The overall goal of the proposed research and training plan is to prepare the Ms. Daniels for an academic career in child mental health services research and, more specifically, to enable her to understand and study the mechanisms through which policies affect health practice and contribute to improved outcomes for children with developmental disabilities such as autism. The proposed research will be implemented in the context of a comprehensive training program that has the following objectives: 1) to develop content knowledge in the application of policy to public health research, specifically policies that affect the health care delivery and outcomes for children with developmental disabilities;2) to develop a methodological foundation in the combined use of administrative and policy data for addressing important health policy and services research questions;and 3) to engage in the dissemination of research findings and networking with the broader child mental health services research community. Early identification of autism is critical to achieving the best possible outcomes for children;studies spanning the last few decades consistently demonstrate that intensive early-intervention programs improve cognition and reduce core symptoms of autism. Recent studies have shown that autistic disorder can be reliably diagnosed starting from when a child is two years of age;however, many children are not diagnosed until they reach school age. Delayed diagnosis translates into a missed opportunity to provide crucial services to reduce the disorder's severity and improve developmental outcomes and quality of life. While recent studies have advanced our understanding of factors that influence age of diagnosis, many identified factors are not modifiable. Previous studies have found significant geographic variation in age of diagnosis, yet have failed to identify community- or state-level factors that adequately explain this variation. Efforts to reduce age of diagnosis must be informed by a broader understanding of the mechanisms through which policies affect health practice and the extent to which health practice leads to improvements in child health outcomes. The proposed study will address these issues through the following questions: 1) To what extent do states'Early and Periodic Screening, Diagnosis and Treatment (EPSDT) policies affect child-level compliance with American Academy of Pediatrics (AAP) guidelines for well-child care?, 2) Are children with autistic disorder whose well-child care complies with AAP guidelines diagnosed earlier?,and3) Is having a usual source of care independently associated with age of diagnosis, independent of adherence to these AAP guidelines? These questions will be investigated through an in-depth examination of service use claims over the two-year period prior to diagnosis in a sample of preschool- aged children who were enrolled in Medicaid sometime between 2001 and 2005. The proposed project is aligned with the mission and objectives of the National Institute of Mental Health in that it will address research gaps relative to enhancing of services to address the diverse needs of children with autism.
The proposed study has the potential to affect public health policy and intervention strategies in the areas well-child care and the early detection and diagnosis of autistic disorder. This study may help to inform future recommendations related to the frequency and timing well-child care for pre-school aged children. In addition, findings may help to inform state policy decisions relative to the allocation of resources for the early detection of autistic disorder.
| Daniels, Amy M; Mandell, David S (2014) Explaining differences in age at autism spectrum disorder diagnosis: a critical review. Autism 18:583-97 |
| Daniels, Amy M; Mandell, David S (2013) Children's compliance with American Academy of Pediatrics' well-child care visit guidelines and the early detection of autism. J Autism Dev Disord 43:2844-54 |
