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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.
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“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
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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
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