Implementing an early detection program for autism in primary healthcare: Screening, education of healthcare professionals, referrals for diagnostic evaluation, and early intervention

Abstract

BackgroundImproving early detection of children with autism spectrum disorder (ASD) is critical because it allows for earlier intervention, which has been shown to improve outcomes in core behavioral and skill deficits related to ASD. We studied the implementation of an early detection program for ASD in primary healthcare and evaluated its results. MethodNine primary healthcare centers in the capital area of Reykjavik, Iceland were randomly selected for participation. The program included the following: screening for ASD with the Modified Checklist for Autism in Toddlers, Revised with Follow-up during routine developmental surveillance at 30 months of age; education of well-child care professionals; referrals for diagnostic evaluation; and early intervention. ResultsAmong the 1586 children screened, 26 screened positive and 25 were evaluated, of whom 18 were diagnosed with ASD and six with other neurodevelopmental disorders, giving positive predictive values (PPVs) of 0.72 and 0.96, respectively. The screening detected eight children with ASD who were missed by other referrers. The mean time from screening to intervention was 3.56 months (SD = 4.00), and 18.28 months (SD = 2.72) from screening to diagnostic evaluation. Of the well-child care professionals who attended an educational course, 79 % had not received prior education on ASD. Participation in the course contributed to increased self-perceived knowledge and confidence in identifying behaviors indicating ASD. ConclusionThe screening was well received by stakeholders, and PPV for ASD was relatively high, providing evidence of its feasibility. The long wait-time for diagnostic evaluation and the lack of ASD education among well-child care professionals needs to be addressed.