Barriers to autism screening in family medicine practice: a qualitative study

Abstract

Participants had differing views on the increased incidence of autism. Most participants attributed the increase to changes in diagnostic criteria. There was no consensus on the benefit of implementing universal screening for autism during the 18- or 24-month visit. Many preferred to identify potential problems through general developmental assessments and observations. No participants used specific screening tools for autism, and only one participant was aware of such a tool (M-CHAT). Lack of adequate training on child development and screening methods as well as limited availability of community-based resources to manage children with autism was seen as major barriers to routine screening. Suggested solutions included working toward a stronger evidence base, improving physician training and continuing education, and making systemic changes in healthcare. In conclusion, universal screening for autism at the 18- and 24-month visits is not widely accepted, nor is it implemented by family physicians.

Promoting Optimal Development: Identifying Infants and Young Children With Developmental Disorders Through Developmental Surveillance and Screening

“…9,21,[85][86][87][88][89][90][91][92] However, in one study, rates of screening in family medicine practices for ASD have been reported to be lower. 94 Feasibility and effectiveness of parent-report screening tools also have been verified. 9,21,86,88 However, despite the success of screening, a few studies have shown that rates of referral to early intervention were good but not universal, and referrals to specialists were low.…”

Whittling Down the Wait Time

“…8,9 There are multiple factors that account for the more than the 2-year difference between earliest signs to diagnosis that may delay entry into early intervention (EI) programs. These barriers, which include time-consuming evaluations, 10 cost of care, 11 lack of providers, 12 lack of comfort in diagnosing by primary care providers, 12 and other challenges, each require different approaches in order to begin to close this gap.…”

Diagnosis lost: Differences between children who had and who currently have an autism spectrum disorder diagnosis

“…The high percentage of children in the present study who lost an ASD diagnosis because it was changed (73.5% of 13.1%, or over 9% of all school-aged CSHCN ever diagnosed with ASD) suggests overdiagnosis may be more common in this population than expected. Overdiagnosis could be the result of difficulty distinguishing children with ASD from children who possess language delays or global developmental delays (Lord, 1995) and because variability in the quality of screening and evaluation practices confound diagnostic precision (Fenikile et al, 2014). …”