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Autism Spectrum Disorder Screening During the COVID-19 Pandemic in a Large Primary Care Network
Kate E Wallis1, Ekaterina Nekrasova2, Amanda E Bennett3
1Division of Developmental and Behavioral Pediatrics (KE Wallis, AE Bennett, JS Miller, and W Guthrie), Children's Hospital of Philadelphia, Philadelphia, Pa; Department of Pediatrics (KE Wallis, AE Bennett, AG Fiks, M Gerdes, BP Jenssen, JS Miller, D Shu, and W Guthrie), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa; Center for Autism Research (KE Wallis, AE Bennett, JS Miller, and W Guthrie), Children's Hospital of Philadelphia, Philadelphia, Pa; Center for Pediatric Clinical Effectiveness (KE Wallis, E Nekrasova, AG Fiks, M Gerdes, BP Jenssen, D Shu, and W Guthrie), Children's Hospital of Philadelphia, Philadelphia, Pa.
Insights
The COVID-19 pandemic reduced autism spectrum disorder (ASD) screening completion in well-child visits, particularly for non-Hispanic White children. Catch-up screening strategies are needed for all children.
Area of Science:
- Pediatric Health
- Public Health
- Developmental Pediatrics
Background:
- The COVID-19 pandemic significantly disrupted healthcare delivery, including routine well-child care.
- Autism Spectrum Disorder (ASD) screening is crucial for early identification and intervention in young children.
- Understanding pandemic's impact on screening equity is vital for addressing developmental disparities.
Purpose of the Study:
- To evaluate the effect of the COVID-19 pandemic on autism spectrum disorder (ASD) screening rates and equity.
- To compare ASD screening completion and positivity before and during the pandemic in a primary care setting.
- To analyze screening trends across diverse sociodemographic groups.
Main Methods:
- A retrospective cohort study compared children aged 16-26 months before (n=26,779) and during (n=24,549) the COVID-19 pandemic.
- Data on well-child visits and Modified Checklist for Autism in Toddlers with Follow-up (M-CHAT/F) screening were extracted from electronic health records.
- Logistic regression models were used to compare screening completion and positivity rates, stratified by sociodemographic factors.
Main Results:
- Overall eligible well-child visits decreased by 8.3%, with greater declines in Black and publicly insured children.
- ASD screening completion dropped from 89.0% pre-pandemic to 86.4% during the pandemic (P < 0.001).
- Screening declines were observed across most groups, most notably in non-Hispanic White children, while screen-positive rates remained consistent.
Conclusions:
- The COVID-19 pandemic led to a decline in well-child visits and ASD screenings, with varied impacts across racial and ethnic groups.
- Observed changes in screen-completion rates do not necessarily reflect increased screening disparities due to shifts in patient populations.
- Implementing catch-up screening initiatives is recommended to ensure all children receive timely ASD evaluations.
Objective:
To assess the impact of the COVID-19 pandemic on screening for autism spectrum disorder (ASD) and screening equity among eligible children presenting for well-child care in a large primary care pediatric network, we compared rates of ASD screening completion and positivity during the pandemic to the year prior, stratified by sociodemographic factors.
Methods:
Patients who presented for in-person well-child care at 16 to 26 months between March 1, 2020 and February 28, 2021 (COVID-19 cohort, n = 24,549) were compared to those who presented between March 1, 2019 and February 29, 2020 (pre-COVID-19 cohort, n = 26,779). Demographics and rates of completion and positivity of the Modified Checklist for Autism in Toddlers with Follow-up (M-CHAT/F) were calculated from the electronic health record and compared by cohort using logistic regression models.
Results:
Total eligible visits decreased by 8.3% between cohorts, with a greater decline in Black and publicly insured children. In the pre-COVID-19 cohort, 89.0% of eligible children were screened at least once, compared to 86.4% during the pandemic (P < 0.001). Significant declines in screening completion were observed across all sociodemographic groups except among Asian children, with the sharpest declines among non-Hispanic White children. Sociodemographic differences were not observed in screen-positive rates by cohort.
Conclusions:
Well-child visits and ASD screenings declined across groups, but with different patterns by race and ethnicity during the COVID-19 pandemic. Findings regarding screen-completion rates should not be interpreted as a decline in screening disparities, given differences in who presented for care. Strategies for catch-up screening for all children should be considered.
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