Primary Care Autism Screening with the Parent's Observations of Social Interactions.

The study used electronic health records, so paper referrals or autism diagnoses that were not coded may have been missed. Not all children with a positive screen were referred or evaluated, so the screen's ability to find autism could be affected by clinician judgment and access to diagnosis. The autism outcome required an autism code and then chart confirmation; only 80% of children with an autism code were confirmed, and children without an autism code were not counted as having autism. Follow-up ran through September 11, 2024, when children were 42 to 107 months old, so diagnoses made after that point would not be counted. The cohort was mostly non-Hispanic White and commercially insured, so the findings may not apply equally to other populations. Provider and clinic practice patterns affected referral decisions, so results may not generalize to other health care systems. Because the study was retrospective and observational, it shows association, not that the POSI caused earlier diagnosis.

Do not treat a positive POSI screen as a confirmed autism diagnosis. Only 9.2% of children with a positive screen were later diagnosed, and only 21.6% of children with a positive screen were referred for developmental evaluation.