Disability Evaluations: How health disparities impact accessibility for toddlers in Early Head Start

• In Event: Poster Session 01
  In Poster Session: PS 01 Topic - Developmental Disabilities

Abstract

Introduction: The average age of developmental disability (DD) diagnoses in the US is around 6 years old (Daniels & Mandell, 2014). However, DD can be accurately diagnosed by age 2 in many cases (Barbaro & Halder, 2016), allowing for early evidence-based interventions that can improve adaptive behavioral skills and school readiness (Guralnick, 2005). Unfortunately, delays in diagnosis hinder treatment, as intervention services often require specific diagnosis (Bailey et al., 2004). Many factors may predict who receives diagnostic evaluations including gender, socioeconomics, race/ethnicity, urban/rural status, child prematurity and birthweight, developmental milestones, behavior problems and parental symptomatology. In Aim 1, this study investigated which factors influenced whether a child received a developmental evaluation in an at-risk Early Head Start (EHS) sample by age 3. In Aim 2, this study examined a similar question using a subsample of children with increased developmental risk, determined based on Ages and Stages Questionnaire-3rd edition (ASQ-3) scores more than one standard deviation below average.

Methods: Data were drawn from a nationally-representative, longitudinal study of families in EHS (n=272; Vogel & Boller, 2014), with 48.0% female, 32.0% White, 19.7% Black and 37.2% Hispanic/Latinx families. Sociodemographic variables were collected at child age 2 while evaluation status was gathered at age 3. The ASQ-3 (Squires, 2009), Auditory Comprehension Scale of the Preschool Language Scales-4 (Zimmerman et al., 2002), maternal depression (Radloff, 1977), parent distress (Abidin, 1995), and behavior problems (Briggs-Gowan & Carter, 2006) were collected at age 2. Weighting was used for accurate representation of the population and to address attrition.

Results: For Aim 1, boys were more likely than girls to receive an evaluation, and Black children were less likely to receive an evaluation compared to White children (Table 1). As expected, lower ASQ scores, more behavior problems, prematurity and low birthweight led to higher likelihood of an evaluation. Those in urban settings were more than 18 times as likely to have received an evaluation compared to rural geographic regions. Parent mental health played an important role as well, with one point higher on the parental distress leading to a child being 10 times less likely to receive an evaluation. For Aim 2, largely similar factors predicted evaluation (Table 2), along with delays in communication, fine motor, problem-solving and personal social behavior.

Discussion: This study found evidence for several foreseeable contributors (i.e. prematurity, low birthweight, behavior problems and developmental milestones), while other troubling indicators were also contributing to access, such as geographical status, race, and maternal depression. Future research should explore how parent mental health may impact evaluation access, with emphasis on bidirectional associations between parental mental health and child developmental milestones. Unequal treatment, discrimination, and inequitable access to care within the healthcare system is a significant problem in the US (Braveman, 2006). As investigations into health disparities expand, access to these diagnostic evaluations should be a priority as they gatekeep essential interventions, and specific efforts need to be made to support Black and rural families in gaining access to evaluations.

Authors

• Maire Claire Diemer, University of Missouri- St. Louis
  Presenting Author

• Emily D. Gerstein, University of Missouri-St. Louis
  Non-Presenting Author