IMPORTANCE The American Academy of Pediatrics recommends referring children at elevated risk of autism spectrum disorder (ASD) for Part C early intervention (EI) services, but notes that EI services often fail to provide ASD screening. OBJECTIVE To evaluate the hypothesis that a multistage screening protocol for ASD implemented in 3 EI settings will increase autism detection, especially among Spanish-speaking families. DESIGN, SETTING, AND PARTICIPANTS Difference-in-differences analyses with propensity score weighting of a quasi-experimental design using administrative data on 3 implementation EI agencies and 9 comparison EI agencies from 2012 to 2018 provided by the Massachusetts Department of Public Health. Eligible children were aged 14 to 36 months, enrolled in EI, had no prior ASD diagnosis or medical condition precluding participation, and had parents who spoke English or Spanish. The final analytic sample included 33 326 unique patients assessed across 150 200 person-quarters. EXPOSURES Multistage ASD assessment protocol including ASD screening questionnaires, observational screener, and diagnostic evaluation. MAIN OUTCOMES AND MEASURES Increased incidence of ASD diagnoses as documented in Department of Public Health records and reductions in language-associated health care disparities. RESULTS Implementation of screening at 3 EI sites was associated with a significant increase in the rate of ASD diagnoses (incidence rate ratios [IRR], 1.6; 95% CI, 1.3-2.1; P < .001), representing an additional 8.1 diagnoses per 1000 children per quarter. Among Spanish-speaking families, screening was also associated with a significant increase in the rate of ASD diagnoses (IRR, 2.6; 95% CI, 1.6-4.3; P < .001), representing 15.4 additional diagnoses per 1000 children per quarter-a larger increase than for non-Spanish-speaking families (interaction IRR, 1.8; 95% CI, 1.0-3.1; P = .005). Exploratory analyses revealed that screening was associated with a larger increase in the rate of ASD diagnoses among boys (IRR, 1.8; 95% CI, 1.4-2.3; P < .001) than among girls (IRR, 1.1; 95% CI, 0.6-1.7; P = .84). CONCLUSIONS AND RELEVANCE In this study, associations between increased rates of ASD diagnoses and reductions in disparities for Spanish-speaking households support the effectiveness of multistage screening in EI. This study provides a comprehensive evaluation of ASD screening in EI settings as well as a rigorous evaluation of ASD screening in any setting with a no-screening comparison condition. Given that the intervention included multiple components, mechanisms of action warrant further research, as do disparities by child sex.

中文翻译：

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在早期干预环境中进行筛查以改善自闭症诊断和减少健康差异的有效性。

重要性 美国儿科学会建议将自闭症谱系障碍 (ASD) 高风险儿童转诊至 C 部分早期干预 (EI) 服务，但指出 EI 服务通常无法提供 ASD 筛查。目的 评估在 3 种 EI 设置中实施的 ASD 多阶段筛查方案将增加自闭症检测的假设，尤其是在讲西班牙语的家庭中。设计、设置和参与者 使用马萨诸塞州公共卫生部提供的 2012 年至 2018 年 3 个实施 EI 机构和 9 个比较 EI 机构的行政数据，使用准实验设计的倾向得分加权进行差异分析。符合条件的儿童年龄在 14 至 36 个月之间，参加了 EI，之前没有 ASD 诊断或身体状况妨碍参与，并且有说英语或西班牙语的父母。最终分析样本包括在 150 200 人宿舍中评估的 33 326 名独特患者。暴露 多阶段 ASD 评估协议，包括 ASD 筛查问卷、观察筛查和诊断评估。主要成果和措施 公共卫生部记录中记录的 ASD 诊断率增加，语言相关的医疗保健差异减少。结果 在 3 个 EI 站点实施筛查与 ASD 诊断率显着增加相关（发生率比 [IRR]，1.6；95% CI，1.3-2.1；P < .001），代表每增加 8.1 个诊断每季度 1000 名儿童。在讲西班牙语的家庭中，筛查也与 ASD 诊断率的显着增加有关（IRR，2.6；95% 置信区间，1.6-4.3；P < .001），代表每季度每 1000 名儿童有 15.4 例额外诊断——增幅大于非西班牙语家庭（交互 IRR，1.8；95% CI，1.0-3.1；P = .005）。探索性分析显示，与女孩相比（IRR，1.1；95% CI，0.6），筛查与男孩的 ASD 诊断率（IRR，1.8；95% CI，1.4-2.3；P < .001）有更大的相关性-1.7；P = .84）。结论和相关性 在这项研究中，ASD 诊断率增加与西班牙语家庭差异减少之间的关联支持 EI 多阶段筛查的有效性。本研究对 EI 环境中的 ASD 筛查进行了全面评估，并在任何具有非筛查比较条件的环境中对 ASD 筛查进行了严格评估。