Primary Care Autism Screening and Later Autism Diagnosis

Area of Science:

• Pediatric healthcare
• Developmental pediatrics
• Autism spectrum disorder research

Background:

• Early detection of autism spectrum disorder (ASD) is crucial for timely intervention.
• The Modified Checklist for Autism in Toddlers (M-CHAT) is a widely used screening tool.
• Understanding screening completion rates and associated factors is important for public health.

Purpose of the Study:

• To determine the proportion of toddlers screened using the M-CHAT.
• To identify characteristics linked to M-CHAT screening completion.
• To examine the association between M-CHAT screening and later ASD diagnosis.

Main Methods:

• Retrospective analysis of electronic health records from 20 clinics (2013-2016).
• Inclusion of 36,233 toddlers attending 18- and 24-month well-child visits.
• Provider interviews to assess M-CHAT scoring and referral practices.

Main Results:

• 73% of toddlers were screened; 1.4% were diagnosed with ASD.
• Hispanic children and those seen by family physicians were less likely to be screened.
• Screen-positive children had a significantly higher likelihood of ASD diagnosis at a younger age (APR: 10.3).
• M-CHAT sensitivity was 33.1%; positive predictive value was 17.8%.
• Providers often omitted M-CHAT follow-up interviews and referral patterns were inconsistent.

Conclusions:

• While most toddlers undergo ASD screening, disparities in access exist.
• Screening is associated with earlier ASD diagnosis, highlighting its benefits.
• Improving M-CHAT fidelity and referral processes is essential for real-world effectiveness.