Research Review: ASD Screening and Referral Guidelines

Welcome back to another episode on “what the AUTISM?!” This podcast is for anyone who is struggling with understanding what autism is and how we can better empower our autism community through research proven methods. In each episode, I will be sharing with you ground-breaking research and how the diagnosis of autism can often be misunderstood. If you are a new listener to our podcast, I highly recommend you start from episode 1 to catch you up to speed on various terminology and concepts! Now let’s get started…

Today I wanted to talk about a research article that was published back in May 2020. It’s titled “Adherence to Screening and Referral Guidelines for Autism Spectrum Disorder in Toddlers in Pediatric Primary Care.” If you would like to follow along while listening to the podcast or if you’d like to review this study at another time, I have left a PDF file of this research study on our Facebook page. 

But the objective of this study was to identify and study the various factors that are associated with doctors/physicians completing a follow-up interview and referring families to the appropriate next step in services after the initial screening for autism. The American Academy of Pediatrics (also referred to as AAP) recommends that all young children are screened for the autism spectrum disorder (ASD) during their regular check ups with their pediatrician. But a common concern that has been discussed is the disparities in the ASD diagnosis and intervention across children of minority. This research study goes into depth on some potential contributors and some possible things to consider when we discuss the diagnosing of autism and the immediate next steps taken by physicians in their recommendations and referrals.

Prior studies that examined referrals after developmental screening suggest that patient characteristics such as race, ethnicity, or gender may influence physicians’ responses. One specific study which I’ll also include on our facebook page, found that a girl with language delays was 60% more likely than a boy with similar symptoms to audiology. Among a sample of very-low-birthweight infants who are eligible for early intervention services, referrals were much lower among children of black mothers, mothers without private insurance, or from towns with higher poverty rates. 

So in today’s research study, the researchers examined a group of children with positive results in their screening to estimate rates of completion of follow up interviews and the physicians’ adherence to AAP guidelines in referring patients to early intervention services, audiology, and/or for an ASD evaluation immediately. In this particular study, the screening that was provided was a M-CHAT-F which is a parent-report tool that involves 23 "yes/no" questions about a child’s behaviors to determine their risk of ASD. There is also a SWYC Milestones questionnaires that includes 10 age-specific questions to evaluate children’s attainment of motor, cognitive, and language skills. As part of routine care, caregivers completed both of these questionnaires and screening measures on an electronic tablet or through an electronic patient portal prior to their visitation with their physician. I won’t dig too far into the specific methods and measurements, but I did want to review the results of this study with you for us to have some type of dialogue of what this could mean for your child if you are questioning potential diagnosis of autism. 

The results of this study found that there are multiple factors associated with increased likelihood of follow-up interviews being completed. The research study includes very easy charts and tables that break down the various factors, such as ethnicities, genders, etc and the percentage of each population group that are provided with follow up interviews.

From this study, researchers found that despite a high rate of screening across pediatric primary care, the level of adherence to guidelines for completing the follow-up interview and immediate referral once a child tests positive on the M-CHAT-F screening could be improved. Also, an important area to note is that when high-risk patients were provided follow-up interviews, various studies have found a substantial percentage of these patients to be formally diagnosed with ASD. So this comes to show how important these follow-up interviews are in getting a child diagnosed with ASD and referred to services immediately. 

The various results of this study show that clinical judgment plays a role in who received follow-up interviews post the initial screening. While only 10% of children who were administered the follow-up interview continued to screen positive for autism, we cannot assume the same proportion would hold true for children who were not administered the follow-up interview. 

With all these various results and comparisons across ethnicity, gender, insurance types, etc, it’s safe to say that the level of follow-up post any initial screenings for ASD completed by physicians reveal a level of bias and discrepancy. Now what does this mean for you the parents?

I would like to urge all of our parents as you are preparing yourself and your child for visitations with the pediatric doctor/physician, that you are understanding this level of bias. The initial screening method is a way for the doctor to determine the level of risk that your child may be facing for the autism diagnosis. Choose into follow-ups and ask questions about recommendations about early intervention services and audiology services. If you’re having even a small percentage of suspicion that your child may have autism, get a formal diagnostic evaluation completed. Pediatric physicians are all extremely knowledgable in what your child may need to be most successful in their development; however, this study that we reviewed today reveals that clinical judgment of these physicians play a key role in early discovery and screening of ASD. It’s always important to question and be informed as you meet with your child’s physician. 

Ending: But this concludes another episode here at What the Autism. If you have any specific questions or concerns you’d like me to cover, please reach out to us through any platform. Our facebook page and instagram handle is @whattheautism and our email address is whattheautismpodcast@gmail.com. We upload a new episode on your favorite podcast platform every Wednesday. Please note that this podcast has been created to discuss my personal experiences and opinions and is not a means of medical or psychological recommendations. 

But If you enjoyed this podcast, please make sure to follow and subscribe to our podcast channel and I’ll see you in episode 12.