Pediatric Autism Identification in Primary Care From 2013 to 2023

Autism spectrum disorder (ASD) is typically diagnosed by specialists; however, long waitlists and provider shortages can limit access. Primary care providers (PCPs) are frequently the first point of contact for families and may be well-positioned to recognize early developmental concerns. This study examined whether PCPs were increasingly reported as the first providers to tell families their child has ASD, and evaluated differences by race, ethnicity, and household income.

We analyzed National Survey of Children's Health (NSCH) data, restricting the analysis to reported ASD identification from 2013 onward to align with the timing of changes to the DSM-5 ASD diagnostic criteria. Using generalized estimating equations, we assessed changes over time in the proportion of families who were first told their child had ASD by a PCP. Child's diagnostic age, race and ethnicity, and household income were covariates in the model.

During 2013-2023, the percentage of families first told their child had ASD by a PCP ranged from 10.7% to 21.5% (average = 16.2%). After 2018, the likelihood of families reporting a PCP as the first provider increased, with statistically significant increases among Hispanic children and children from low-income households. The average age of =children when families were first told (5.3 years) remained stable over the study period.

From 2013 to 2023, PCPs remained a minority source to first tell a family about their child's ASD. They were more often reported as the first providers to tell families in more recent years (2018-2023), particularly for Hispanic or low-income families.