The goal of the proposed work is to implement a system-level intervention to (a) improve early detection of autism spectrum disorders (ASD) and (b) increase early access to autism specific early intervention services, especially for children who often are not given the known benefits of early intervention services. The proposed study builds on a funded multi-stage screening study that is currently being implemented in 3 Early Intervention programs serving children in the Circle of Promise, a Boston region with high social/economic risk and comprised of a high percentage of children from racial/ethnic minority populations, English language learners, or living in poverty. ASD Rates are increasing in the U.S., with recent estimates indicating that 1 in 88 children have ASD. Early diagnosis and intervention are crucial to ensuring optimal long-term outcomes;yet significant disparities exist in rates and age of diagnosis. Children in the above groups are less likely to be diagnosed and are diagnosed 1-2 years later than White, non-poor, English speaking children. This delay limits access to autism-specific early treatments. Timely identification and treatment requires at least two steps: 1) knowing and identifying the early signs of ASD, and 2) acting early. Pediatricians, parents, and EI providers must decide whether a child is showing enough signs to justify further assessment or treatment, or whether the child is at low enough risk to forego immediate action. Thus, acting early requires the about groups to evaluate the early signs and choose a yes/no course of action, which we refer to as a clinical threshold. We believe that early identification and access to care can be improved both by increasing knowledge of the early signs of ASD and by influencing these decision thresholds regarding when to screen, assess, and refer to ASD-specific interventions. Moreover, access to services requires agreement and cooperation among these decision-makers. Guided by our prior theoretical work and engagement with pediatricians and EI providers, we will influence improved access and receipt of needed services for children with ASD by offering: (1) multistage ASD screening to all EI-enrolled children ages 14-24 months, (2) motivational interviewing to parents whose children qualify for ASD services, and (3) systematic outreach to pediatricians from EI sites. This system- level approach involves altering the context in which pediatricians, EI providers, and parents assess and act on signs of ASD to reduce disparities in access to ASD diagnosis and services. This study will test the following hypotheses: 1) Exposed children with ASD will be more likely to be identified, referred, and receive ASD services, regardless of race/ethnicity, language or poverty status;2) Exposed pediatricians and EI providers will identify more children with ASDs and refer to assessment and services at higher rates;and 3) Exposed parents of children with ASD will report greater agreement with and will be more likely to follow through on ASD-specific assessment and service referrals.

Public Health Relevance

Autism Spectrum Disorders (ASD) are now recognized as a significant public health concern due to recent high prevalence estimates (1 in every 88 children) and the high costs associated with special education and adult service supports required by many affected individuals. The goal of the proposed work is to implement a system-level intervention that aims to increase coordinated care across pediatricians, early intervention providers and parents to: (a) improve early detection of ASD and (b) increase early access to autism specific early intervention services, especially among children who too often are not afforded the known long-term benefits of early intervention services. By increasing early access to ASD appropriate interventions, we hope to minimize health disparities in access to care and improve quality of life for all children with ASD and their families.

National Institute of Health (NIH)
National Institute of Mental Health (NIMH)
Research Project (R01)
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Special Emphasis Panel (ZMH1-ERB-K (05))
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Pintello, Denise
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University of Massachusetts Boston
Schools of Arts and Sciences
United States
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