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Updated: Jun 29, 2025
Eye Tracking Young Children with Autism
Published on: March 27, 2012
Role of Primary Care Clinician Concern During Screening for Early Identification of Autism
Andrea Trubanova Wieckowski1, Riane K Ramsey2, Kirsty Coulter3
1A.J. Drexel Autism Institute, Drexel University, Philadelphia, PA.
Insights
Primary care clinician concern aids early autism identification. Combining clinician concern with autism screening improves diagnostic accuracy and evaluation attendance in toddlers.
Area of Science:
- Developmental Pediatrics
- Autism Spectrum Disorder Research
Background:
- Early identification of autism spectrum disorder (ASD) is crucial for timely intervention.
- Primary care settings offer opportunities for universal screening and surveillance of developmental disorders.
Purpose of the Study:
- To assess the added value of primary care clinician (PCC)-indicated concern in conjunction with standardized screening for early autism detection.
- To determine if PCC concern enhances the accuracy and efficiency of autism identification in toddlers.
Main Methods:
- A total of 7,039 toddlers (aged 14.24-22.43 months) participated in two studies involving autism screening during primary care visits.
- Parents completed the Modified Checklist for Autism in Toddlers, Revised, with Follow-Up; PCCs indicated autism concerns, with varying requirements across studies.
- Children with high likelihood for autism based on screening results and/or PCC concern were invited for diagnostic evaluation.
Main Results:
- PCC-indicated autism concerns were consistent regardless of whether indication was required or encouraged.
- The combination of positive screening and PCC concern yielded the highest positive predictive values for autism and any developmental disorder, alongside increased evaluation attendance.
- PCCs identified children with more apparent autism characteristics more readily than those with subtler signs.
Conclusions:
- The study supports the American Academy of Pediatrics' recommendation for integrating autism screening and surveillance into routine well-child visits.
- A high likelihood of autism indicated by either the screening tool or PCC concern warrants referral for diagnostic evaluation.
Objective:
The aim of this study was to evaluate the added value of primary care clinician (PCC)-indicated concern during primary care universal standardized screening in early identification of autism.
Methods:
Toddlers were screened for autism during primary care checkups (n = 7,039, aged 14.24-22.43 months) in 2 studies. Parents completed the Modified Checklist for Autism in Toddlers, Revised, with Follow-Up. For each participant, PCCs indicated whether they had autism concerns (optional in 1 study-before or after viewing screening results, required before viewing screen results in the other). Children at high likelihood for autism from screen result and/or PCC concern (n = 615) were invited for a diagnostic evaluation; 283 children attended the evaluation.
Results:
Rates of PCC-indicated autism concerns were similar whether PCCs were required or encouraged to indicate concerns. High likelihood of autism indication on both screen and PCC concern resulted in the highest positive predictive value for autism and positive predictive value for any developmental disorder, as well as the highest evaluation attendance, with no significant difference between the positive screen-only and PCC concern-only groups. Although the frequency of PCC-indicated autism concern did not differ significantly based on the child's cognitive level, PCCs were more likely to identify children with more obvious autism characteristics compared with more subtle autism characteristics as having autism.
Conclusion:
The findings support the recommendation of the American Academy of Pediatrics that both screening and surveillance for autism be incorporated into well-child visits. High likelihood of autism on either screen or PCC concern should trigger a referral for an evaluation.
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