Screening and referral practices for autism spectrum disorder in primary pediatric care
Abstract
OBJECTIVES: To examine screening practices for autism spectrum disorder (ASD), subsequent referrals, and diagnostic outcomes within a large network of primary pediatric care practices. METHODS: Rates of ASD screening with the Modified Checklist for Autism in Toddlers (M-CHAT) at 18- and 24-month well-child visits were examined among 290 primary care providers within 54 pediatric practices between June 2014 and June 2016. Demographic, referral, and diagnostic data were abstracted from the medical records for all children who failed the M-CHAT (ie, score of ≥3) at either or both visits. RESULTS: Rates of M-CHAT screening were 93% at 18 months and 82% at 24 months. Among 23 514 screens, scores of 648 (3%) were ≥3 (386 at 18 months, 262 at 24 months) among 530 unique children who failed 1 or both screenings. Among screen-failed cases, 18% received a diagnosis of ASD and 59% received ≥1 non-ASD neurodevelopmental disorder diagnosis within the follow-up period. Only 31% of children were referred to a specialist for additional evaluation. CONCLUSIONS: High rates of ASD-specific screening do not necessarily translate to increases in subsequent referrals for ASD evaluation or ASD diagnoses. Low rates of referrals and/or lack of follow-through on referrals appear to contribute to delays in children’s receipt of ASD diagnoses. Additional education of primary care providers regarding the referral process after a failed ASD screening is warranted.
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Referrals for evaluation and intervention for children who screen at higher likelihood of autism remain low.
“Specifically, referrals for evaluation and intervention for children who screen at higher likelihood of autism remain low (Downs et al., 2019; Monteiro et al., 2019).”
From Navigating the Challenges: A Commentary on Barriers to Autism Screening in Childcare Centers (2026) · cites this paper as Monteiro et al., 2019
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- Authors
- Monteiro, S. A., Dempsey, J., Berry, L. N., Voigt, R. G., & Goin-Kochel, R. P.
- Affiliations
- Baylor College of Medicine (US)
- Children's Hospital Colorado (US)
- aAutism Center, Texas Children’s Hospital, Houston, Texas;
- Corresponding author
- Monteiro, Sonia A.
- Venue
- Pediatrics
- Publisher
- American Academy of Pediatrics (AAP)
- Published
- 2019-10-01
- Volume
- 144
- Issue
- 4
- ISSN
- 0031-4005 (ISSN-L)
- 1098-4275
- OpenAlex
- W2972700401
- Cited by
- 97
- References
- 33
- Citations by year
- 2026: 7 · 2025: 15 · 2024: 16 · 2023: 16 · 2022: 13 · 2021: 18 · 2020: 9 · 2019: 3
- FWCI
- 6.25
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- PEDIATRICS (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (U54HD083092)
- 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 spectrum disorder, autism screening, pediatric primary care, referral patterns, diagnostic findings, M-CHAT, neurodevelopmental disorders, specialist referral, delayed diagnosis, well-child visits
- MeSH terms
- Autism Spectrum Disorder, Age Factors, Child, Preschool, Humans, Infant, Pediatrics, Referral and Consultation, Checklist, Lost to Follow-Up, Neurodevelopmental Disorders
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