Factors Associated with Caregivers' Decisions to Pursue a Diagnostic Evaluation After a Positive Autism Screen in Primary Care.
YiQin Zhu, Naomi O Davis, Lauren Franz and 7 others
PMID 39373883WHAT IT FOUND
Even when barriers like cost and language were removed, Black families were less likely to pursue autism evaluation after a positive screen.
Spanish-speaking families had high uptake. Child sex, income, and screen severity did not predict who followed up.
Key findings
01Black children had significantly lower rates of receiving a diagnostic evaluation compared to Hispanic/Latino and White children, despite free access and no referral barriers.
02Children of Spanish-speaking caregivers had a higher rate of evaluation completion than those of English-speaking caregivers, though this difference was not statistically significant.
03The number of autism signs endorsed by the caregiver on the screening questionnaire did not differ significantly between children who received an evaluation and those who did not.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
The sample size was small (129 children), which limited the power to detect differences in some subgroups and prevented analysis of Asian children. The study relied on caregivers declining or not responding, but did not measure *why* they declined, leaving the root causes of the disparity unexplained. Household income data was missing for some participants, which could bias the analysis of socioeconomic factors. For a small subgroup, it was unclear if follow-up screening questions were administered, potentially affecting the accuracy of the 'positive' screen definition.
Declared interests
Author Dawson is on the Scientific Advisory Board of Tris Pharma, was a consultant to Apple, and receives royalties from publishers. The study was conducted within a university medical center.
The easy way to misread this
Do not conclude that language barriers are the primary driver of disparity in this context, as Spanish-speaking families actually had higher uptake rates. The key finding is that removing financial and access barriers did not eliminate the racial disparity in follow-through for Black families, suggesting other factors like trust or systemic bias are at play.