The DOI matches its Crossref record; 29 of the 29 references it cites were found in a registry or an index.
Primary Care Autism Screening and Later Autism Diagnosis
Open accessAbstract
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.
Overview
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Verification
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
The source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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
Experimental — accuracy not yet measured
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Citations
Cites
Regression Modeling Strategies
Harrell, F. E. (2001) · Springer series in statistics · doi:10.1007/978-1-4757-3462-1 · Cited by 9,270
Baio, J., Wiggins, L., Christensen, D. L., Maenner, M. J., Daniels, J., Warren, Z., Kurzius-Spencer, M., Zahorodny, W., Robinson, C., Rosenberg, et al. (2018) · MMWR. Surveillance Summaries · doi:10.15585/mmwr.ss6706a1 · Cited by 6,078
Identification and Evaluation of Children With Autism Spectrum Disorders
Johnson, C. P., Myers, S. M., & and the Council on Children With Disabilities (2007) · Pediatrics · doi:10.1542/peds.2007-2361 · Cited by 2,011
Validation of the Modified Checklist for Autism in Toddlers, Revised With Follow-up (M-CHAT-R/F)
Robins, D. L., Casagrande, K., Barton, M., Chen, C.-M. A., Dumont-Mathieu, T., & Fein, D. (2014) · Pediatrics · doi:10.1542/peds.2013-1813 · Cited by 1,081
Zwaigenbaum, L., Bauman, M. L., Choueiri, R., Kasari, C., Carter, A., Granpeesheh, D., Mailloux, Z., Smith Roley, S., Wagner, S., Fein, D., et al. (2015) · Pediatrics · doi:10.1542/peds.2014-3667e · Cited by 856
Greenland, S. (2004) · American Journal of Epidemiology · doi:10.1093/aje/kwh221 · Cited by 728
Zou, G., & Donner, A. P. (2011) · Statistical Methods in Medical Research · doi:10.1177/0962280211427759 · Cited by 720
Christensen, D., Bilder, D. A., Zahorodny, W. M., Pettygrove, S. D., Durkin, M. S., Fitzgerald, R. T., Rice, C. E., Kurzius‐Spencer, M., Baio, J., & Yeargin‐Allsopp, M. (2015) · Journal of Developmental & Behavioral Pediatrics · doi:10.1097/dbp.0000000000000235 · Cited by 412
Knighton, A. J., Savitz, L. A., Belnap, T., Stephenson, B., & VanDerslice, J. A. (2016) · eGEMs (Generating Evidence & Methods to improve patient outcomes) · doi:10.13063/2327-9214.1238 · Cited by 322
Malaria Surveillance — United States, 2015
Mace, K. E., Arguin, P. M., & Tan, K. R. (2018) · MMWR Surveillance Summaries · doi:10.15585/mmwr.ss6707a1 · Cited by 281
Cited by
Sorted by citations
Items 101–144 of 144
Choueiri, R., DeMeo, M., Tokatli, V., Zhu, G., & Zhang, B. (2024) · Pediatric Investigation · doi:10.1002/ped4.12453 · Cited by 1
Boosting Autism Screening and Referrals with EHR-Integrated Tools at Well-Child Visits
Vundavalli, S., Brown, C. L., Chaparro, J. D., Chandawarkar, A. R., Bester, S., Newmeyer, A. J. M., & Barnhardt, E. W. (2024) · Journal of Developmental & Behavioral Pediatrics · doi:10.1097/dbp.0000000000001325 · Cited by 1
Feasibility of Large-Scale Development-Focused EEG Research in a Hospital-Based Primary Care Setting
Conroy, K., Wilkinson, C. L., Francis, B., Said, A. J., Constantino, C., Chung, H., Tager-Flusberg, H. B., & Nelson, C. A. (2025) · Academic Pediatrics · doi:10.1016/j.acap.2025.103163 · Cited by 1
Harrison, A. J., Bowman, K. L., Bub, K. L., Brown, J. A., Lieberman‐Betz, R. G., & Vail, C. O. (2025) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-025-07154-7 · Cited by 1
Autism screening and diagnosis in children with congenital heart disease
