**1. Introduction**

During the last decade, research on Autism Spectrum Disorder (ASD) has made tremendous progress with regard to early identification and diagnosis. These advances were made possible by a growing number of rigorous research studies with large sample sizes that utilized a combination of: (1) retrospective parent report and home video studies [1], (2) prospective studies of infant siblings of children with ASD [2], (3) population-wide studies of ASD screening tools [3], and (4) studies on the early stability of diagnostic classifications [4]. Advances in best practices related to early identification are reflected in a 2006 policy statement published by the American Academy of Pediatrics [5], and a corresponding set of clinical practice guidelines [6]. According to these guidelines, it is recommended that Primary Care Providers (PCPs; e.g., family physicians, pediatricians) administer formal screening tests during every well-child visit scheduled at 18 and 24 months, independent of known risk factors or reported concerns. Moreover, PCPs are urged to promptly refer children for Early Inter‐ vention1 services as soon as ASD is seriously considered.

Even though the age of first diagnosis has gradually decreased during the last decade [7], population based studies reveal that most children with ASD continue to be diagnosed after three years of age [8]. Given that a reliable diagnosis of ASD is possible by 24 months, and that about 90% of parents whose children are later diagnosed with ASD express documented concerns before age 2 [9], the gap between best practice guidelines and community imple‐

<sup>1</sup> Throughout this chapter, we use capital letters when referring to the publicly funded Early Intervention system

© 2013 Siller et al.; licensee InTech. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. © 2013 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

mentation is tangible. This chapter outlines a sequence of four connected activities aimed at improving early identification of ASD and promoting successful referrals for Early Interven‐ tion services. For each step in the sequence, this chapter (1) describes the barriers that autism advocates, families, and PCPs face, and (2) showcases novel educational approaches that aim to promote families' access to prompt and appropriate Early Intervention services.

namely the predominance of negative and stigmatizing stories about ASD in the media and so‐ cial stigma that may vary across cultures. It is unclear whether stigma and negative stereo‐ types interfere with people's ability to access accurate information, whether a lack of accurate information promotes stigma and stereotypes, or whether the two are reciprocally linked.

Promoting Early Identification of Autism in the Primary Care Setting: Bridging the Gap Between What We Know and

What We Do

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http://dx.doi.org/10.5772/53715

In addition to being a key source of entertainment and news, mass media tends to perpetuate stereotypes and social beliefs in a way that defines and maintains an existing social order [14]. Portrayals of ASD in film (e.g., *Rainman, What's Eating Gilbert Grape?*), fiction (e.g., *The Curious Incident of the Dog in the Night-Time* [15]; *Daniel Isn't Talking* [16]), and non-fiction parent ac‐ counts of ASD (e.g., *Real Boy: A True Story of Autism, Early Intervention, and Recovery* [17]; *Let Me Hear Your Voice: A Family's Triumph Over Autism* [18]) provide an index of the general increase in ASD awareness. However, there is some disagreement as to whether these representations have a positive or negative impact on awareness efforts [19, 20]. Claims of 'miracle cures' for ASD that victimize vulnerable families and contribute to unrealistic perceptions of the treata‐ bility of ASD are clearly harmful [21]. Jones and Harwood provided a content analysis of 1,228 articles about ASD published from 2002 to 2005 in the Australian media [20]. This analysis re‐ vealed some interesting patterns, including a limited amount of factual information in media sources, and descriptions of people with ASD as either dangerous and uncontrollable or un‐ loved and poorly treated. Overall there was a predominance of 'negative' stories about ASD in‐ cluding numerous references to the impact on families, difficulties with diagnosis, and criminal cases. The authors submit that the implication of this type of coverage is likely a re‐ duction in people's willingness to engage with individuals with ASD, creating barriers for so‐ cial and educational inclusion. Further research is needed to evaluate the impact of media

Vast differences in attitudes and approaches to ASD have been reported for culturally and lin‐ guistically diverse groups. For example, it has been reported that families in Korea are hesi‐ tant to seek help for their children's developmental problems, including ASD, because they are seen as a mark of shame [22]. The effects of stigma have been evaluated for HIV/AIDS, mental illness, ASD, tuberculosis, leprosy, and cancer [23]. Social stigma relating to a condition or dis‐ order can contribute to decreases in willingness to disclose disease status, health-seeking be‐ havior, quality of care received, and social support [24]. Stigma may also be inadvertently perpetuated by healthcare professionals who maintain prejudice and negative stereotypes about ASD and mental health conditions [25, 26]. Cultural interpretations of disability can of‐ ten be found in the context of religion. For example, a qualitative study indicated that Ortho‐ dox Jewish Israeli parents view their child with ASD as having a high spiritual status or important religious mission [27]. In contrast, almost half of the Irish families interviewed by Coulthard and Fitzgerald reported that having a child with ASD had prompted them to dis‐ tance themselves from religion [28]. Cultural perspectives may also influence families' uptake of services. For example, a general lack of trust in service providers has been described as one

factor related to African American's underutilization of mental health services [29].

**1.** Portrayals of ASD in the media

**2.** Cultural representations of ASD

stereotypes of ASD on screening and early identification efforts.

**Figure 1.** A sequence of four connected activities aimed at improving early identification of ASD and promoting suc‐ cessful referrals for Early Intervention services.
