Developmental and Autism Spectrum Disorder Screening Practices Among Primary Care Physicians

Background:

Evidence has shown that children with Autism Spectrum Disorders (ASD) have improved outcomes through early detection, diagnosis, and intervention. Recommendations for developmental and ASD screening have been published for over 10 years; however, the mean age of diagnosis is reported as 4 years of age.

Objectives:

The study objectives were to examine developmental and ASD screening practices among primary care physicians and to identify potential opportunities to support improvement in these practices.

Methods:  

Sixty primary care physicians affiliated with a Midwest university-based hospital system were sent an online survey with 27 questions regarding current developmental screening and referral practices, barriers to screening, level of previous training and perceived need for future training about developmental and ASD screening. A total of 34 physicians completed the survey (56.7%). Thirty-three percent were general pediatricians, 58% were family physicians, and 9% were medicine/pediatric physicians. Survey data were analyzed based on frequency of responses.

Results:  

Overall, 52% of responding physicians reported the use of developmental screening tools at well child evaluations. Family physicians were more likely to report the use of developmental screening tools compared to pediatric physicians (63% versus 36%, respectively). Of physicians who do not routinely screen for developmental delays, reliance on clinical observation was most frequently indicated as the reason (69%).

Overall, 58% of responding physicians report routine use of ASD screening tools. Interestingly, pediatric physicians were more likely to report routine ASD screening over family physicians (93% versus 32% respectively). The most frequently reported first course of action when physicians suspects ASD was to refer to a clinical specialist over the option of administering an ASD screening tool for the following age categories: <24 months (39%), 2-3 years (58%), and 4-5 years (66%). Most frequently reported barrier for ASD screening was not being familiar enough with the ASD screening tools (36%).

Conclusions:  

Findings from this study show a continued lack of adherence to the recommended guidelines for developmental and ASD screening among primary care providers. The results  indicate there is a gap in ASD screening knowledge among family physicians indicating a need to focus training efforts on this population of providers. Findings also suggest a lack of knowledge among primary care physicians on what to do with patients suspected of having ASD, including when to screen using a standardized tool and when to refer to a clinical specialist. The results of this study are important for determining where practice improvements for screening and referral need to be made and for guiding future training efforts in this area.