Perez, N. L. O., Rios, P. M., Marchman, V. A., Aishworiya, R., Wang, S. F., & Feldman, H. M. (2026) · Frontiers in Pediatrics · doi:10.3389/fped.2026.1839114 · Cited by 1
Pediatric tracheostomy audiometric outcomes – A quality improvement initiative
Narayanan, A. M., Dabbous, H. K., John, R. S., Kou, Y., Johnson, R. F., & Chorney, S. R. (2023) · International Journal of Pediatric Otorhinolaryngology · doi:10.1016/j.ijporl.2023.111694 · Cited by 1
Autism Spectrum Disorder at Home and in School
Bone, M., & Leppert, M. L. O. (2024) · Pediatric Clinics of North America · doi:10.1016/j.pcl.2024.01.008 · Cited by 2
Developmental screening at 18 months using the Nipissing District Developmental Screen
Borkhoff, C. M., Imsirovic, H., Bayoumi, I., Macarthur, C., Nurse, K. M., To, T. M., Feldman, M., Lau, E., Knight, B. D., Birken, C. S., et al. (2025) · Paediatrics & Child Health · doi:10.1093/pch/pxaf023 · Cited by 1
Borkhoff, C. M., Imsirovic, H., Bayoumi, I., Macarthur, C., Nurse, K. M., To, T. M., Feldman, M. E., Lau, E., Knight, B. D., Birken, C. S., et al. (2025) · PLoS ONE · doi:10.1371/journal.pone.0326751 · Cited by 1
Integrated Scale for Diagnosis of Autism Spectrum Disorder (ISD-ASD)
Rúa, M. O. (2022) · International Journal for Innovation Education and Research · doi:10.31686/ijier.vol10.iss9.3906 · Cited by 1
(2021) · doi:10.5121/csit.2021.1115 · Cited by 1
Screen Often and With Trusted Community Members to Improve Autism Identification for Latine Children
Wallis, K. E., Abdul-Chani, M. M., & Zuckerman, K. E. (2022) · Archives of Pediatrics and Adolescent Medicine · doi:10.1001/jamapediatrics.2021.5377 · Cited by 1
Navigating the Challenges: A Commentary on Barriers to Autism Screening in Childcare Centers
Wieckowski, A. T., Perez Liz, G., McGhee Hassrick, E., Koku, E., Frick, E., Austin, A., & Robins, D. L. (2026) · Behavioral Sciences · doi:10.3390/bs16010079
Crais, E. R. (2021) · Medical Research Archives · doi:10.18103/mra.v9i5.2402
Fuentes‐Afflick, E. (2021) · The Journal of Pediatrics · doi:10.1016/j.jpeds.2021.03.059
Dursun, O. B., Turan, B., Öğütlü, H., Binici, N. C., Örengül, A. C., Alataş, E., Özdemir, R. M., Taşlıbeyaz, E., Karaman, S., Mukaddes, N. M., et al. (2021) · SSRN Electronic Journal · doi:10.2139/ssrn.3918480
Early screening tools for Autism Spectrum Disorder in infancy and toddlers
Guanghua, C. H. E. N., Guanpeng, T. A. O., Luyu, Z. H. A. I., & Bai, X. (2022) · Advances in Psychological Science · doi:10.3724/sp.j.1042.2022.00738
Rockwell, D., Sterling, D., & Mello, M. (2022) · Advances in higher education and professional development book series · doi:10.4018/978-1-6684-5103-8.ch009
Goin‐Kochel, R. P. (2023) · Journal of Pediatrics & Child Care · doi:10.13188/2380-0534.1000036
Towards a Novel Machine Learning and Hybrid Questionnaire Based Approach for Early Autism Detection
Hadri, S. A., & Bouramoul, A. (2023) · Lecture notes in networks and systems · doi:10.1007/978-3-031-30396-8_5
Diagnostic Tests for Autism Spectrum Disorder in Morocco
Hassib, O., & Oumaima Hassib, B. T. (2023) · Journal of Hunan University Natural Sciences · doi:10.55463/issn.1674-2974.50.3.18
Genésio, I., Salgado, J., Gouveia, P. M., Matos, I. V., Gonzaga, D., Machado, L., Prior, C., & Soares, S. (2023) · Research in Autism · doi:10.1016/j.rasd.2023.102219
Early Identification of Females with Autism: Comprehensive Evaluation
Gabrielsen, T. P., Begay, K. K., Campbell, K. M., Hahn, K., & Harrington, L. T. (2023) · Springer eBooks · doi:10.1007/978-3-031-33969-1_2
Self-citationNavedo, M. Y. (2023) · Revista Inclusiones · doi:10.58210/fprc3496
