Primary Care Autism Screening and Later Autism Diagnosis

Keywords

Autism/ASD, Developmental/Behavioral Issues, autistic disorder, toddler, physicians, family, Hispanics or Latinos

Abstract

OBJECTIVES: To describe the proportion of children screened by the Modified Checklist for Autism in Toddlers (M-CHAT), identify characteristics associated with screen completion, and examine associations between autism spectrum disorder (ASD) screening and later ASD diagnosis.

METHODS: We examined data from children attending 18- and 24-month visits between 2013 and 2016 from 20 clinics within a health care system for evidence of screening with the M-CHAT and subsequent coding of ASD diagnosis at age .4.75 years. We interviewed providers for information about usual methods of M-CHAT scoring and ASD referral.

RESULTS: Of 36233 toddlers, 73% were screened and 1.4% were later diagnosed with ASD. Hispanic children were less likely to be screened (adjusted prevalence ratio [APR]: 0.95, 95% confidence interval [CI]: 0.92–0.98), and family physicians were less likely to screen (APR: 0.12, 95% CI: 0.09–0.15). Compared with unscreened children, screen-positive children were more likely to be diagnosed with ASD (APR: 10.3, 95% CI: 7.6–14.1) and were diagnosed younger (38.5 vs 48.5 months, P , .001). The M-CHAT’s sensitivity for ASD diagnosis was 33.1%, and the positive predictive value was 17.8%. Providers routinely omitted the M-CHAT follow-up interview and had uneven referral patterns.

CONCLUSIONS: A majority of children were screened for ASD, but disparities exist among those screened. Benefits for screen-positive children are improved detection and younger age of diagnosis. Performance of the M-CHAT can be improved in real-world health care settings by administering screens with fidelity and facilitating timely ASD evaluations for screen-positive children. Providers should continue to monitor for signs of ASD in screen-negative children.

Original Publication Citation

Carbone, P.S., Campbell, K., Wilkes, J., Stoddard, G., Huynh, K., Young, P.C., Gabrielsen, T.P. (2020) Primary care autism screening and later autism diagnosis within a large healthcare system. Pediatrics 146 (2) e20192314 https://doi.org/10.1542/peds.2019-2314

Document Type

Peer-Reviewed Article

Publication Date

2020

Publisher

American Academy of Pediatrics

Language

English

College

David O. McKay School of Education

Department

Counseling Psychology and Special Education

University Standing at Time of Publication

Associate Professor

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