Identifying Early Concerns of Autism Spectrum Disorder: The Influence of Patient Ethnicity in Pediatric Physician Decision-Making



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Background: The latency between when symptoms of autism spectrum disorder (ASD) emerge and when children are diagnosed by a health care provider is well-documented. Such delays in ASD diagnosis are even higher for ethnic minority children. This is particularly true for Latino children, though reasons for these disparities are not yet clear. Given the importance of early intervention in improving outcomes in ASD, early and accurate diagnosis for all children is critical. While many children with ASD and their families rely heavily on school-based services, it is often physicians, particularly pediatricians, who have the earliest opportunities to identify symptoms of ASD; however, these important providers may lack sufficient training in and familiarity with ASD. Considering the growing population of Latino families in the United States, increased understanding about potential provider-level factors contributing to ASD diagnostic disparities for Latino children is needed. Purpose: The aims of the study were to examine (1) the effect of child ethnicity (Latino or non-Latino White) upon physician identification of ASD symptoms and subsequent diagnostic decision-making and treatment recommendations; (2) the influence of physician self-reported confidence related to recognizing ASD as a diagnostic consideration; and (3) physician characteristics and experiences that may affect their consideration of an ASD diagnosis, particularly for Latino children. Methods: Sixty-five pediatric physicians were randomly presented with one of two versions of a clinical vignette (i.e. Latino child, White child) that described a hypothetical child (4 year-old male) presenting with various symptoms of ASD and were asked to answer questions designed to gather information about physicians’ identification of ASD symptoms and subsequent decision-making regarding diagnostic considerations and treatment recommendations; a scale of provider confidence in serving children with ASD was also developed and administered. Results: A series of chi-square tests of homogeneity indicated no significant differences in physician recognition of ASD as a differential diagnosis and subsequent diagnostic decision-making and treatment recommendations based on child ethnicity. However, logistic regression indicated physician self-reported confidence in serving children with ASD moderated the effects child ethnicity had on ASD as a first diagnostic consideration; participants who reported higher confidence were more likely to consider ASD as a first diagnostic consideration when the child in the vignette was Latino. Moreover, a measure of confidence was psychometrically assessed as a promising way to measure physician confidence in serving children with ASD that may be used in future studies. Conclusions: The current study offers initial information about pediatric physicians’ decision-making regarding diagnostic considerations and treatment recommendations when presented with a young child with various symptoms of ASD, findings that were not previously available in research. Additionally, findings from this study highlight the role physician self-reported confidence has on the diagnostic consideration of ASD with Latino children. The study also offers unique information regarding physician perceived challenges related to identifying and diagnosing ASD, which represent opportunities for cross-disciplinary collaborations and consultative partnerships between school psychologists and pediatricians. Results are discussed in the context of implications for such cross-disciplinary work with the goal of reducing ASD diagnostic disparities for ethnic minority children.



Autism spectrum disorder (ASD), Diagnostic disparities, Latina/o children, Pediatric physicians, School psychology