Improving Screening and Early Identification Practices for Children

with Autism Spectrum Disorders in State Public Health Offices

Eric G. Kurtz, Ph.D

Leadership Education in Neurodevelopmental Disorders (SD LEND)

Center for Disabilities (SD UCEDD), Department of Pediatrics at the University of South Dakota Sanford School of Medicine

BACKGROUND:

While the prevalence of children identified with Autism Spectrum Disorder (ASD) is
continually on the rise, there remains much needed improvement in diagnosing the
disorder early (by age 3). Symptoms of ASD present themselves as early as 18 months
of age, sometimes earlier. All children are able to be reliably diagnosed by the age of 2
years. This delay in diagnosis results in children lacking appropriate early intervention,
which leads to a higher risk for negative outcomes throughout the life course. Some of
the barriers to early diagnosis include providers waiting for parents to communicate
concerns, lack of time or reimbursement for screening procedures, lack of providers
with expertise in ASD, and children not making it to a diagnostic evaluation after high
risk screening results. These barriers become even more pronounced in rural and
frontier locations and other underserved populations.

PURPOSE:

Design and implement a training and technical assistance program to improve

screening and early diagnosis of ASD
Collaborate with Title V/public health offices to address barriers to screening and
early identification efforts

PARTICIPANTS:

141 nurses, dieticians, social workers and clinic administrators from 67 offices across
South Dakota
All participants serve patients from rural, low-income, underserved and
underrepresented populations

METHOD:

Full day training to enhance ASD knowledge base, identify early warning signs,
effective screening procedures, and communicating concerns to parents
Trainings were conducted through didactic instruction, interactive discussion, and
case studies
Initial training followed by individual technical assistance to participants
Pretest-posttest design was used to measure impact
TRAINING MATERIALS:
Centers for Disease Control and Preventions (CDC) Learn the Signs Act Early website
and materials
Autism Case Training (ACT)
Module 1: Early Warning Signs of Autism
Module 2: Screening for Autism
Module 3: Communicating Concerns: Screening and Diagnosis Results
Module 5: Early Intervention and Education

RESULTS:

Impact and outcome measures of the program indicate significant increases in perceived knowledge base
and understanding of ASD, recognizing the early warning signs, comfort level and ability to implement
effective screening practices for ASD, and communicating results and recommendations to parents.
Results of additional analyses indicate a significant increase in the implementation of Evidence-Based
Practices (EBP) after the training was provided. A comparison in the means between Q11(The degree to
which you and your organization implemented EBP to screen children that were suspected of Autism
Spectrum Disorder BEFORE the training) and Q20 (The degree to which you and your organization
implemented Evidence-Based Practices to screen children that were suspected of Autism Spectrum
Disorder AFTER the training) indicates the degree to which EBP were implemented before and after the
training participants received: Mean Q11 = 2.64 Mean Q20 = 3.09 A paired t-test was conducted to
determine whether there was any significant difference in the way in which each participant perceived
there to be a difference in the degree to which they implemented EBP before and after the training. Results
were t = -.15; df = 55; p < .005. In combination with the means this suggests there was a statistically
significant difference in the degree to which participants improved their implementation of EBP following
the training. An effect size is the magnitude or strength of the difference resulting from the training.
Cohens d for paired samples was computed (d =.42) which indicates a moderate level of effect.
Outcome / Impact

Percentage

Increased and/or improved

professional knowledge, skills and
capacity for screening for ASD.

85%

Improved reliability and validity of

screening results

75%

Enhance overall ability for screening

for ASD

98%

Increased frequency of
implementation of EBPs for screening
for ASD

47%

Increased capacity to identify and

implement effective practices,
interventions, resources and supports
for youth/children with ASD

75%

Improve outcomes for youth

and adults with ASD and other
developmental disabilities

74%

DISCUSSION:

Through a targeted training and technical

assistance plan, significant improvements can
be made in the implementation of effective
screening practices for ASD in underserved and
underrepresented populations. While the
results of this project are very promising, efforts
must be expanded and monitored. Additional
plans include formulating individualized
technical assistance plans for each public
health office aimed at addressing the specific
barriers to improving screening rates of
children, and sustaining the progress
accomplished. Rates of screening must be
monitored across the state, and additional
study must be conducted to examine the
direct impact of these efforts for children
and families.