Autism Screening in Childcare Settings

自闭症谱系障碍（ASD）的早期发现有助于早期干预， 预后在幼儿检查期间，医疗之家的普遍筛查成功地发现了许多 ASD的病例，但摄取率仍然很低，部分原因是成功的ASD筛查存在许多障碍， 儿科医生，包括有限的时间和资源，在良好的儿童访问，和低信心， 筛选过程。此外，来自少数民族和低收入家庭的得不到充分服务的儿童也不太可能得到教育。 与他们的白色和中产阶级同龄人相比， 早期诊断和ASD干预。目前的提案旨在扩大儿科筛查范围， 访问，通过开发和评估新的战略，成功地筛选ASD在托儿中心，其中 许多儿童每周花30多个小时。虽然已经进行了筛选研究， 儿童保育中心，常规使用这种替代设置的可行性尚未得到广泛解决， 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。早期 儿童教育提供者（ECEP）有广泛的接触规范的儿童行为和许多小时 与儿童的接触，包括许多在服务不足的社区，登记参加托儿服务。因此，在本发明中， ECEP参与幼儿筛查可能为ASD的显著改善提供机会 早期发现和减少诊断和早期治疗年龄的差异。但有 儿童保育中心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，本试点研究的目标是探索系统性的障碍和促进因素， 筛选由ECEP，包括文化犹豫，并使用所确定的战略，检查性能 说明的幼儿自闭症改良量表，修订版，随访（M-CHAT-R/F）配对， 儿童保育中心的年龄和阶段表。具体目标是：（1）利用定性 方法（实地观察和半结构化访谈）与ECEP调查组织障碍 和促进者在儿童保育环境中实施ASD筛查，（2）利用定性方法（半 结构化访谈）与儿童进入托儿中心的弱势父母进行家庭调查， 和文化障碍和促进者，父母参与筛查ASD在托儿中心服务 服务不足的家庭，以及（3）在儿童保育中心进行ASD筛查的试点新策略，由 定性调查结果，以评估父母和ECEP之间的协议，儿童保育筛查的准确性， 在托儿中心进行ASD筛查的可接受性。这项拟议研究的结果将直接解决一个差距 在普遍的ASD筛查中，特别是对于服务不足的家庭。在儿童保育中心进行筛查， 补充战略，以现有的筛查在儿科井访问，这将改善儿童的访问， 早期干预和支持的所有背景，对改善结果至关重要。

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.