Addressing current barriers to autism diagnoses through a tiered diagnostic approach involving pediatric primary care providers
Abstract
Formal autism diagnosis from a specialist trained in autism assessment is customary prior to a child accessing early, intensive autism‐specific services. However, long wait lists for diagnostic evaluations and limited specialty workforce have created substantial delays. Additionally, lengthy multidisciplinary evaluations are costly to insurers, inconvenient to families, and disproportionally impact under‐resourced families. Diagnostic delays can impede access to intervention services. These barriers, combined with evidence regarding the importance of receiving early, autism‐specific treatment, demand new approaches enabling access to autism specific services before comprehensive evaluation. Pediatric primary care providers (PCPs) are often the only health care professionals with whom a family interacts during early childhood and can play a crucial role in helping children with autism symptoms access services. Many strategies for autism diagnosis in primary care are being developed and tested; however, they have yet to be broadly adopted by PCPs, primarily due to critical implementation barriers in primary care settings. There is also not enough evidence on the accuracy of PCPs' diagnostic impressions without extensive specialty support, resulting in PCP hesitancy in diagnosing ASD, as well as family and service provider hesitancy in accepting a PCP autism diagnosis. In this commentary, we explore the acute need for shortening waitlists for autism evaluations through a tiered diagnostic approach, in which PCPs can rule in or rule out autism in children, for whom diagnosis is clear, and refer more complex cases for specialist evaluations, and explore implementation challenges to this approach.
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ASD is beginning to be identified more in lower-SES groups than previously; however, barriers to services still exist for lower-SES families of children with ASD (e.g., transportation, childcare, and job accommodations).
“ASD is beginning to be identified more in lower-SES groups than previously (7,11); however, barriers to services still exist for lower-SES families of children with ASD (e.g., transportation, childcare, and job accommodations) (18–26).”
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Shaw, K. A., Bilder, D. A., McArthur, D., Williams, A. R., Amoakohene, E., Bakian, A. V., Durkin, M. S., Fitzgerald, R. T., Furnier, S. M., Hughes, M. M., et al. (2023) · MMWR. Surveillance Summaries · doi:10.15585/mmwr.ss7201a1 · Cited by 223 · see citing works
- Authors
- Wieckowski, A. T., Zuckerman, K. E., Broder‐Fingert, S., & Robins, D. L.
- Affiliations
- Drexel University (US)
- Oregon Health & Science University (US)
- University of Massachusetts Chan Medical School (US)
- Corresponding author
- Wieckowski, Andrea Trubanova
- Venue
- Autism Research
- Publisher
- Wiley
- Published
- 2022-10-17
- Volume
- 15
- Issue
- 12
- Pages
- 2216-2222
- ISSN
- 1939-3792 (ISSN-L)
- 1939-3806
- OpenAlex
- W4306677949
- Cited by
- 38
- References
- 18
- Citations by year
- 2026: 11 · 2025: 7 · 2024: 14 · 2023: 5 · 2022: 1
- FWCI
- 3.48
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Autism Research (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
- Health Sciences › Medicine › Psychiatry and Mental health › Child Nutrition and Feeding Issues
- Social Sciences › Psychology › Clinical Psychology › Family and Disability Support Research
- Keywords
- autism diagnosis, pediatric primary care, delayed diagnosis, autism spectrum disorder, specialist referral, implementation barriers, diagnostic accuracy
- MeSH terms
- Autism Spectrum Disorder, Autistic Disorder, Child, Child, Preschool, Humans, Primary Health Care
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