Screening in Childcare Settings

儿童保育机构中的自闭症筛查

• 批准号: 10606070
• 负责人: Diana L Robins
• 金额: $ 22.73万
• 依托单位: DREXEL UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-01-20 至 2024-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10606070
• 关键词: Address; Age; Agreement; Black race; Child; Child Behavior; Child Care; Child Development; Child Support; Childhood; Communities; Data; Decision Making; Development; Diagnosis; Disabled Children; Disadvantaged; Disparity; Disparity in diagnosis; Early Diagnosis; Early Intervention; Early identification; Early treatment; Education; Enrollment; Ethnic Origin; Evaluation; Exposure to; Family; Goals; HIV; Home; Hour; Improve Access; Income; Intervention; Interview; Link; Measures; Medical; Mental Health; Methods; Outcome; Parents; Perception; Performance; Pilot Projects; Play; Poverty; Primary Care; Process; Prognosis; Provider; Qualitative Methods; Questionnaires; Recommendation; Reporting; Research; Resources; Risk; Screening Result; Screening procedure; Sociology; Structure; Symptoms; Testing; Thick; Time; Toddler; Trust; Visit; Well Child Visits; access disparities; autism spectrum disorder; care providers; checkup examination; community setting; design; disorder risk; disparity reduction; early childhood; early screening; experience; follow-up; health care availability; implementation facilitators; improved; improved outcome; informant; innovation; insight; lower income families; minority children; novel; novel strategies; pediatrician; peer; racial disparity; research clinical testing; satisfaction; screening; social stigma; socioeconomic disparity; theories; underserved community; uptake

Early detection of autism spectrum disorder (ASD) facilitates early intervention, which improves lifelong prognosis. Universal screening in the medical home during toddler check-ups is successful at detecting many cases of ASD, yet uptake remains low, in part due to many barriers to successful ASD screening by pediatricians, including limited time and resources during the well-child visits, and low confidence in the screening process. In addition, underserved children from minority and low-income families are less likely to be screened compared to their White and middle-class peers, exacerbating the known disparities in access to early diagnosis and ASD intervention. The current proposal aims to expand beyond screening at pediatric well- visits, by developing and evaluating novel strategies to successfully screen for ASD in childcare centers, where many children spend more than 30 hours per week. Although there have been screening studies conducted in childcare centers, the feasibility of routinely using this alternate setting has not been widely addressed yet, and preliminary findings indicate that primary care strategies are not acceptable in childcare settings. Early Childhood Education Providers (ECEPs) have extensive exposure to normative child behavior and many hours of engagement with children, including many in underserved communities, enrolled in childcare. Thus, engagement of ECEPs in toddler screening could present an opportunity for significant improvement in ASD early identification and reduction of disparities in age of diagnosis and early treatment. However, there are existing barriers to autism screening in childcare centers, including low parental acceptance, which is critical to identify and address. Therefore, the goal of this pilot study is to explore barriers and facilitators of systematic screening by ECEPs, including cultural hesitancy, and using the strategies identified, examine the performance of the illustrated Modified Checklist for Autism in Toddlers, Revised, with Follow-Up (M-CHAT-R/F) paired with the Ages and Stages Questionnaires in childcare centers. The specific aims are to: (1) utilize qualitative methods (field observations and semi-structured interviews) with ECEPs to investigate organizational barriers and facilitators for implementation of ASD screening in childcare setting, (2) utilize qualitative methods (semi- structured interviews) with disadvantaged parents of children attending childcare centers to investigate familial and cultural barriers and facilitators for parent engagement in screening for ASD in childcare centers serving underserved families, and (3) pilot novel strategies for ASD screening in childcare centers, informed by the qualitative findings, to evaluate agreement between parents and ECEPs, accuracy of childcare screening, and acceptability of ASD screening in childcare centers. Results of this proposed study will directly address a gap in universal ASD screening, particularly for underserved families. Screening in childcare centers provides a complementary strategy to existing screening at pediatric well-visits, which will improve access of children from all backgrounds to early interventions and supports, critical for improved outcomes.

自闭症谱系障碍(ASD)的早期发现有助于早期干预，从而提高终生 预后。在学步儿童体检期间在医疗院进行普遍筛查成功地发现了许多 ASD的病例，但摄取率仍然很低，部分原因是通过以下方式成功筛查ASD存在许多障碍 儿科医生，包括在健康儿童就诊期间时间和资源有限，以及对儿童健康状况的信心较低 筛选过程。此外，来自少数族裔和低收入家庭的未得到充分服务的儿童不太可能 与白人和中产阶级同龄人相比，他们受到了筛查，加剧了在获得 早期诊断和ASD干预。目前的提案旨在扩大到儿科水井的筛查范围- 走访，通过开发和评估新的战略，在托儿中心成功筛查自闭症， 许多孩子每周花费的时间超过30个小时。尽管已经进行了筛查研究， 在托儿中心，常规使用这种替代设置的可行性还没有得到广泛的解决，而且 初步调查结果表明，初级保健战略在儿童保育环境中是不可接受的。早些时候 儿童教育提供者(ECEP)广泛接触标准的儿童行为和许多小时 与儿童，包括许多在服务不足的社区的儿童接触，并在托儿所注册。因此， ECEP在幼儿筛查中的参与可能为ASD的显著改善提供机会 及早发现和减少诊断和早期治疗年龄上的差距。然而，有一些 在托儿中心进行自闭症筛查的现有障碍，包括父母接受度低，这对 标识和地址。因此，这项先导性研究的目标是探索系统性的障碍和促进者 通过ECEP进行筛选，包括文化上的犹豫，并使用确定的策略来检查绩效 儿童自闭症的图文并茂的修订版检查表，后续(M-Chat-R/F) 托儿中心的年龄和阶段调查问卷。具体目标是：(1)利用质的 ECEP调查组织障碍的方法(实地观察和半结构访谈) 和在托儿环境中实施自闭症筛查的促进者，(2)利用定性方法(半 结构化访谈)对在托儿中心就诊的弱势儿童父母进行调查 在提供服务的托儿中心中，父母参与ASD筛查的文化障碍和促进者 服务不足的家庭，以及(3)在托儿中心试行自闭症筛查的新战略，由 定性结果，以评估父母和ECEP之间的一致性，儿童保育筛查的准确性，以及 儿童保育中心自闭症筛查的可接受性。这项拟议研究的结果将直接解决这一差距 在普遍的自闭症筛查中，特别是对服务不足的家庭。托儿中心的筛查提供了 对儿科探访现有筛查的补充战略，这将改善儿童从 所有背景都支持早期干预和支持，这对改善结果至关重要。