Role of Primary Care Clinician Concern During Screening for Early Identification of Autism.
Andrea Trubanova Wieckowski, Riane K Ramsey, Kirsty Coulter and 5 others
PMID 38564788WHAT IT FOUND
When both the autism screener and the clinician's own concern flagged a toddler, families were much more likely to attend the diagnostic evaluation.
Screening alone caught nearly half the autism cases, so do not skip referrals just because you lack a specific concern.
Key findings
01Families were significantly more likely to attend a diagnostic evaluation if both the screener and the clinician indicated high likelihood of autism (69.93%) compared to when only one method flagged the child (39.01% or 37.31%).
02Screening alone detected nearly half of the autism cases in the study, meaning clinicians should refer for evaluation when screeners indicate concerns even if they do not have their own clear autism concern.
03Clinicians were more likely to note concerns for children with more obvious autism characteristics, whereas the screener identified cases across the full spectrum of severity.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
Only 46% of the children identified as high likelihood attended the diagnostic evaluation, so the accuracy of the screening methods (positive predictive value) may be biased toward those who did attend. In the study where reporting concerns was optional, some clinicians left the field blank, making it unclear if they had no concern or simply forgot to report it. The study used a no-cost evaluation with prompt scheduling, which removes common barriers like cost and waitlists. Real-world attendance rates may be lower. The analysis combined two studies with slightly different protocols regarding how clinicians were asked to report concerns.
Declared interests
The authors declared no conflicts of interest. The work was supported by the National Institute of Health (N.I.H.).
The easy way to misread this
Do not assume that a negative screener means you can ignore your own clinical suspicion, nor that a positive screener requires your personal agreement to refer. The data shows that screening and clinician concern catch different subsets of children, and relying on only one method misses a significant number of autism cases.