Pediatricians reported language as barrier to providing ASD screening

WASHINGTON — Many pediatricians find it difficult to assess autism spectrum disorder risk among Latino children in families whose primary language is Spanish, according to findings presented here during the Pediatric Academic Societies Annual Meeting.

According to Katharine E. Zuckerman, MD, MPH, division of general pediatrics and Child and Adolescent Health Measurement Initivative, Oregon Health and Science University, Portland, Ore., and colleagues, a minority of pediatricians offer Spanish language autism spectrum disorder (ASD) screening.

“Only about one in 10 pediatricians are offering recommended screening in Spanish, even if Latinos make up a significant proportion of their practice,” she said.

Based on these results, Zuckerman and colleagues suggested that promoting language-appropriate screening practices and providing support to pediatricians for screening and referral for children in these families may help reduce ethnic differences in ASD diagnosis.

“Disparities exist in autism care,” she said. “Compared with white children, Latino children are less likely to have an ASD diagnosis overall and are more likely to be diagnosed later. This group is also more likely to be misdiagnosed.”

Zuckerman and colleagues surveyed a random sample of 500 pediatricians, all of whom were asked if they offered ASD screening per AAP Bright Futures guidelines, and whether they offered Spanish screening for families with Spanish language preference.

Pediatricians were then asked to rate the difficulty of identifying signs and symptoms of an ASD among children from white; Latino families who primarily spoke English; and Latino families who spoke primarily Spanish.

The investigators compared ASD screening rates and attitudes among pediatricians who patient population consisted of 25% or less Latino patients vs. pediatricians whose patient population consisted of more than 25% Latino patients. McNemar’s test was used to compare difficulty recognizing ASD signs/symptoms among children from Latino English language, Latino Spanish language and white families, Zuckerman said during her presentation.

A total of 62.6% of pediatricians responded to the survey; 41.9% reported they offered ASD screening per Bright Futures guidelines, and 27.7% offered ASD screening in Spanish. Among pediatricians in practices with 25% of fewer Latino patients, only 16.9% reported that they offered ASD screening in Spanish vs. 40.2% of pediatricians whose practice included more than 25% of Latino patients (P=.001).  Only 10.5% of all pediatricians were offering both ASD and general developmental screening in Spanish. 

According to the survey data, 60.4% of pediatricians said it was somewhat/very difficult to assess ASD risk among Latino children in Spanish primary language families vs. 34.8% of pediatricians who said it was somewhat/very difficult (P<.001) among Latino children in English primary language families.

A total of 33.2% surveyed pediatricians reported that the screening process was somewhat/very difficult (P <.001) for white children.

Even among pediatricians with more than 25% Latino patients reported that assessing ASD risk for Latino children in Spanish primary language families was often perceived as difficult (46.0% stating somewhat/very difficult vs. 27.2% for white children; P<.001).

“Latino children who have primary Spanish language in their household who have parents with limited English proficiency are highly unlikely to receive ASD screening in their family’s primary language,” Zuckerman said. 

For more information:

Zuckerman KE. #2365.5. Presented at: Pediatric Academic Societies Annual Meeting; May 4-7, 2013; Washington.

Disclosure: Zuckerman reports no relevant financial disclosures.