Autism: Few General Doctors Prepared to Screen, Diagnose Latino Kids
Clinicians face special challenges in diagnosing autism spectrum disorders (ASDs) in Latino children, according to a new study published online August 19 and in the September issue of Pediatrics. The authors identify strategies for overcoming those obstacles.
Katharine E. Zuckerman, MD, MPH, from Oregon Health & Science University, Portland, and colleagues note that primary care physicians can play a key role in spotting ASDs early with Latino children.
Promoting language-appropriate screening, disseminating culturally appropriate ASD materials to Latino families, improving the specialist workforce, and providing primary care pediatrician support in screening and referral for Latino children may be important ways to reduce racial and ethnic differences in care.
Previous studies have shown that Latino children are diagnosed with ASDs less often than white children and that when the diagnosis is made, it is often later than in white children.
To find out more about that issue and how care for Latino children might be improved, the researchers conducted a mail-based survey of 267 primary care pediatricians in California. They asked how often the pediatricians used bilingual screenings to assess for general development, as well as for the presence of ASD. They also asked the pediatricians how they perceived ASD-related knowledge among Latino parents compared with white parents.
In addition, the researchers queried the pediatricians about what sorts of difficulties they encountered in assessing ASDs in Latino children compared with white children.
Although more than three quarters (81%) of the pediatricians surveyed offered some type of developmental screening, only about a fifth offered Spanish-based ASD screening that conformed to guidelines published by the American Academy of Pediatrics. Only about 1 in 10 of the clinicians offered both general developmental and ASD screening that was Spanish-based.
Moreover, most of the respondents felt that Latino parents were less knowledgeable about ASD than white parents.
The clinicians report having more difficulty screening for ASD children who came from Spanish-speaking homes; this was true even in practices in which more than a quarter of the patients were Latino.
“To our knowledge, this is the first study investigating [primary care pediatrician] perspectives on disparities in ASD identification,” the authors write. “This study points to modifiable provider-related factors that may contribute to ASD diagnostic delays among Latinos. The data may help inform future interventions to reduce racial and ethnic differences in ASD care,” they conclude.
Pediatrics. 2013;132:445-453.
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