Elsevier

The Journal of Pediatrics

Volume 215, December 2019, Pages 238-243
The Journal of Pediatrics

Original Article
Participation in Part C Early Intervention: One Key to an Earlier Diagnosis of Autism Spectrum Disorder?

https://doi.org/10.1016/j.jpeds.2019.06.034Get rights and content

Objective

To determine whether participation in a state early intervention program is associated with reduction in the age of diagnosis of autism spectrum disorder (ASD).

Study design

State agency, Medicaid, and Census data were integrated for children with ASD enrolled in a Medicaid waiver between February 2007 and March 2015 (N = 1613). Ordinary least squares regression was used to estimate the relationship between participation in a state early intervention program and their age of diagnosis of ASD.

Results

The model explained 34% of variation in age of diagnosis (F[17,1595] = 49.20, P < .0001, adj R2 = 0.34). After adjustment for key variables, compared with children who did not participate in early intervention, children who did participate were diagnosed 2 years earlier (β = −23.97, P < .0001).

Conclusions

Although conducted in only 1 state, this study suggests that participation in early intervention programs may be instrumental in earlier diagnosis of ASD. These findings underscore the importance of identifying children who qualify for early intervention programs, the value of encouraging childhood professionals (eg, early care providers and educators) to refer given documented barriers to pediatrician referral, and the need for research that identifies the mechanisms by which programs may promote earlier diagnosis (eg, service coordination, parent support).

Section snippets

Methods

The author integrated 3 data sources. State administrative data accessed via the South Carolina Department of Disabilities and Special Needs included children with ASD diagnosed by age 8 years enrolled in a Medicaid waiver between February 2007 and March 2015. The Office of Revenue and Fiscal Affairs provided census tract and Medicaid claims data. Details about the waiver and data integration have been published elsewhere.15 Children were included in the study if assigned a census-tract ID to

Results

Table I includes descriptive statistics for the 1613 children in the sample. There were more male than female subjects, most children had a diagnosis of intellectual disability (64.9%), and a minority of children had a diagnosis of Asperger, Rett syndrome, and pervasive developmental disorder not otherwise specified (18.9%). More than one-third of children identified as white (41.2%), and more than two-thirds lived in an urban neighborhood (68.9%). The average age of diagnosis was just older

Discussion

Using a large sample of children with ASD in a Southeastern state, this study suggests that participation in a state early intervention program enables earlier diagnosis, after controlling for clinical, sociodemographic, and geographic characteristics, as well as period effects. Compared with children who did not participate, children who participated before their date of diagnosis were diagnosed 2 years earlier. In a cross-sectional record review of children evaluated at a tertiary referral

Data Statement

Data sharing statement available at www.jpeds.com.

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