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ECHO (Extension for Community Healthcare Outcomes) Autism STAT: A Diagnostic Accuracy Study of Community-Based
Kristin Sohl1,2, Leeore Levinstein1, Alexandra James1,2
1University of Missouri, School of Medicine, Columbia, MO.
Insights
Primary care clinicians can accurately diagnose autism spectrum disorder (ASD) in young children. Training primary care physicians can lead to earlier ASD diagnosis and intervention, improving access to care.
Area of Science:
- Pediatric Healthcare
- Developmental Pediatrics
- Autism Spectrum Disorder Research
Background:
- Early diagnosis of autism spectrum disorder (ASD) is crucial but often delayed, with an average age of diagnosis at 4.4 years.
- Current diagnostic practices rely on specialized centers, limiting accessibility for many families.
Purpose of the Study:
- To evaluate the diagnostic accuracy of primary care physicians trained to identify autism spectrum disorder (ASD) in children aged 14 to 48 months.
- To assess caregiver satisfaction with community-based ASD diagnosis.
Main Methods:
- A diagnostic accuracy study involved 20 children diagnosed with ASD by trained primary care clinicians.
- An independent gold-standard evaluation at a regional autism center confirmed diagnoses.
- Caregiver perceptions of the diagnostic process were collected using a Likert scale.
Main Results:
- 19 out of 20 (95%) ASD diagnoses made by trained primary care clinicians were confirmed by gold-standard evaluation.
- Caregivers reported high satisfaction (4.8/5) with receiving diagnoses in their local community.
Conclusions:
- Primary care clinicians can be effectively trained to reliably diagnose ASD in young children with unambiguous symptoms.
- Implementing ASD diagnosis in primary care settings has the potential to significantly reduce diagnostic delays and improve access to early interventions.
Objective:
Children can be reliably diagnosed with autism spectrum disorder (ASD) by a highly trained clinician as early as 12 to 24 months of age, but recent estimates indicate that the average age of diagnosis is 4.4 years. We hypothesized that trained primary care physicians and practitioners can reliably and accurately diagnose children 14 to 48 months with unambiguous symptoms of ASD.
Methods:
Through this diagnostic accuracy study, 20 patients diagnosed with ASD by clinicians trained through the ECHO (Extension for Community Healthcare Outcomes) Autism STAT program participated in an independent gold-standard evaluation at a regional autism center. Caregiver perceptions of the diagnostic process were also assessed.
Results:
Of the 20 patients who received a diagnosis of ASD by a trained clinician and completed the study, 19 diagnoses were confirmed by a gold-standard evaluation. Caregivers indicated that undergoing diagnosis in their local community rather than an autism specialty center was helpful (4.8/5 on a 5-point Likert scale, n = 19). Results of this study demonstrate that primary care clinicians can be trained to reliably diagnose ASD in children 14 to 48 months with unambiguous symptoms.
Conclusion:
Diagnosis in the primary care setting may lead to earlier diagnosis and quicker connection to evidence-based therapies and interventions. Given the potential impact of increasing access to high-quality diagnostic services, the role of primary care clinicians in the diagnosis of ASD should be further evaluated.
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