P3B344: Primary Care Pediatrician Use of the RITA-T to Streamline Autism Referrals

Background: Secondary autism screeners such as the STAT (Screening Tool for Autism in Toddlers) have already proven useful within South Carolina tertiary care developmental centers (DEC) to provisionally diagnose autism and refer for early intensive behavioral intervention (EIBI) while a child awaits a full autism evaluation. However, the STAT has not effectively been integrated into busy primary care pediatric practices, in part because of time constraints. Recently, a more efficient secondary screener, the Rapid Interactive Screening Test for Autism in Toddlers (RITA-T) has been successfully integrated into autism screening and diagnostic processes at tertiary care centers involved with its development, and shown promise as a screening tool when used by early intervention providers in underserved communities. Though the RITA-T seems to lend itself well to clinical integration, there has yet to be any published data on this scenario.

Methods: This IRB approved study follows 30 children who are referred to our DEC with a completed RITA-T from their primary care pediatrician (PCP) from October 2022 – June 2023. Referrals are flagged for direct scheduling into a standard autism screening evaluation within one month, where an interdisciplinary team of social work and developmental-behavioral pediatrics (DBP) performs an internal RITA-T, STAT, and the Capute Scales developmental assessment. Children meeting criteria for a provisional diagnosis of ASD are prescribed EIBI and other appropriate therapies and scheduled for an ADOS. The primary aim is to determine whether RITA-T screening scores by primary care pediatricians will correlate with a provisional diagnosis of ASD after DBP subspecialty evaluation. This study is part of a larger project that is comparing time to appointment, evaluation, diagnosis, and receipt of early intervention services between the children referred through the streamlined model compared to those referred through the traditional system. Once all 30 children complete their autism screening evaluation, analysis will involve Interrater agreement between community pediatrician performed RITA-T “at-risk” cut-off scoring compared to formal Autism diagnosis will be determined using Cohen’s kappa agreement statistics. Secondary analyses will include Intraclass correlation coefficient assessment between pediatrician’s and developmental evaluation center social worker’s performed RITA-T total score.

Results: With 19 initial autism screening evaluation visits completed so far, 100% of those with Pediatrician RITA-T scores in Moderate Risk range or High-Risk Range were given a provisional diagnosis of autism and referred for an ADOS. Of the eight patients who have completed their ADOS, seven received a final diagnosis of autism.

Conclusion: Preliminary results support that administration of the RITA-T by a PCP is a feasible tool to streamline referrals for toddlers with scores of moderate to high risk of autism. Integration of the RITA-T into primary care clinics, combined with developmental evaluation center partnership, can facilitate a rapid diagnostic pathway.