Date of Award

8-30-2022

Document Type

Open Access Thesis

Degree Name

Master of Arts (MA)

Department

Clinical Psychology

First Advisor

Abbey Eisenhower

Second Advisor

Alice S. Carter

Third Advisor

Laurel Wainwright

Abstract

Though autism can be diagnosed as early as 18 months for many children, the current average age of diagnosis is between 3 and 4 years old. Children of color are diagnosed even later. Several studies have examined this disparity and have found that one significant contributor is pediatric providers’ screening practices. Though the American Academy of Pediatrics (AAP) recommends autism specific screening at 18- and 24-month well-child visits, many pediatricians report only screening if they are concerned or if the parent mentions a concern. In light of recent findings that Black and Latinx parents may have fewer autism-related concerns than White parents prior to their child’s autism diagnosis, it may be that pediatricians screen children of color less often due to parents not voicing concerns. Such practices could contribute to delayed screening and diagnosis for children of color. Thus, the current study examined whether the number of parents’ autism-related concerns pre-diagnosis mediates the relation between race and timeliness of autism screening and diagnosis. As a secondary data analysis, this project used data from a screening study implemented at 3 Part C Early Intervention (EI) agencies, including the parents of the 516 children that received an autism diagnosis. EI providers are increasingly being relied upon to screen for autism and in the larger study, it was found that they deviated from the screening protocol, as do pediatricians. As such, it is possible that similar patterns of delayed screening and diagnosis can be observed in the EI settings. It was first examined whether autism related parent concerns predicted timeliness to screening and diagnosis. Fewer concerns predicted greater time to screening and diagnosis. Next, differences in parent concerns across races was examined. Black parents reported fewer concerns than White parents; there were no differences between other racial groups. Finally, a mediation path was analyzed for Black and White parents; concerns mediated the relation between race and timeliness of diagnosis but did not mediate the pathway between race and timeliness of screening. The current study is the first to identify how the number of parents’ autism-related concerns is related to the timeliness of autism screening and diagnosis. It also helps further explore parents’ autism-related concerns, an unstudied contributor to delayed autism diagnosis among Black children. These findings shed light on the importance of how parent concerns are elicited by providers and the need for improved practices both to elicit concerns and ensure timely diagnosis in the absence of parents’ concerns.

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