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Barriers to autism screening in family medicine practice: a qualitative study
Tsehaiwork Sunny Fenikilé1, Kathryn Ellerbeck1, Melissa K Filippi2
11Department of Pediatrics,University of Kansas Medical Center,Kansas City,Kansas,USA.
Insights
Family physicians face barriers to autism screening at well-child visits, citing lack of training and resources. Universal autism screening is not widely accepted or implemented.
Area of Science:
- Pediatric Medicine
- Developmental Pediatrics
- Autism Spectrum Disorder (ASD) Research
Background:
- The American Academy of Pediatrics recommends universal autism screening at 18- and 24-month well-child visits.
- Despite recommendations, family physicians' adoption of autism screening tools is inconsistent.
Purpose of the Study:
- To explore barriers family physicians encounter in adopting recommended autism screening.
- To understand current practices and perceptions regarding autism screening in primary care.
Main Methods:
- Qualitative study involving 15 family physicians in the Kansas City metropolitan area.
- Data collected through three focus groups and six semi-structured interviews.
- Inductive coding and standard text analysis of verbatim transcripts.
Main Results:
- Physicians expressed varied opinions on autism incidence, often attributing increases to diagnostic changes.
- No consensus existed on the benefit of universal autism screening; general developmental assessments were preferred.
- Lack of training, awareness of screening tools (e.g., M-CHAT), and limited community resources were identified as key barriers.
Conclusions:
- Universal autism screening at 18- and 24-month visits is not widely accepted or implemented by family physicians.
- Improving physician training, strengthening the evidence base, and enhancing community resources are crucial for increasing screening adoption.
- Systemic changes in healthcare are needed to support early autism detection and intervention.
Aim:
We explored potential barriers to adoption of recommended screening for autism by family physicians at 18- and 24-month well-child visits.
Background:
The American Academy of Pediatrics recommends early detection and intervention of autism through the use of a standardized autism-specific screening tool on all children at the 18- and 24-month well-child visits. However, not all family physicians screen for autism.
Methods:
Three focus groups and six semi-structured interviews were conducted with 15 family physicians in the Kansas City metropolitan area. Verbatim transcripts were inductively coded; data were analyzed using standard text analysis.
Findings:
Participants had differing views on the increased incidence of autism. Most participants attributed the increase to changes in diagnostic criteria. There was no consensus on the benefit of implementing universal screening for autism during the 18- or 24-month visit. Many preferred to identify potential problems through general developmental assessments and observations. No participants used specific screening tools for autism, and only one participant was aware of such a tool (M-CHAT). Lack of adequate training on child development and screening methods as well as limited availability of community-based resources to manage children with autism was seen as major barriers to routine screening. Suggested solutions included working toward a stronger evidence base, improving physician training and continuing education, and making systemic changes in healthcare. In conclusion, universal screening for autism at the 18- and 24-month visits is not widely accepted, nor is it implemented by family physicians.
