Applying an Intersectionality Framework to Examine Service Utilization Disparities Among Young Autistic Children Enrolled in Early Intervention

Families whose social identities (e.g., race, ethnicity, economic resource access, educational attainment) are societally marginalized demonstrate disproportionately reduced utilization of state-provided early intervention (EI) services for infants and toddlers (Feinberg et al., 2011; Khetani, Richardson, & McManus, 2017). Less is known about disparities in EI service and autism-specialized service utilization of young children enrolled in EI who are already diagnosed with autism spectrum disorder (ASD). Given that autism researchers and professionals recommend early intensive provision of intervention services to young children diagnosed with autism, it is important to better understand intervention service access disparities. Extant research on this topic has almost exclusively examined disparities across groups delineated according to one social identity, like race or economic resource access. Intersectionality framework, in contrast, emphasizes that peoples’ lived experiences differ according to the intersection of multiple identities, given that we all occupy all of our identities simultaneously. Though used in qualitative research about healthcare access among children with autism (e.g., Singh & Bunyak, 2019), an intersectionality framework has yet to be employed in quantitative research on healthcare access among young autistic children. Method. This study applied two intersectionality-aligned analytic methods to generate representations of intersectional identities: two- and three-way interactions and latent class analysis (LCA). These analytic methods were first applied to a large sample of children with autism enrolled in EI, using administrative data routinely collected by the state public health department. In a small subset of that sample who participated in an intensive diagnostic and developmental evaluation as part of a larger study focused on reducing diagnostic disparities, the same analytic methods were used to create intersectionality representations utilizing the detailed identity-related information collected at diagnostic evaluation. Results. Intersectional identities were related to service utilization most consistently when represented through latent class analysis (LCA). LCA-generated classes were delineated according to several identities. LCA models from the administrative and intensive samples included a class with participants characterized as Hispanic or Latiné and a class with participants occupying primarily identities that are associated with societally conferred privilege. Other classes were defined according to family primary language, caregiver educational attainment, and caregiver place of birth. Interaction testing via linear regressions yielded intersectional findings that varied based on the sample and the type of service examined. In the administrative sample, intersectional identities of race and ethnicity and family primary language and ethnicity were related to general EI service utilization, whereas intersectional identity captured via two- and three-way interactions were unrelated to ASD-specific service utilization. In contrast, in the intensive sample, intersectional groups represented by two- and three-way interaction terms were significant predictors of ASD-specific service utilization, and no interaction terms were related to general EI service utilization. Conclusions. This study sought improved understanding of service utilization patterns in early intervention among families with young autistic children using an intersectionality framework. Study results suggest that service utilization differs across intersectional identity groups when these groups are represented in multiple ways analytically, and that these effects are significant above and beyond the impacts of identities examined separately. Broadly speaking, this study offers preliminary evidence that an intersectionality framework is both quantitatively feasible and helpful in understanding service utilization in this population, and that intersectionality is an important framework to apply to quantitative autism research as a means of generating more robust reflections of families’ lived experiences as they relate to access to care variables like service utilization

Effects of Child Behavior Problems on the Development of Preschoolers' Sleep Problems: A Longitudinal Examination

Honors (Bachelor's)PsychologyChild Behavioral HealthUniversity of Michiganhttp://deepblue.lib.umich.edu/bitstream/2027.42/96473/1/oostingd.pd

Reciprocal Associations between Language Ability and Social Functioning Development over a Two-Year Period in Young Pre-Verbal Children with Autism Spectrum Disorder

Impairments in language and social functioning are core symptoms of autism spectrum disorder (ASD). Longitudinal research on language abilities and social functioning in young children whose development is proceeding as expected and those with development delays suggests that skill development in one domain affects skill development in the other. However, much extant research with young children with ASD has examined developmental trajectories of these abilities separately, with little focus on the relations of these domains across the early childhood years. Pre-verbal young children with ASD, who have significantly impaired expressive language in toddlerhood, are a group of particular clinical relevance, given that greater language abilities at school entry have been shown to predict positive long-term adjustment in many areas, including social functioning. Further, given that attention to and engagement with social contexts is necessary for language to develop, and that growing language skills can facilitate further social engagement, there is reason to hypothesize that early social functioning may exert effects on language development over time. This has yet to be tested empirically within samples of very young children with ASD. Thus, the present study examined reciprocal associations between language and social functioning in a sample of very young pre-verbal children with ASD over a two-year period. In addition, moderating effects of previously-identified predictors of language and social functioning outcomes (nonverbal cognitive functioning, initiation of and response to joint attention, and autism symptom severity) on these associations were explored. Cross-lagged panel analyses revealed significant within-timepoint synchronous correlations and within-domain autoregressive paths over time. All cross-lagged paths were significant while controlling for construct stability paths and synchronous correlations. Nonverbal cognitive functioning moderated autoregressive language ability paths, while autism symptom severity moderated T2 to T3 language ability and social functioning paths. For very young pre-verbal children with ASD, language ability and social functioning appear to exert concurrent and cascading developmental influences on one another, with skills in one domain influencing the other both cross-sectionally and longitudinally. These findings support simultaneous targeting of these skill domains during intervention for very young pre-verbal children with ASD

Applying a User-Centered Design Framework to Develop a Remote Research Assessment Protocol for a Randomized Clinical Trial for Toddlers with Early Autism Characteristics

COVID-19 required many research teams to shift from in-person to remote assessments, which posed both procedural and theoretical challenges. While research has explored the utility of remote assessments for autism diagnosis from the perspective of families and clinicians, less is known about their application in clinical trials. This paper describes the development of a remote research assessment protocol for a randomized clinical trial focusing on the implementation of reciprocal imitation teaching (RIT) with toddlers in Part C early intervention. This project spans two phases. For Phase 1, our team developed and documented a series of steps utilizing user-centered design (UCD) strategies (e.g., recruiting potential users, creating a prototype, engaging in iterative development) for the purpose of redesigning an assessment protocol for a remote environment. For Phase 2, we examined preliminary outcomes of the redesign process. Primary end users (assessors) rated post-redesign usability and acceptability, while acceptability was examined using attrition data from secondary end users (family participants). Preliminary fidelity of implementation was also examined. The iterative redesign process allowed the research team to refine aspects of the assessment that ultimately led to promising preliminary ratings of usability, acceptability, and feasibility, as well as high fidelity. Preliminary data suggest that the redesigned assessment appears to be an acceptable, feasible, and usable tool for autism clinical trial research and that assessors can use it with fidelity. Further research is needed to examine the reliability and validity of the assessment, as well as implementation characteristics on a larger scale.No embarg