Comparing Autism Screeners and Physician Surveillance Techniques At 18- and 24-Month Well Child Visits

Background:  The American Academy of Pediatrics recommends autism-specific screening at 18- and 24-month well child visits in addition to scheduled developmental screening (Johnson & Myers, 2007).  However, little research has examined the use of autism-specific screening instruments in primary care settings.  Physician concern alone is not adequate in identifying children with autism as pediatricians missed 81% of children who were diagnosed with ASD after failing the M-CHAT (Robins, 2008). Pediatricians also missed 68% of children who screened positive for developmental delay on the Ages and Stages Questionnaire (Hix-Small, 2007). Further, since 92% of caregivers of children with ASD initially discuss concerns with their primary care providers (Siegel, 1988), it is crucial that physicians be able to adequately determine when a child’s clinical presentation necessitates further developmental testing.

Objectives:  The aim of this study is to examine the relation between scores on the Ages and Stages Questionnaire 3 (ASQ-3), an abbreviated 30-item research version of the Early Screening for Autism and Communication Disorders (ESAC; Wetherby, Woods, & Lord, 2009), physician concerns and parent concerns in 18- and 24-month old children.

Methods:  Caregivers of children completed the ASQ-3 and the 30-item abbreviated ESAC at 18- and 24-month well-child visits at one university medical clinic and two rural medical clinics in Alabama. To date, 38 caregivers have participated.  The ASQ-3 identifies delays in five areas:  communication, gross motor, fine motor, problem solving, and personal-social.  The abbreviated ESAC is a 30 item questionnaire that identifies delays in two areas:  interacting/communicating and interests/activities; it also has an “additional comments” section.  Physicians also completed questionnaires, in which they noted any delays in motor, language, or social development and indicated whether or not they made referrals for developmental testing.

Results:  Preliminary data indicate that the ASQ-3 communication domain was negatively correlated with the abbreviated ESAC total score (r = -.46, p = .006) and with physician-concerns about language skills (r = -.40, p = .015). That is, lower standard scores on the ASQ-3 communication domain were correlated with increased ASD symptoms on the abbreviated ESAC and increased physician concern. No significant correlation was found between physician-identified delay and the abbreviated ESAC.  Initial parental concern and physician-concerns about language skills were positively correlated with the number of physician referrals (r = .70, p < .001 and r = .60, p <.001, respectively).  Parents indicated concerns following completion of the abbreviated ESAC and these concerns were significantly correlated with abbreviated ESAC total.  Data collection is ongoing.

Conclusions:  There is a modest correlation between the abbreviated ESAC and the ASQ-3, indicating that although the measures are related, they are not redundant.  The lack of relationship between physician concerns and abbreviated ESAC total score highlights the importance of using autism-specific training for physicians.  Physician training may increase early identification and early intervention referral rates.  These results also highlight the importance of caregiver screening in addition to physician surveillance for autism.