P3B345: Beyond Screening: Diagnostic Evaluation of Autism in Pediatric Primary Care

Background: Screening for developmental deviations in early childhood is a primary function of pediatric primary care. Routine screening for autism has significantly improved the identification of young children at risk for autism. However significant delay in second level diagnostic evaluation of these children hampers confirmation of the diagnosis needed for access to early interventions. This delay deprives children and families from starting the interventions during the short window of maximum brain plasticity when interventions are most effective. Currently, the average delay from initial concern to the diagnosis of ASD is 2 years. This delay is significantly longer for minority and underserved children. A shortage of providers with the skills to diagnose ASD is the major contributor to the observed diagnostic delay.

Methods: In this paper, we describe the results of implementation of an autism diagnostic program in the pediatric primary care setting.
In this program, a primary care pediatrician trained in administration of the ADOS-2 performed the diagnostic evaluation and coordinated access to medical and educational services using resources that are commonly available in the primary care medical home.

Results: From April 2021-May 2022, 20 children underwent evaluation, 18 received the diagnosis of ASD. Eight children/families participated in a retrospective cross-sectional study of this program. The median age at diagnosis was 32 months compared to 49 months documented by the 2023 CDC data. Median time from referral to diagnosis was 1.3 months compared to 6-12 months from historic data. Average parent satisfaction score was 4.2 on a 5-point Likert scale, indicating high satisfaction with the process.

Conclusion: We conclude that the primary care setting offers the opportunity to improve access to second level diagnostic evaluation for autism for young children and can decrease the time from referral to diagnosis while delivering an excellent family experience.