The diagnostic odyssey of autism: a cross-sectional study of 3 age cohorts of children from the 2016–2018 National Survey of Children’s Health

Background Autism prevalence has increased rapidly in recent years, however, nationally representative estimates on the ages of first identification and intervention are out of date. Objectives: (1) To estimate the ages at which children with autism receive their first diagnosis, intervention plan, and developmental services; and (2) To evaluate differences in ages at events by birth cohort and sociodemographic characteristics. Methods Using cross-sectional data from the 2016–2018 National Survey of Children’s Health (NSCH), we examined associations via linear regression among a sample of 2303 children aged 2–17 years old, who had ever been diagnosed with autism and either (1) ever had a plan for special education or early intervention, or (2) ever received special services to meet developmental needs. Exposures included age cohort, child, household and healthcare provider characteristics. Results Most children in the study sample (n = 2303) were over age 6 years, male, of non-Hispanic white race/ethnicity and had mild/moderate autism. Mean ages (years) at first diagnosis was 4.56 (SE = 0.13); first plan was 4.43 (SE = 0.11); and first services was 4.10 (SE = 0.11). After adjustment for exposures and survey year, the middle childhood cohort was 18 months older at first intervention (β = 1.49, 95% CI, 1.18–1.81), and adolescents were 38 months older at first diagnosis (β = 3.16, 95% CI, 2.72–3.60) compared to those in early childhood. Younger ages at events were observed among: Hispanic/Latinx as compared to white children, those with moderate or severe symptoms as compared to mild symptoms, and children who received their diagnosis from a specialist as compared to psychologists or psychiatrists. Conclusions Children with autism receive their first diagnosis, intervention plans and developmental services at younger ages than they had in the past. Future research is needed to identify the mechanisms for these improvements in early identification and intervention to accelerate additional progress.

A Study of Safety, Security, Health, and Developmental Services in Secondary Schools

This work aims to find out the safety and security services provided to secondary school teachers and find the difference in supplying these services to the teachers based on job status and their experiences. A selfmade questionnaire was used to collect data from hundred teachers that include both genders (male & female). The aim of the study was Data shows that there is a significant gender wise difference in the provision of safety and security services, particularly female need more security. The interview was also used, and data were collected from 10 teachers through interviews. Most of the teachers responded that there is a lack of these services in schools. Further suggestions were given to improve the condition of such services.

COMPARING WAIT TIMES OF SINGLE-MOTHER AND TWO-PARENT HOUSEHOLDS ACCESSING DEVELOPMENTAL SERVICES THROUGH SCHOOL-BASED HEALTH CLINICS

BACKGROUND Families in inner-city neighborhoods experience socioeconomic challenges that inhibit access to healthcare providers who could detect development concerns in children. Additionally, studies show low-income, single motherhood to be a significant risk factor for childhood developmental issues. With wait times for developmental assessments and publicly funded services ranging from 9 to 18 months, children may not receive diagnosis and support in a timely manner. School-based health clinics (SBHCs) are easy access points for children to receive necessary services, such as diagnoses and management of health and developmental concerns especially for inner city children facing barriers to health care access. OBJECTIVES To measure the efficacy of SBHCs in alleviating barriers to developmental services for children from inner-city, single-mother households, by comparing wait times to children from two-parent households. DESIGN/METHODS A retrospective chart review of 700 children from two inner-city SBHCs was conducted over 7 years. Family demographic data were collected through the registration process and analyzed. Wait times for developmental assessments were determined from the first developmental concern to assessment by a developmental paediatrician. Independent t-tests were used to compare wait times for children from single-mother households to children from two-parent households. RESULTS The mean age of children seen was 6.9 years (two-parent households) and 7.6 years (single-mother households). 35% of children from single-mother households (n=169), and 36% of children from two-parent households (n=369) received referrals to the SBHC developmental paediatrician. The mean wait times were 129.08 days for single-mother households, and 105.81 days for two-parent households. No significant difference was found in wait time from first developmental concern to seeing a developmental paediatrician (p>0.05). CONCLUSION The SBHC program is a novel healthcare delivery model alleviating barriers to developmental healthcare access for both single-mother and two-parent families. Wait times experienced by SBHC users to see developmental specialists were shorter than the times reported in the literature. The lack of significant difference in wait times between children from single-mother and two-parent households demonstrates how SBHCs alleviate barriers to single-mother households as effectively as two-parent households.