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Autism Screening in Childcare Settings

儿童保育机构中的自闭症筛查

基本信息

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
项目类别：
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

项目摘要

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.

早期发现自闭症谱系障碍（ASD）有助于早期干预，从而改善终身