Latinos are the largest growing population in the U.S., yet they have the lowest autism diagnosis rate. And, according to Dr. Lauren Herlihy, who works at the Hospital for Special Care in Connecticut, when Latino children are diagnosed with autism, they tend to be diagnosed, on average, 2.5 years older than non-Latino children.
The earlier a child is diagnosed with autism, the better the long term outcome. Dr. Herlihy, explains: “What we know about autism, early diagnosis usually leads to earlier entry into treatment and early intensive intervention on the symptoms of autism are what are known to lead to better outcome. There haven’t been longitudinal studies, that I am aware of, to look at what is on the trajectory of children who are diagnosed later, but it would stand to reason that they might have less access to services and therefore less of a good outcome in terms of building more skills or acquiring language.”
Autism diagnosis continues to have many barriers for the Latino community. A variety of sources point to a language barrier for the reasoning for this. “The literature makes a distinction between primary Spanish speaking Latino children in the U.S. versus primary English speaking Latino families in the U.S.,” says Herlihy. “Particularly getting access to diagnostic evaluation and treatment in Spanish, especially in a state like Connecticut is more challenging. While there may be a lot of Spanish speakers and readily available interpreters in the health care system, there are not a lot that specialize in diagnosing and treating autism.”
One way that Connecticut has moved to bridge the gap in early diagnosis for Latino children is universal screening for every child that goes through a pediatrician’s office at both 18 and 24 months of age. Herlihy says that this is one thing that they take a lot of pride in, here in Connecticut, and believes other states should follow suit. With all the barriers and disparities in diagnosing autism based on race, Herlihy believes this is the best thing that can be done to reduce the barriers.
When parents hear about the disparities in early diagnosis in autism they usually wonder if they should be looking for signs themselves. And while education on the topic certainly is helpful, Herlihy expresses that with universal screening the mission isn’t to arm the parents, but to arm the healthcare providers. “It’s not about a parent needing to know signs of autism, recognize that’s a concern and then reach out to the pediatrician and ask for help, but pediatrician screening allows these standardized measures that ask parents about the early signs of autism, that would trigger a referral on its own with the parent not needing to know the signs of autism. … The majority of pediatricians in Connecticut do this, and are wonderful.”
The American Academy of Pediatrics recommended universal screening for autism in 2015 after a study looking at evidence for autism in peer-reviewed articles. The study states: “Although there have been considerable advances in characterizing early behavioral markers predictive of autism spectrum disorders (ASDs), as summarized in this special issue to Pediatrics, translation into clinical practice requires that the process of monitoring for such early risk markers be operationalized to facilitate broad implementation. To that end, universal screening for ASD has been recommended by the American Academy of Pediatrics (AAP) to ensure consistent practice and optimal detection of young children with early signs of ASD across a range of clinical and community contexts.”
There continues to be a push to bridge the gap in early diagnosis, and universal screening has been a giant leap. Research continues to grow in this area for Latinos as well. Herlihy says she gets the impression that along with reserach and screening, there has been quite a bit of awareness-raising in Spanish, in terms of literature that is out there in the general population of looking for signs of autism.
To help with this, Herlihy gives us three signs of autism:
- A Child that is not making eye contact, doesn’t look people in the eye when they speak to them. 2.) Young children who play with toys in unusual and repetitive way instead of playing pretend with them for example
- Young children who play with toys in unusual and repetitive way instead of playing pretend with them for example
- Children who don’t use gestures as much to communicate, they won’t point at something or don’t understand when you are pointing at something: non verbal communication impairment.
In Connecticut, early detection is key for not only the child but for those with medicaid. There are very few clinics in Connecticut that accept Medicaid for this diagnostic type of evaluation, however, if children are identified early through the early intervention system, which is free, that they would receive this evaluation and it wouldn’t have to go through the insurance.