Diagnosis of Autism Spectrum Disorders Requires More Than Screening

Abstract

Research Article| December 01 2019 Diagnosis of Autism Spectrum Disorders Requires More Than Screening AAP Grand Rounds (2019) 42 (6): 66. https://doi.org/10.1542/gr.42-6-66 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Diagnosis of Autism Spectrum Disorders Requires More Than Screening. AAP Grand Rounds December 2019; 42 (6): 66. https://doi.org/10.1542/gr.42-6-66 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: autism spectrum disorder Source: Monteiro SA, Dempsey J, Berry LN, et al. Screening and referral practices for autism spectrum disorder in primary pediatric care. Pediatrics. 2019; 144(4): e20183326; doi: https://doi.org/10.1542/peds.2018-3326Google Scholar Investigators from Baylor College of Medicine, Houston, TX, and the University of Colorado School of Medicine, Aurora, CO, conducted a retrospective study to determine rates of (a) screening for autism spectrum disorder (ASD) at 18- and 24-month well-child visits to primary care pediatricians using the Modified Checklist for Autism in Toddlers (M-CHAT); (b) referral for those failing screening; and (c) diagnosis of ASD in children who failed the screen. For the study, the authors abstracted data on children having an 18-month and/or 24-month well-child visit between 2014 and 2016 to one of 290 pediatricians who were part of a hospital-owned network of 59 practices that shared a centralized electronic medical record (EMR) system. Within the network, use of M-CHAT at the 18- and 24-month visit is a standard practice. The rate of screening with M-CHAT at each of the visits was determined. The EMR of children who failed the M-CHAT screen (defined as a score ≥3) was reviewed to determine whether a referral to an autism specialist was made and completed, and subsequent diagnoses of ASD or other neurodevelopmental conditions, with a follow-up period of 23–46 months in these patients. Among 13,417 children eligible for screening at 18 months, the M-CHAT was completed for 12,531 (93%), while the M-CHAT was completed for 10,983 of 13,328 (82%) at 24 months. A total of 532 unique children failed 648 M-CHAT screens (3%). Of these 532 children, 2 died. For the remaining 530 patients, 165 (31%) were referred for additional evaluation by a subspecialist, including 122 at or before the 18- or 24-month visit (mean age at referral 20.8 months) and 69 later than the 24-month visit (mean age at referral 36 months). Visits with autism specialists were completed by 68 children (59%) who were referred at or before the 18- or 24-month visit, and 42 were diagnosed with an ASD at a mean age of 27 months. Among those referred later than the 24-month visit, 39 (57%) completed the subspecialist evaluation, and 31 were diagnosed with an ASD. Overall, including 17 children diagnosed through another mechanism, 96 of the 530 children (18%) who failed an M-CHAT screening were diagnosed with an ASD. An additional 314 patients (59%) were diagnosed with other neurodevelopmental conditions, including delayed speech, language disorders, and global delay by their primary care pediatrician. The authors conclude that despite high rates of screening for ASD by primary care pediatricians, rates of referral for further ASD evaluation for children who failed an M-CHAT screen were suboptimal. Dr Doherty has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device. The term ASDs encompasses a broad clinical category comprised of many biologically distinct... You do not currently have access to this content.