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，从而改善了终生 预后。在蹒跚学步的检查期间，在医疗之家进行的普遍筛查成功地检测了许多 ASD病例，但吸收仍然很低，部分原因是许多成功的ASD筛查障碍 儿科医生，包括在孩子访问期间的有限时间和资源，对 筛选过程。此外，来自少数民族和低收入家庭的服务不足的儿童不太可能 与白人和中产阶级同龄人相比，筛选了，加剧了已知差异 早期诊断和ASD干预。当前的提案旨在扩大不仅仅是在小儿井的筛查 通过制定和评估新型策略来访问，以成功地筛选在育儿中心中的ASD， 许多孩子每周花费超过30个小时。尽管已经进行了筛查研究 育儿中心，常规使用此替代设置的可行性尚未被广泛解决，并且 初步发现表明，在育儿环境中不可接受初级保健策略。早期的 儿童教育提供者（ECEPS）广泛接触规范性儿童行为和许多小时 与儿童的互动，包括服务不足的社区中的许多人参与育儿。因此， 在幼儿筛查中参与ECEP可以为ASD显着改善的机会 诊断年龄和早期治疗年龄的早期鉴定和降低。但是，有 育儿中心中自闭症筛查的现有障碍，包括低父母接受，这对 识别和解决。因此，这项试验研究的目的是探索系统的障碍和促进者 通过ECEP进行筛选，包括文化犹豫，并使用所识别的策略检查表现 在幼儿中自闭症的插图修改后的清单，并与后续（M-Chat-r/f）进行了修订 育儿中心的年龄和阶段问卷。具体目的是：（1）使用定性 与ECEPS调查组织障碍的方法（现场观察​​和半结构化访谈） 以及在育儿环境中实施ASD筛查的促进者，（2）使用定性方法（半半） 结构化访谈）与参加育儿中心的儿童的处境不利的父母进行调查 以及在为育儿中心筛查ASD筛查的文化障碍和促进者 服务欠佳的家庭和（3）试验在育儿中心筛查ASD筛查的新型策略，由 定性发现，评估父母与ECEP之间的协议，育儿筛查的准确性以及 在托儿中心筛查的可接受性。这项拟议的研究的结果将直接解决差距 在通用ASD筛查中，特别是对于服务不足的家庭。托儿中心的筛查提供了 在儿科良好访问中进行现有筛查的互补策略，这将改善儿童的进入 早期干预和支持的所有背景对于改善结果至关重要。