Improving Access for Autism Diagnosis in Toddlers from a Multi-Cultural and Underserved Community

Background: Toddlers from families in underserved and low socioeconomic areas have difficulties accessing Autism Spectrum Disorders (ASD) diagnostic evaluations and treatment services in a timely manner. This can lead to sub-optimal outcomes. Furthermore, language and cultural barriers add to further delays.

Objectives: To improve access to autism diagnostic and treatment services in an underserved and multicultural community in Massachusetts (Worcester), while integrating a new level two screening test, the Rapid Interactive Screening Test for Autism in Toddlers (RITA-T) was introduced in an Early Intervention (EI) program. Current wait time for an autism evaluation in those below the age of three years old is 3-5 months.

Methods:

The RITA-T consists of nine interactive activities that evaluate developmental constructs delayed in toddlers with risk of autism. The RITA-T takes approximately ten minutes to administer. The language and commands integrated in the test are simple and do not require an advanced knowledge of the English language for comprehension. Four Early Intervention (EI) providers from the largest EI program in Worcester, THOM EI, were trained on the RITA-T. They administered the test to those who either had a positive Modified Checklist for Autism in Toddlers, Revised (MCHAT-R) or behavior concerns for ASD. Following screening, the toddler and his/her family were referred for further comprehensive testing by a diagnostic team in a tertiary care center. Those provided with an ASD diagnosis were referred to Applied Behavioral Analysis (ABA) services. Opportunities for follow up were offered for all.

Results: A total of 81 toddlers (78% male) were evaluated. Of the 81 toddlers evaluated, 58% were white, 20% were Hispanic, 15% were African-American, and 7.4% were Asian. The average age at screening was 27.4 months and the average time elapsed between RITA-T and final diagnosis was 42 days for children diagnosed with ASD, down from 3-5 months wait time. Referrals doubled to the local ABA provider, and age at referral decreased from 30 to 28 months.

Conclusions: The RITA-T is a useful Level 2 autism screening test that improves access for diagnosis and treatment for those in multicultural and underserved communities. Decreased wait times and expedited referrals to services improves outcome. Generalization of this model to other EI programs is underway in MA.