Building Capacity for Community Pediatric Autism Diagnosis: A Systemic Review of Physician Training Programs.
Xiaoning Guan, Lonnie Zwaigenbaum, Lyn K Sonnenberg
PMID 34907998WHAT IT FOUND
Six small, low-quality studies suggest trained pediatricians can match expert autism diagnosis 71 to 100% of the time and cut wait times by about half.
The authors say the evidence is too thin to recommend any specific training approach.
Key findings
01Five of the six studies found that training primary care providers in autism diagnosis cut the wait time to see a diagnostician by roughly half compared with waiting for a specialist team.
02Four of the six studies found that trained primary care providers agreed with blinded expert teams on whether a child had autism 71 to 100% of the time, though none of these figures were adjusted for chance agreement.
03The authors state there is insufficient evidence from these six studies to draw conclusions about the effects of primary care provider training in autism diagnosis or to recommend one training approach over another.
STILL TO COME
How it was doneWhat they found
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What it does not show
All six included studies were rated fair to poor in methodological quality. None used a randomized design, and none took steps to ensure the training was delivered consistently across sessions. Sample sizes were very small: 1 to 27 providers and 14 to 91 children per study. In the accuracy comparisons, only a subset of assessed children was included in the analysis, and in three of four studies the criteria for selecting which children to include were not reported. The training programs differed so much in format, duration, content, and setting that the review could not compare them or combine their data. The studies spanned the transition from DSM-IV to DSM-5 diagnostic criteria, making it harder to compare what the providers were actually being asked to diagnose. The authors state explicitly that the evidence is insufficient to draw conclusions about the effects of primary care provider training or to recommend one approach over another.
Declared interests
The authors declare no conflict of interest.
The easy way to misread this
Do not read the 71 to 100% diagnostic agreement as proof that primary care provider training reliably produces accurate autism diagnoses. All six studies were nonrandomized with small samples, the agreement figures were not adjusted for chance, and the authors state the evidence is insufficient to draw conclusions or recommend any specific training approach.
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