A new study takes a novel approach to identifying autism among low-income and minority children in medically underserved areas by training teachers in day cares and preschools to recognize the disorder.
In the study by researchers at Children’s Specialized Hospital in Mountainside, teachers screened 1,000 children and identified 31 cases of autism that had gone undiagnosed.
“We found that unless we go out into underserved communities we are going to be missing many children who have autism,” said lead research Dr. Yvette Janvier, developmental/behavioral pediatrician and medical director.
The results may point the way to a paradigm shift in screening for autism, Janvier said. The American Academy of Pediatrics recommends that children be screened for autism at 18 months and 24 months.
“We found that when we offered training to the preschools they were very hungry for the information and very interested in learning and getting involved,” she said. The teachers spend several hours a day with children, and can be more objective than parents when it comes to seeing developmental issues.
“Instead of looking at this from a traditional medical model — all children go to doctors, so let the doctors do it — I think we need to look at a more education and systemic model,” Janvier said.
Autism is identified on average much later in low income and minority communities, where the average age at diagnosis is 8 or 9, compared with an average age of 4 in more affluent areas, Janvier said. But autism can be diagnosed at 18 months, and the earlier a child begins a program of intensive behavioral therapy, the better the outcome for the child’s cognitive, emotional and behavioral development, she said.
“What this tells us very clearly is low income families are facing barriers that limit their access to crucial autism services both in diagnosis and intervention,” said Michael Rosanoff, Autism Speaks associate director of public health research and scientific affairs, who has reviewed Janiver’s study.
“We don’t know how cultural difference may make the early warning signs of autism more difficult to detect,” Rosanoff said. “We need to better understand how we can overcome these challenges that low income and ethnic minority families are facing so we can get the appropriate care to them earlier.”
Rosanoff agrees with the goal of building capacity for screening at day cares and preschools. The study suggested that there should be evaluation by day care teachers, in combination with parent reporting. “We need to teach parents and teachers how to look for the early warning signs of autism,” he said.
In March, the Centers for Disease Control and Prevention reported a new estimate that one in 88 children nationally have autism, and that the rate for New Jersey was about one in 50. But Rosanoff said the state statistics rely on a small sample and are not a true picture of prevalence. New Jersey is doing a better job than many other states at diagnosis, but said the disorder continues to be underreported.
The study was funded by a two-year, $500,000 grant from the New Jersey Governor’s Council for Medical Research and the Treatment of Autism and it worked with children and teachers in Newark, Plainfield, Elizabeth, Trenton, New Brunswick and Bridgeton.
The state Department of Health in June will award $8 million in five-year autism research grants, and Janvier has applied for funding for a study of telemedicine to improve autism diagnosis in low-income communities. The study would use of high definition video to allow clinicians to screen children from remote locations, thus increasing the number of children screened.