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Cited by 144Autism Spectrum Disorder ResearchChild Nutrition and Feeding IssuesFamily and Disability Support Research

Primary care autism screening and later autism diagnosis

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Carbone, Paul S., Campbell, Kathleen, Wilkes, Jacob, Stoddard, Gregory J., Huynh, Kelly, Young, Paul C., Gabrielsen, Terisa P.·2020·Pediatrics
DOI 10.1542/peds.2019-2314PMC PMC7397730
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Abstract

OBJECTIVES: To describe the proportion of children screened by the Modified Checklist for Autism in Toddlers (M-CHAT), identify characteristics associated with screen completion, and examine associations between autism spectrum disorder (ASD) screening and later ASD diagnosis. METHODS: We examined data from children attending 18- and 24-month visits between 2013 and 2016 from 20 clinics within a health care system for evidence of screening with the M-CHAT and subsequent coding of ASD diagnosis at age >4.75 years. We interviewed providers for information about usual methods of M-CHAT scoring and ASD referral. RESULTS: Of 36 233 toddlers, 73% were screened and 1.4% were later diagnosed with ASD. Hispanic children were less likely to be screened (adjusted prevalence ratio [APR]: 0.95, 95% confidence interval [CI]: 0.92–0.98), and family physicians were less likely to screen (APR: 0.12, 95% CI: 0.09–0.15). Compared with unscreened children, screen-positive children were more likely to be diagnosed with ASD (APR: 10.3, 95% CI: 7.6–14.1) and were diagnosed younger (38.5 vs 48.5 months, P < .001). The M-CHAT’s sensitivity for ASD diagnosis was 33.1%, and the positive predictive value was 17.8%. Providers routinely omitted the M-CHAT follow-up interview and had uneven referral patterns. CONCLUSIONS: A majority of children were screened for ASD, but disparities exist among those screened. Benefits for screen-positive children are improved detection and younger age of diagnosis. Performance of the M-CHAT can be improved in real-world health care settings by administering screens with fidelity and facilitating timely ASD evaluations for screen-positive children. Providers should continue to monitor for signs of ASD in screen-negative children.

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  • Patients from minority groups in the United States are screened less often for autism.

    “Additionally, patients from minority groups in the United States are screened less often (Carbone et al., 2020; Guthrie et al., 2019; Zuckerman et al., 2013)”

    From Navigating the Challenges: A Commentary on Barriers to Autism Screening in Childcare Centers (2026) · cites this paper as Carbone et al., 2020

    The Results (M-CHAT Screening) report that Hispanic children were less likely to be screened, including after multivariable adjustment. The study examined toddlers in one US health care system; it does not establish that minority groups generally, or patients of all ages, are screened less often. (LLM, conf=0.86)

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Research works printed but not linked: 1

  1. [6]Coury D, Wolfe A, Lipkin PH, Hyman S. Screening of young children for autism spectrum disorders: results from a national survey of pediatricians. In: Proceedings from the Pediatric Academic Societies Annual Meeting; May 6–9, 2017; San Francisco, CA. [Google Scholar]

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Authors
Carbone, P. S., Campbell, K., Wilkes, J., Stoddard, G. J., Huynh, K., Young, P. C., & Gabrielsen, T. P.
Affiliations
  • Departments of Pediatrics and
  • Intermountain Healthcare (US)
  • University of Utah (US)
  • Brigham Young University (US)
Corresponding author
Carbone, Paul S.
ORCID
Venue
Pediatrics
Publisher
American Academy of Pediatrics (AAP)
Published
2020-08-01
Volume
146
Issue
2
ISSN
  • 0031-4005 (ISSN-L)
  • 1098-4275
DOI
10.1542/peds.2019-2314
PMC
PMC7397730
OpenAlex
W3039245992
Cited by
144
References
29
Citations by year
2026: 17 · 2025: 15 · 2024: 27 · 2023: 26 · 2022: 26 · 2021: 25 · 2020: 8
FWCI
11.41
Type
journal article
Language
en
Open access
Locations
  • PEDIATRICS (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • ScholarsArchive (Brigham Young University) (submittedVersion)
Funders
  • National Institutes of Health (5ul1tr001067-05, UL1TR002538, UL1TR000105)
  • National Heart, Lung, and Blood Institute (R38HL143605)
  • National Institute of Diabetes and Digestive and Kidney Diseases (R18DK123372)
  • National Center for Research Resources (UL1RR025764)
  • National Center for Advancing Translational Sciences (UL1-TR001067)
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, M-CHAT, primary care, toddlers, ASD diagnosis, screening sensitivity, positive predictive value, racial and ethnic disparities, Hispanic children, general practitioners, age at diagnosis
MeSH terms
Autism Spectrum Disorder, Child, Preschool, Female, Follow-Up Studies, Hispanic or Latino, Humans, Infant, Male, Mass Screening, Neuropsychological Tests, Predictive Value of Tests, Primary Health Care, Sensitivity and Specificity, Utah, Early Diagnosis, Healthcare Disparities, Checklist, Delayed Diagnosis

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