Boston Medical Center, Boston, MA.
Boston University School of Public Health, Boston, MA.
J Dev Behav Pediatr. 2021 Sep 1;42(7):515-523. doi: 10.1097/DBP.0000000000000928.
Families, pediatric providers, and service systems would benefit from expanded knowledge regarding (1) who is most likely to receive a recommended diagnostic evaluation after a positive primary care-administered autism screen and (2) of those who screen positive, who is most likely to be diagnosed with autism?
Participants included 309 predominantly low-income, racial/ethnic minority parents and their child, aged 15 to 27 months, who screened positive on the Modified Checklist for Autism in Toddlers, Revised with Follow-Up (M-CHAT-R/F). Generalized estimating equations were used to fit models of predictors for each binary outcome: receiving a diagnostic evaluation and receiving an autism diagnosis on evaluation.
Significant predictors of diagnostic evaluation receipt included the parent being older or non-Hispanic and the child having private insurance, lower child communication functioning, or receiving Early Intervention services. Significant predictors of an autism diagnosis on evaluation included male child, lower child communication functioning, screening directly in the parent's preferred language, White/non-Hispanic parent, and no parent history of mood disorder.
Children with younger parents, Hispanic ethnicity, relatively higher communication skills, public insurance, and no Early Intervention services were less likely to receive recommended diagnostic care. Reduced likelihood of autism diagnosis after a positive screen in non-White/non-Hispanic subgroups supports previous research indicating issues with M-CHAT-R/F positive predictive power for racial/ethnic minorities. The use of telephonic interpreters to administer screens, as opposed to directly screening in families' preferred languages, may lead to identification of fewer true autism cases. Thus, multilingual clinical staff capacity may improve positive predictive power of autism screening.
家庭、儿科医生和服务系统将从扩大以下方面的知识中受益：（1）在初级保健管理的自闭症筛查呈阳性后，最有可能接受推荐的诊断评估的人群；（2）在筛查呈阳性的人群中，最有可能被诊断为自闭症的人群。
参与者包括 309 名主要来自低收入、种族/族裔少数群体的父母及其 15 至 27 个月大的孩子，他们在改良婴幼儿自闭症检查表修订版（M-CHAT-R/F）上筛查呈阳性。广义估计方程用于拟合每个二项结果的预测因素模型：接受诊断评估和在评估中接受自闭症诊断。
诊断评估接受的显著预测因素包括父母年龄较大或为非西班牙裔，以及孩子拥有私人保险、较低的儿童沟通功能或接受早期干预服务。评估中自闭症诊断的显著预测因素包括男孩、较低的儿童沟通功能、直接用父母首选的语言进行筛查、白人/非西班牙裔父母以及父母没有情绪障碍史。
父母较年轻、西班牙裔、相对较高的沟通技能、公共保险和没有早期干预服务的儿童不太可能接受推荐的诊断护理。在非白人和非西班牙裔亚组中，M-CHAT-R/F 阳性预测力较低的情况下，筛查呈阳性后自闭症诊断的可能性降低，这支持了先前的研究表明 M-CHAT-R/F 对种族/族裔少数群体的阳性预测力存在问题。使用电话口译员进行筛查，而不是直接用家庭首选的语言进行筛查，可能会导致更少的真正自闭症病例被识别。因此，多语言临床人员的能力可能会提高自闭症筛查的阳性预测力。
