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SCREENING OF YOUNG CHILDREN FOR AUTISM SPECTRUM DISORDERS:

RESULTS FROM A NATIONAL SURVEY OF PEDIATRICIANS


Daniel Coury1, Audrey Wolfe2, Paul H. Lipkin3, Briella Baer3, Susan L. Hyman4,
5 6
Susan E. Levy , Michelle M. Macias , Blake Sisk 7

1. Nationwide Children's Hospital, Columbus, OH; 2. Massachusetts General Hospital, Boston, MA; 3. Kennedy Krieger Institute, Baltimore,
MD; 4. University of Rochester, Rochester, NY; 5. Children's Hospital of Philadelphia, Philadelphia, PA; 6. Medical University of South
Carolina, Charleston, SC; 7. American Academy of Pediatrics, Elk Grove Village, IL

1. BACKGROUND 5. T
Description of analysis objective
ABLE 2: METHODS AND TOOLS FOR ASD SCREENING 7. SUMMARY OF RESULTS
• Research shows that early identification of children with autism Table 2: Pediatricians' Use of Methods and Tools for ASD Screening, 2016 Table 1
spectrum disorder (ASD) as well as intensive, early • 81% of pediatricians report “always/almost always” using one
Method/Tool % Pediatricians Reportinga
intervention during the toddler and preschool years improves or more formal tools to screen for ASD
outcomes. Clinical assessment guided by a formal screening instrument 64.5%
• Current guidelines recommend screening all children for ASD Table 2
Informal milestone checklist review by you or staff 48.6%
with a standardized tool at 18 and 24 months of age. • Among pediatricians screening for ASD in 2016:
Clinical assessment without the use of a formal screening instrument/checklist 44.7% • 74% report using the Modified Checklist for Autism in
2. OBJECTIVE Informal milestone checklist filled out by parents 33.9%
Toddlers (M-CHAT)
• To better understand practice behavior of general • 45% assess for ASD without the use of a formal screening
pediatricians in the U.S. around screening and diagnosis of Formal screening using a standardized instrument: instrument/checklist
ASD in children <36 months of age. • 34% use informal developmental milestone checklists filled
Modified Checklist for Autism in Toddlers (M-CHAT) 74.1%
out by parents as an assessment tool
3. METHODS Ages & Stages Questionnaire (ASQ) 41.9%
Figure 1
Data Parents’ Evaluation of Developmental Status (PEDS) 12.5%
• When pediatricians report using a formal screening tool to
• Nationally representative survey of pediatricians from
Denver II 10.2% assess for ASD, survey results show that 88% screen at 18
American Academy of Pediatrics’ Periodic Survey
months and 74% screen at 24 months
• 2016, response rate=47, N=515 Screening Tool for Autism in Two-Year Olds (STAT) 3.0%
• 43% reported use of a formal screening tool when surveillance
Pervasive Developmental Disorders Screening Test-II (PDDST-II) 2.6% indicates a concern for delayed or disordered development
• Sample restrictions: Respondents who provide primary
8. CONCLUSION
Note: Survey Question: How often do you or your staff use the following methods or tools to identify children birth to 35 months of age at risk for autism?
patient care and assess for developmental risk or autism
a. Percent reporting “always/almost always”
• Note: analysis in Figure 1 restricted to only respondents
reporting formal ASD screening • The results indicate efforts by multiple organizations to
6. FIGURE 1: PATIENT AGE AND ASD SCREENING increase routine screening for ASD have been effective, as
Key Variables Figure 1: At What Age(s) do Pediatricians Report Screening Patients for pediatricians report screening for ASD at very high rates
• If respondents assess for developmental risk or autism using ASD Using a Formal Screening Tool?
formal tools • Use of formal screening tools allows pediatricians to identify
• Method/tool used to identify children at risk for ASD 9 months 14% children at risk for ASD as well as diagnose children with ASD
• Frequency of use of standardized ASD screening tools earlier in life, thus allowing those children earlier access to
• Patients’ age at ASD screening with formal tool 12 months 16% services and ultimately improving outcomes

Analysis 18 months 88%


• Descriptive statistics used to examine pediatricians’ use of 9. LIMITATIONS
methods and tools for ASD screening and patient age at 24 months 74% • This analysis is based on self-report survey data, and is generalizable
which screening takes place to the pediatrician members of the AAP

30 months 22%
4. TABLE 1: FORMAL ASD SCREENING 10. ACKNOWLEDGEMENTS
Table 1: Pediatricians' Use of One or More Formal ASD Other 9%
• This research was supported by the American Academy of Pediatrics,
Screening Tools, 2016 When surveillance and we are grateful to all of the pediatricians who participated in the
% Pediatricians Reportinga
indicates a concern 43% Periodic Survey
for development • Project was supported in part by the Health Resources and Services
One or more formal tools to screen for ASD 80.6% 0% 20% 40% 60% 80% 100% Administration (HRSA) of the U.S. Department of Health and Human
Note: Survey Question: How often do you or your staff use the following methods or tools to identify Services (HHS) under cooperative agreement UA3 MC11054 – Autism
children birth to 35 months of age at risk for autism? Note: Survey question: At what age(s) do you usually perform autism screening, using a formal (standardized) screening instrument, in your practice?; analysis Intervention Research Network on Physical Health
a. Percent reporting “always/almost always” restricted to pediatricians reporting formal ASD screening