# Navigating the Challenges: A Commentary on Barriers to Autism Screening in Childcare Centers

## TL;DR

This paper discusses the challenges of autism screening in childcare centers and suggests strategies to improve access and reduce delays in diagnosis.

## Contribution

The paper introduces strategies to address barriers in autism screening within childcare centers, based on a pilot study.

## Key findings

- Childcare staff hesitate to address autism concerns due to stigma and lack of guidance.
- Legal and ethical challenges arise regarding consent and data privacy in childcare screening.
- Public awareness is crucial for effective autism screening across different settings.

## Abstract

Although the American Academy of Pediatrics has long recommended universal autism-specific screening at well-child pediatric visits, implementation challenges in primary care settings interfere with high-fidelity universal autism screening. These challenges delay autism identification for some children, leading to delays in needed services and supports. Prior findings indicate that new solutions must be developed to bridge the gap in access to autism screening for families, particularly among those who are under-resourced. One approach is expanding screening to other community settings, such as childcare centers, but there are barriers to this approach, which this commentary aims to address. We discuss challenges and barriers in childcare screening identified through our recently completed pilot study screening for autism in childcare centers, with suggested strategies to address them. These challenges include hesitation among childcare staff to guide conversations or concerns about autism, and stigma around autism diagnosis and presentation. Other challenges relate to emerging concerns regarding legal, ethical, and professional roles and responsibilities surrounding informed consent and data privacy, as well as the identification of children without timely follow-up evaluation and services. There is a need for increasing public awareness as an essential component of autism screening across settings. Our commentary discusses different considerations and practice strategies to meet these needs.