Research In Practice Blog

What we did:    

In this qualitative study, our team conducted and analyzed interviews with 11 Black mothers from Pennsylvania and New Jersey whose child had screened positive on an autism screener during 18- to 24-month well-child visits. Of the 11 mothers, seven reported having a child with autism, one did not, and three were unsure or in middle of the diagnostic process. The interviews explored their perspectives on the early screening process and preferences in provider communications and interactions regarding autism screening in primary care. The interviews were conducted by telephone between August 2022 and July 2023. Transcripts were double-coded with >95% agreement and analyzed using thematic analysis until thematic saturation.  

Why we did it:    

Data on autism rates tracked by The Centers for Disease Control and Prevention’s Autism and Developmental Disabilities Monitoring (ADDM) revealed in 2020 that autism rates among Black children have exceeded those of White children. However, disparities in how and when children are identified persist. For example, fewer Black children (75.9%) were evaluated by 36 months compared with Hispanic (79.8%) and White children (79.1%). Understanding how Black mothers engage in the process of developmental screening, and their preferences for care, can help us better understand how to improve this process and ameliorate gaps in early autism identification and care.    

What we found:  

We were excited to find that nearly half of mothers shared statements that characterized their trust in their pediatricians.  

Moms shared the following:    

“She [the pediatrician] wants what’s best for my child […], I know that. That’s why I’m sticking to her. If she were to leave the center where she’s at now, and go somewhere, I would follow her. She is amazing, and she’s good at what she does. I know that she cares for my child just as much as I care for him.” (participant 07)  

Another participant shared,  

“I don’t let her see any other doctor than her. Her doctor has a long waiting list, so I know she’s a great doctor.” (participant 01)  

Notably, pediatrician trust was promoted by (1) educational level of the pediatrician, (2) perceived demand for the pediatrician (e.g., having a waitlist), (3) immediate resources offered to families during visits, (4) perception that the pediatrician takes their time with the family, and (5) the pediatrician’s level of compassion towards the family.  

We found the following primary themes emerged:  

1. In primary care, the pediatrician is the preferred person mothers wish to hear from when they have concerns regarding autism, their child’s development, and/or potential delays. Mothers prefer that the pediatrician is the one responsible for reporting positive early autism screening results (i.e., M-CHAT) to them in primary care.  

“I wouldn’t be fine with accepting the information [from a non-pediatrician]. Like I would accept it, but I would still go behind them to figure out exactly what it is or what it’s not and what’s true about that, so I wouldn’t like beat myself up right then and there about what they’re saying, but when I talk to my pediatrician, I would take a better understanding of it.” (participant 09)  

2. Mothers want to discuss developmental concerns with family members.
3. Online resources provide key information to moms on autism and child development  

“Yes, I normally look things up on Google. I use Google for a lot of my information.” (participant 09)  

“I’m in different parenting groups on Facebook. I can always ask a question, and the ladies in the group are really helpful with answering questions and things like that.” (participant 06)  

4. Moms value face-to-face time with their child’s clinician  

“Sometimes things just need to be explained […], Because I don’t think that automated stuff is always that personal. Thinking about your child, you might want to get something like that [screening information] in person.” (participant 010)  

5. Families face barriers to completing the M-CHAT (e.g., distracted by kids, not enough time, technological barriers, not always understanding items)  

Why this matters and what comes next:  

“Our findings demonstrate that Black mothers prefer to have their key developmental conversations with their pediatricians in primary care settings, and that the patient-provider relationship can be imbued with trust. Trust that moms may naturally enter primary care with and that is bolstered by factors that may even precede first appointments such as perceived education levels of pediatricians and long waitlist (suggesting the doctor is in high demand for some mothers); and trust that is earned through positive interactions shaped by compassion, taking one’s time, and dependability,” said Ashlee Yates Flanagan, first author of the paper and Research Psychologist in CHOP’s Department of Child and Adolescent Psychiatry and Behavioral Sciences.    

Policies focusing on face-to-face interactions and trust-building approaches better align with the preferences expressed by Black mothers in the primary community care. Ensuring parents have opportunities for face-to-face interactions free of time restraints can increase trust between parents and providers during autism screening in primary care, specifically for Black populations. This study also emphasizes the importance of online and social media tools in information- sharing for Black families. 

“Given the trust that families have in their pediatricians, it is critical that pediatricians have the time and confidence to address developmental concerns in an honest and compassionate manner. Families, and Black mothers in particular, want their concerns taken seriously by their trusted pediatrician,” explains Kate E. Wallis, senior author of the paper and core faculty member at Clinical Futures, a CHOP Research Institute Center of Emphasis. 

Citation: Yates Flanagan A, Hill T, Childs M, Wozniak-Kelly SN, Guthrie W, Wallis KE. Black Mothers' Perspectives on the Early Childhood Screening Process and the Modified Checklist for Autism in Toddlers in Primary Care. J Dev Behav Pediatr. 2026 Jan 22. doi: 10.1097/DBP.0000000000001459. Epub ahead of print. PMID: 41569042.