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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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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: Carbone, Paul S.
Campbell, Kathleen
Wilkes, Jacob
Stoddard, Gregory J.
Young, Paul C.
Gabrielsen, Terisa P.
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: green
www.ncbi.nlm.nih.gov
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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