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Associations Among Referral Concerns, Screening Results, and Diagnostic Outcomes of Young Children Assessed in a
Rebecca McNally Keehn1, Qing Tang2, Nancy Swigonski3
1Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN.
Insights
Early autism spectrum disorder (ASD) screening in primary care shows that primary care provider (PCP) concerns, positive MCHAT-R/F, and ASQ-3 delays predict ASD diagnosis. This highlights the importance of integrated screening for early identification.
Area of Science:
- Developmental Pediatrics
- Autism Spectrum Disorder (ASD) Research
- Primary Care Screening
Background:
- The Early Autism Evaluation Hub system aimed to enhance developmental screening and ASD evaluation access.
- In 2019, 858 children (18-48 months) underwent ASD evaluations, with 40% diagnosed.
- Data collected included referral concerns, screening results (MCHAT-R/F, ASQ-3), and diagnostic outcomes.
Purpose of the Study:
- To investigate the relationship between referral concerns, screening results, and diagnostic outcomes in early ASD evaluations.
- To examine concordance between primary care provider (PCP) and caregiver referral concerns.
- To understand how screening tools and referral reasons predict ASD diagnosis.
Main Methods:
- Analysis of data from 858 children (18-48 months) evaluated through the Early Autism Evaluation Hub system.
- Collected data included PCP- and caregiver-reported referral concerns.
- Utilized Modified Checklist for Autism in Toddlers, Revised with Follow-Up (MCHAT-R/F) and Ages and Stages Questionnaire, Third Edition (ASQ-3) screening results.
Main Results:
- Low agreement was observed between PCP and caregiver referral concerns for autism spectrum disorder (ASD).
- Positive MCHAT-R/F screens correlated with PCP-reported concerns, and MCHAT-R/F raw scores related to both PCP and caregiver concerns.
- PCP-reported ASD concerns, positive MCHAT-R/F, and specific ASQ-3 delays (Communication, Personal Social) significantly increased the likelihood of an ASD diagnosis.
Conclusions:
- Findings underscore the importance of understanding PCP and caregiver perspectives in early ASD identification.
- Collaborative decision-making and shared understanding between PCPs and caregivers can improve referral processes.
- These insights can inform educational strategies and enhance early ASD identification approaches.
Objectives:
To examine associations between referral concerns, screening results, and diagnostic outcomes for young children evaluated across a statewide primary care network for early screening and diagnosis of autism spectrum disorder (ASD).
Study Design:
The Early Autism Evaluation Hub system was developed to increase developmental screening and improve access to timely ASD evaluations in local communities. In 2019, 858 children (ages 18-48 months; 40% diagnosed with ASD) received ASD evaluations across 12 Early Autism Evaluation Hubs. Data on primary care provider (PCP)- and caregiver-reported referral concerns, Modified Checklist for Autism in Toddlers, Revised with Follow-Up (MCHAT-R/F) and Ages and Stages Questionnaire, Third Edition (ASQ-3), and diagnostic outcome were collected.
Results:
Among children evaluated, there was low concordance between PCP and caregiver referral concern. Although a positive MCHAT-R/F screen was associated with PCP but not caregiver-reported ASD referral concern, there was a significant linear relationship between MCHAT-R/F raw scores and both PCP and caregiver ASD referral concern. A different pattern of ASQ-3 delays was found to be associated with PCP-reported as compared with caregiver-reported ASD referral concern. Finally, PCP-reported ASD referral concern, positive MCHAT-R/F, and ASQ-3 Communication and Personal Social delays were associated with a significantly higher likelihood of subsequent ASD diagnosis.
Conclusions:
Understanding how community PCPs use surveillance and screening data, the extent to which PCPs and caregivers have shared understanding and engage in collaborative decision-making about evaluation referral, and how these factors relate to diagnostic outcomes has the potential to impact educational efforts for both PCPs and caregivers of young children, as well as inform the development of more efficacious early identification approaches.
