Accuracy Of Family Doctors As Compared To Medical Specialists In Predicting The Presence Of An Autism Spectrum Disorder In Children And Youth

Background: Provincial Standards and Guidelines for assessment of an Autism Spectrum Disorder (ASD) introduced in 2002 required that barriers to obtaining diagnostic assessment be reduced. In B.C., as elsewhere, it was reported that requiring a child to see a community pediatrician (or specialist) to obtain a referral for an ASD assessment led to unacceptable delays in identification. As a result, when the British Columbia Autism Assessment Network (BCAAN) was established referrals were accepted from primary care physicians (PCP’s) as well as specialist physicians (pediatricians and child psychiatrists). There have been questions about whether this practice would lead to inappropriate referrals.

Objectives: The purpose of this study is to evaluate if PCP’s are as accurate in identifying children at risk for an ASD as child specialists.

Methods: All children and youth (C&Y) referred to BCAAN between 2003 and 2007 were included (n=2026; age range=1-18; mean age=7.34). Referral sources for all subjects and diagnostic conclusions (ASD vs. Not ASD) were tabulated on all subjects.

Results: There was no significant difference between PCP’s (51.5% positive, n=392) and specialists (58.3%, n=1634) with regard to accuracy in predicting the presence of an ASD.

Child Psychiatrists (52.1%, n=288) and pediatricians (59.7%, n=1346) also do not differ significantly in predicting the presence of an ASD. C&Y under 6 and over 6 do not differ statistically.

Conclusions: PCPs and specialist physicians are equally likely to identify the presence of an autism spectrum disorder in children and youth.  As well, no significant differences exist between child psychiatrists and pediatricians. These data support a policy of minimizing barriers to specific ASD diagnostic assessments including allowing PCPs to directly refer.