Cultural and Linguistic Diversity Among Children and Families Referred for Diagnostic Evaluation of Developmental Delay and Disability: Implications for Service Delivery

Abstract

A significant proportion of health‐ and disability‐sector consumers in Australia speak a language other than English (LOTE) at home. Barriers to service access in culturally and linguistically diverse (CALD) populations are acknowledged; however, there is limited data to guide service delivery among care providers. The aims of the present study were to investigate the linguistic diversity of preschool‐aged children and families presenting for diagnostic assessment of developmental delay and disability at the Disability Specialist Unit, a multidisciplinary assessment service, and assess whether CALD status was associated with poorer service engagement. Specifically, it was hypothesized that CALD status would be associated with decreased likelihood of receiving intervention (particularly multidisciplinary intervention) and attending center‐based care, and an increased likelihood of requiring referral to access available government funding. A retrospective record audit was undertaken of 88 clients seen by the Disability Specialist Unit over a 12‐month period to collect information about CALD status (whether a LOTE was spoken at home) and a range of clinically relevant variables including clinical diagnosis/es, age at assessment, involvement with therapies, attendance at center‐based child care, and whether a referral to access government funding was required. Differences between CALD and non‐CALD groups were explored statistically via odds ratios and independent samples t test. Children from CALD backgrounds were significantly less likely than non‐CALD children to be engaged in multidisciplinary therapy at the time of assessment and significantly more likely to require support to access funding than children from non‐CALD families. Furthermore, children from CALD backgrounds were significantly more likely to receive a diagnosis of autism spectrum disorder and global developmental delay or ID. These findings suggest that children from CALD backgrounds are disadvantaged compared to non‐CALD children with respect to service access at the point of tertiary diagnostic evaluation of a developmental disability. Implications for service delivery are discussed.

Sociocultural factors associated with detection of autism among culturally and linguistically diverse communities in Australia

“…In this study, we found significant association between CALD status and delayed age of concern as well as higher severity of autism traits (RRB domain and CSS scores). The main findings are in keeping with our previous research and other Australian study that found evidence for an ‘inverse care law’ in that, children from more disadvantaged backgrounds, including those from CALD background, who are at highest developmental risk, are least likely to access prevention and health promotion programs such as developmental surveillance, and they are late in seeking help for developmental issues [ 48 , 49 ]. As a result, there is a delay in initiation of intervention due to late diagnosis and thereby missed opportunities to maximise the plasticity of the developing brain [ 50 ].…”

Quality and accessibility of written development assessment reports provided to caregivers in a publicly funded child developmental assessment service

“…Given that assessment services in the public sector are referred a significantly higher proportion of individuals with additional vulnerabilities (e.g. low socioeconomic status (SES), cultural and linguistic diversity) compared to those in the private sector (Lewis, 2021; Patel et al, 2021), these assessments may provide one of the only opportunities for children to receive multi-disciplinary and specialised assessment in their lifetime. It is critical that these assessments and subsequent reports give families information that can be utilised to adequately address the needs of children and their family.…”