What Drives Detection and Diagnosis of Autism Spectrum Disorder? Looking Under the Hood of a Multi-stage Screening Process in Early Intervention.
R Christopher Sheldrick, Elizabeth Frenette, Juan Diego Vera and 6 others
PMID 30726534WHAT IT FOUND
Referring children for autism assessment based on provider or parent concern, even when screening scores are negative, found more diagnoses per staff hour than relying on positive scores alone.
Concern was the stronger driver of engagement and diagnosis than the test results.
Key findings
01Pathways using concern alone (Path B) yielded more diagnoses per staff hour than pathways using positive screening scores alone (Path C).
02In survival analysis, provider concern and provider perception of parent concern were statistically significant predictors of completing stage 2 screening, while a positive screen alone was not.
03Providers reported that lack of parental concern was the most common reason for families not continuing with the screening process.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
The study population consisted of children already enrolled in Early Intervention, meaning they were already at higher risk for developmental delays; results may not generalize to general pediatric populations. Concern was measured using single questions completed by the EI provider, which may not fully capture the nuance of parental or provider concern. The study did not track children who did not complete the process, so it cannot determine if missed diagnoses occurred due to false negatives. Cost analysis was based on Medicaid reimbursement rates and estimated staff time, which may not reflect the true cost or resource availability in other clinical settings.
Declared interests
The authors declare no conflicts of interest. The study was funded by the National Institute of Mental Health and the National Institute on Deafness and Other Communication Disorders.
The easy way to misread this
Do not interpret the higher diagnosis yield in the 'concern only' group as evidence that screening tools are ineffective. The study was designed to evaluate a combined protocol where screening and judgment worked together, not to test the accuracy of the tools in isolation.