Multi-stage Screening in Early Intervention: A Critical Strategy for Improving ASD Identification and Addressing Disparities.
Abbey Eisenhower, Frances Martinez Pedraza, R Christopher Sheldrick and 4 others
PMID 32144605WHAT IT FOUND
Embedding two-stage autism screening in Early Intervention caught 83.7% of diagnosed cases.
Follow-through was high, and gaps in diagnosis for children of color or those with limited English vanished after Stage 1. This model helps therapists identify risk without relying on pediatric referrals.
Key findings
01At least 64.9% of eligible children completed Stage 1 screening, and 83.7% of those who reached diagnostic evaluation received an ASD diagnosis.
02After the first screening stage, racial, linguistic, and insurance status no longer predicted participation or diagnosis, suggesting the model reduced disparities in access to evaluation.
03Follow-through was high: 65.3% of Stage 1 positives completed Stage 2, and 84.6% of Stage 2 positives received a diagnostic evaluation.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
The study was conducted in Massachusetts, which has the highest EI penetration in the US (9.4%). Results may not generalize to states with lower EI enrollment. Screening was not universal; providers decided when to screen, which may have influenced who was identified. The study did not track children who did not return packets or those who received diagnoses outside the EI system, so the true prevalence and impact on missed cases are unknown. Stage 1 tools were only available in English and Spanish, limiting applicability for families speaking other languages.
Declared interests
The authors declare no competing interests. The study was supported by federal funding (NIH/ICF).
The easy way to misread this
Do not assume this screening model will work equally well in states with low Early Intervention participation. Massachusetts has the highest EI enrollment in the US, so the reach of this program relied on a system that many other states do not have.