Screening Practices and Factors Influencing Autism Spectrum Disorder Screening By Community Paediatricians

Background:  

Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder which affects 1% of the population.  Research has shown that ASD can be diagnosed in children 2 to 3 years of age with some accuracy. High risk children have been identified prior to 24 months of age. In Canada the median age of diagnosis of ASD is 39 to 55 months, which suggests a later time to diagnosis than seen in other developed countries. Screening is important for early identification of children with ASD, potentially leading to earlier intervention. Research has identified some potential barriers to early identification of ASD; however, information regarding general paediatric practices around ASD screening in Canada is lacking.

Objectives:  

The aim of the study is to examine the use of ASD screening tools and developmental screening tools by community pediatricians. We also evaluated facilitators and barriers to ASD screening by community paediatricians.

Methods:  

A cross sectional survey of community paediatricians was conducted. A questionnaire was developed based on previous survey data. The survey was reviewed by developmental paediatricians and community pediatricians to ensure clarity and ease of use. The questionnaire was distributed to five hundred and sixty paediatricians.

Results:  

There was a 48% response rate (267/560)of whom 132 were eligible. Ninety three percent of responders use a developmental screening tool, namely the Nipissing Developmental Screen, Rourke Baby Record and Ages and Stages Questionnaire. Seventy one percent (71%) of responders use an ASD screening tool when there are concerns for ASD noted. Only 15% of community paediatricians routinely use ASD screening tools, and 14% never use an ASD screening tool. The most commonly used ASD screening tool is the Modified Checklist for Autism in Toddlers, Checklist for Autism In Toddlers and Social Communication Questionnaire.  Community paediatricians refer a child who they suspect of having ASD to a clinical specialist primarily to confirm the diagnosis and to facilitate access to resources and interventions. Community paediatricians are keen to incorporate a formal ASD screening tool in their practice but identified the need for clearer guidelines for ASD screening.

Conclusions:  

The majority of community paediatricians use an ASD screening tool when there are specific concerns for ASD. The time to screen for ASD and the ability to navigate ASD resources and interventions are important barriers for community paediatricians. Clarity around guidelines as to when and how to screen for ASD is needed.