469 - RITA-T Screening Model Improves Equity in the Early Identification of ASD

Poster Number: 469
Publication Number: 469.598

Background: Early identification of ASD in minorities has improved based on CDC data (2020). However, it is still necessary to address disparities in access to children from underserved communities, or from communities with low Area Deprivation Index (ADI) scores.

Objective: Improve equity in ASD early diagnosis using a community-based screening model that integrates the RITA-T (Rapid Interactive Screening Test for Autism in Toddlers).

Design/Methods: Over 14 months, we trained providers from 11 primary care practices and 10 early intervention programs on the RITA-T and helped them set up screening systems in their settings. Our study trained providers on the use of the screening tool reliably, and knowledge of early signs of ASD. We also established an autism RITA-T diagnostic clinic in an urban tertiary care center for those referred from this model. This center had an autism diagnostic clinic with a standard referral system as well. Diagnostic visits for both clinics included administration of measures such as the ADOS-2 (Autism Diagnostic Observation Schedule), CARS-2ST (Childhood Autism Rating Scale), DSM-5 interviews and structured observations. We compared the demographics of those referred from the RITA-T model to those referred for autism evaluations through the standard process. We looked at age, gender, race and ethnicity, zip code areas, and miles traveled to our tertiary clinic. We also measured the time duration between referral and evaluation for each group.

Results: We evaluated 394 toddlers for ASD in total. Of these, 323 were screened using the RITA-T and 71 accessed the clinic through the standard referral process. The age and gender of children were similar between these two groups. The RITA-T group included more diverse racial and ethnic groups though this difference did not reach significance, mostly because of limitations in how this information is gathered by electronic charts. Toddlers evaluated through the RITA-T model traveled significantly further for their diagnostic evaluation, waited less to be evaluated, and came from areas with lower ADI scores than those evaluated in the regular diagnostic clinic. Families expressed satisfaction for the increased communication with their providers and being evaluated in a timely manner.

Conclusion(s): Incorporating the RITA-T screening model within community settings improves equity and access for the early identification of ASD. This model removes barriers that high-risk toddlers have to efficient screening and referral, and improves communication between community providers, diagnosticians, and families.