Autism and developmental screening in a public, primary care setting primarily serving Hispanics: challenges and results.
In primarily Hispanic primary-care clinics, expect M-CHAT/ASQ positive screens around 30 percent and plan extra resources to secure follow-up evaluations.
01Research in Context
What this study did
Doctors added two quick checklists, M-CHAT and ASQ, to regular 18-month check-ups. Most families were Spanish-speaking and used public insurance.
Staff scored the forms the same day and told parents if extra steps were needed.
What they found
About three out of every ten toddlers flagged positive. That is higher than the usual 5-10 percent seen in other clinics.
Even with clear results, only about half of the families finished the next referral visit.
How this fits with other research
Scarpa et al. (2013) saw the M-CHAT miss many rural low-income kids. The high yield here may come from city families and Spanish-language forms.
Eussen et al. (2016) moved the same screening into preschools and still found it doable. Together the studies show the tool works in many places, not just doctor offices.
Li et al. (2018) added a quick nurse play session and phone reminders. Those extras doubled the number of families who completed referrals, a fix this clinic could copy.
Why it matters
If you serve Hispanic families, expect up to one third of M-CHAT screens to come back positive. Plan extra evaluator time and use Spanish-speaking staff to explain why follow-up matters. Borrow the two-step plus call method from Li et al. (2018) to turn more red flags into real diagnoses and early services.
Want CEUs on This Topic?
The ABA Clubhouse has 60+ free CEUs — live every Wednesday. Ethics, supervision & clinical topics.
Join Free →Add a five-minute nurse play observation and a Spanish-language reminder call before the referral deadline
02At a glance
03Original abstract
We implemented screening of children 16-30 months of age (n = 1,760) from a typically under-served, primarily Hispanic, population, at routine pediatric appointments using the modified checklist for autism in toddlers (M-CHAT) and Ages and Stages Questionnaire. Screen positive rates of 26 and 39%, respectively, were higher than previous reports. Hispanics were more likely to score M-CHAT positive than non-Hispanics (adjusted OR 1.7, 95% CI 1.2-2.4), as were those screened in Spanish. About 30% of screen-positive children were referred for further assessment, but only half were seen. Thus screening in this population is feasible, but may require additional resources. Attention to the cultural applicability of screening instruments, as well as to explaining the results or need for additional services to parents, is critical to serve the growing Hispanic population.
Journal of autism and developmental disorders, 2014 · doi:10.1007/s10803-014-2032-y