Exploring the Impact of Immigration, Linguistic, and Cultural Factors on Autism Outcomes in a Sample of Children Receiving Early Intervention Services in New York State

Culture, language, immigration status, and socioeconomic status have a significant impact on the way individuals perceive mental health issues (Ravindran & Myers, 2012). When it comes to identification, treatment, and diagnosis of developmental disabilities in children, more specifically, these factors play key roles in a family\u27s acceptance of the child\u27s needs, involvement in the process, and decision to seek services and support (Palawat & May, 2011; (Tincani et al., 2009). For autism spectrum disorders (ASD), early identification, accurate diagnosis, and access to timely and evidence-based intervention have been linked to optimal outcomes (Garon et al., 2009; Weitlauf et al., 2014). Research has been conducted on ethnic and socioeconomic disparities with regard to optimal outcomes, and consistently demonstrates that children from marginalized and non-dominant cultures are often diagnosed at later ages than European American children (Begeer, El Bouk, Boussaid, Terwogt, & Koot, 2009; Cuccaro ct al., 1996; Mandell et al., 2010; Mandell & Novak, 2005; Zuckerman et al., 2014). Further, qualitative literature on attitudes about disability across various cultures suggest that the way in which a culture defines disability can influence help-seeking behaviors and level of parent advocacy (Daley, 2004; Ennis-cole et al., 2013; Palawat & May, 2012; Ravindran & Myers, 2012; Tincani et al., 2009). Although the qualitative research in these areas provides insight into beliefs and perspectives of parents from various populations, there is minimal quantitative research on the influence of being from a non-dominant immigrant group in the United States on ASD outcomes—including the age of diagnosis and timely utilization of services for their children with ASD. Additionally, although there is evidence outlining the significance of early intervention and the necessity for children with ASD to receive intensive, continuous, behavioral interventions (Ramey et al., 1992; Ramey & Ramey, 1998; Weitlauf et al., 2014), there is a gap in the literature when it comes to identifying any systemic issues that may impact diverse families\u27 ability to access and appropriately utilize these services. The current study aims to explore the associations between immigration background (measured by years in the United States) and outcome variables of age of diagnosis, utilization of recommended services, completion of a plan to continue services (transition plan), and whether parent training was provided within a sample of children who were diagnosed with autism and enrolled in the NYS Early Intervention Program (EIP). The study also explored whether there are outcome differences for children who are in multilingual environments, as well as any group differences across geographic origins. A secondary goal of the study was to assess the interaction between immigration background, ASD symptom severity, and outcome measures, as previous research has touched on this interaction, but the strength of the interaction is unclear (Fountain et al., 2011; David S. Mandell & Novak, 2005). Given that the NYS EIP serves children and families from many different diverse backgrounds, the ultimate goal of the proposed study was to utilize the results to identify ways to adapt the current program at various points (referral, evaluations, service plan development and provision, and program discharge) in order to reduce existing disparities and meet the needs of families from various socioeconomic, cultural, and linguistic backgrounds