Human-Machine Interaction Assisted Autism Identification based on RepNet
Guo, Y., Ho, Y. K., Zhou, J., Zhang, X., Wu, Y., Liao, J., Xie, J., Wen, X., & Zhang, C. (2023) · International Conference on Sensing, Measurement & Data Analytics in the era of Artificial Intelligence (ICSMD) · doi:10.1109/icsmd60522.2023.10490602
Tendências e lacunas dos estudos de autismo no estado do Tocantins, Brasil
de Souza, C. B., Benvindo‐Souza, M., dos Santos, C. G. A., Silva, I. A. D., & Cáceres, M. E. S. (2024) · Revista Ensino & Pesquisa · doi:10.33871/23594381.2024.22.2.8921
Zhu, Y., Davis, N. O., Franz, L., Goldstein, B. A., Green, J., Herkert, D., Howard, J., Reed, A., Spanos, M., & Dawson, G. (2024) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-024-06582-1
Myers, S. M., & Challman, T. D. (2024) · Elsevier eBooks · doi:10.1016/b978-0-12-824060-1.00038-9
Liz, G. P., Thao, D., Reeb, K. L., Goy, I., McCurdy, E. E., Yudell, M., & Robins, D. L. (2025) · Focus on Autism and Other Developmental Disabilities · doi:10.1177/10883576241308544
Flanagan, A. Y., Hill, T. L., Childs, M., Wozniak-Kelly, S. N., Guthrie, W., & Wallis, K. E. (2026) · Journal of Developmental & Behavioral Pediatrics · doi:10.1097/dbp.0000000000001459
WenXu, Y. A. N. G., Zhang, Y., Yang, P., Zhao, C., DU, C., He, J., Cao, Y., Shang, J., Li, L., Liu, Y., et al. (2026) · Frontiers in Public Health · doi:10.3389/fpubh.2026.1758181
Liz, G. P., Wieckowski, A. T., Austin, A., Dickerson, A. F., Frick, E., Dubin, A. H., de Marchena, A. B., & Robins, D. L. (2026) · Behavioral Sciences · doi:10.3390/bs16020289
AlShammari, R. Z., & Almuraisel, M. A. (2026) · BMC Pediatrics · doi:10.1186/s12887-026-06721-w
Stress and Satisfaction in the Diagnostic Process
Lynch, J., Holliday, E. L., Stanley, H. C., Fodstad, J. C., & Minshawi, N. F. (2026) · Autism and child psychopathology series · doi:10.1007/978-3-032-11802-8_4
Universal Autism Screening in Early Learning Programs: A Feasibility Study
Dumont-Mathieu, T. M., Barton, M. L., Chuckta, R., Martinez, N. S., & FEIN, D. A. (2026) · Children · doi:10.3390/children13060775
Demographics, Etiology, and Clinical Presentation
(2026) · American Academy of PediatricsItasca, IL eBooks · doi:10.1542/9781610028844-ch2
Establishing the Autism Diagnosis
(2026) · American Academy of PediatricsItasca, IL eBooks · doi:10.1542/9781610028844-ch6
Primary Care Autism Assessment Training Program Pilot Trial
Lindly, O. J., Gorgas, C., Gooding, L., Blankenship, L., Martin, A. J., Vega-Juárez, R. A., Zuckerman, K. E., & Freeman, K. A. (2026) · Autism · doi:10.1177/13623613261457950
de Marchena, A. B., Wieckowski, A. T., Dickerson, A. F., Cheng, H. S., Liz, G. P., Dubin, A. H., Vivanti, G., Barton, M. L., FEIN, D. A., & Robins, D. L. (2026) · Autism · doi:10.1177/13623613261464200
Kilmer, M., Patton, S. K., Randolph, D., Manges, K., Milone, G., & Pamungkas, L. (2026) · Journal of the American Association of Nurse Practitioners · doi:10.1097/jxx.0000000000001334
Bevan, S. L., Dai, Y., & Liu, J. (2026) · The Journal of School Nursing · doi:10.1177/10598405261473669
Abbas, K., Steingass, K. J., Abrams, M. A., Brown, C. M., Levine, A., Klamer, B. G., & Barnhardt, E. W. (2026) · Journal of Developmental & Behavioral Pediatrics · doi:10.1097/dbp.0000000000001512
Muthuka, J. K., Wanjiku, L. N., Onyango, C., Oluoch, K., Kioko, M., Maluki, J., Nzioki, J. M., & Kim, S. (2026) · Cureus · doi:10.7759/cureus.117972
Metadata
- 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
- 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
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
