Autism May Be Overlooked in Young Latino Children
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MONDAY, Aug. 19 (HealthDay News) -- Latino children typically are diagnosed with autism more than two years later than white children, and new research suggests that language-appropriate screenings and access to autism specialists are two big factors in that delay.
"Parents need to know that early identification of autism is important," said study author Dr. Katharine Zuckerman, an assistant professor of pediatrics at Oregon Health and Science University in Portland. "It leads to better outcomes for the child and better family outcomes. It may even save money. All children should be screened."
Yet Zuckerman's study found that only one in 10 pediatricians administered the general developmental screenings and autism-specific screenings in Spanish for their Spanish-speaking patients.
Dr. Andrew Adesman, chief of developmental and behavioral pediatrics at the Steven & Alexandra Cohen Children's Medical Center in New Hyde Park, N.Y., said there's a screening tool with yes-or-no answers that a pediatrician can still score and assess the risk of autism even if they don't speak Spanish.
But, Adesman said, language barriers can definitely pose problems when trying to assess a child's risk for autism. "To the extent that a language delay is the core symptom, it becomes more difficult to assess the language if the clinician doesn't speak the language," he said. "If the child is living in a bilingual household, it can be difficult to assess differences in language development."
"The signs of language issues can be subtle, and they're hard to identify in the first place," Zuckerman said, which makes it even harder if the pediatrician and the child don't speak the same language.
Still, according to the more than 250 pediatricians surveyed for the study, the biggest barrier to getting a firm autism diagnosis is access to autism specialists.
Adesman agreed that this is a big problem, especially in certain parts of the United States. He recommended, however, that any parent with concerns about their child should request an evaluation through their state's early intervention service, which typically is offered through the department of health. He said these services are free and offered whether or not a child has health insurance. These screenings also are often available in a child's native language.
The pediatricians included in the survey were all from California, and 60 percent were female. Slightly more than half have been in practice for more than 20 years. About half said more than 25 percent of their patients are Latino.
Seventy percent of the doctors said they didn't speak Spanish, or spoke it poorly. Thirty percent said they spoke good or excellent Spanish.
Eighty-one percent offered some form of developmental screening, but just 29 percent offered autism screening in Spanish, according to the American Academy of Pediatrics guidelines. Only 10 percent offered general developmental and autism screenings in Spanish.
Communication and cultural barriers also were cited as reasons for the delay in diagnosis. The pediatricians said they felt that Latino parents don't have as much knowledge about autism as white parents do.
"Latino parents may know less about autism, so they bring up fewer concerns," Zuckerman said. She said autism awareness needs to be raised in Latino communities.
"We need to try to increase the information availability. Parents need to know the early signs of autism," she said, noting that a language delay, a lack of eye contact, not pointing to show interest, not wanting to play interactive games such as peekaboo, and playing with toys in an unusual way, such as only spinning the tires of a toy car instead of pretending to make the car drive, are some possible signs of autism.
Pediatricians need to be encouraged to conduct both developmental and autism screenings, and whenever possible these screenings should be done in the child's primary language. "Early identification of autism is super-important," Zuckerman said. "It's a condition that we know will get better with early therapy. We need to be assessing kids for this."
"Autism affects all genders and ethnicities," Adesman said. "Any family with a concern about their child should [have their child] screened by their pediatrician or through early-intervention services from their state."
Results of the study were released online Aug. 19 and in the September print issue of the journal Pediatrics.
SOURCES: Katharine Zuckerman, M.D., M.P.H., assistant professor, pediatrics, Oregon Health and Science University, Portland; Andrew Adesman, M.D., chief, developmental and behavioral pediatrics, Steven & Alexandra Cohen Children's Medical Center, New Hyde Park, N.Y.; Aug. 19, 2013, Pediatrics, online