ECHO Autism STAT: Accelerating Early Access to Autism Diagnosis

Abstract

Although early diagnosis of autism is critical for promoting access to early intervention, many children experience significant diagnostic delays. Shortages of healthcare providers, limited capacity at autism centers, and geographic and socioeconomic challenges contribute to these delays. The current pilot study examined the feasibility of a new model for training community-based primary care providers (PCPs) in underserved areas in screening and diagnosis of young children at highest risk for autism. By combining hands-on training in standardized techniques with ongoing virtual mentorship and practice, the program emphasized both timely diagnosis and appropriate referral for more comprehensive assessment when necessary. Results indicated improvements in PCP practice and self-efficacy, and feasibility of the model for enhancing local access to care.

Commentary: Embracing innovation is necessary to improve assessment and care for individuals with ASD: a reflection on Kanne and Bishop (2020)

“…Differential diagnosis of ASD is complex, but arguably, not equally complex across the continuum of children identified for assessment. In fact, there is a growing empirical literature supporting the accuracy and potential benefit of professional triage of cases based on complexity (i.e., apparent clarity of symptoms) including models utilizing community‐pediatrician leads (Mazurek et al, 2019; Swanson et al, 2014), brief targeted consultation by expert behavioral providers embedded within primary care settings (Hine et al, 2019), telehealth supported models (Stainbrook et al, 2019), and risk‐based models informed by ASD screening with in early intervention systems (Rotholz et al, 2017). Consistently, there appears to be a sizeable portion of young children for whom marked social communication impairments and restrictive and repetitive behaviors clearly indicative of ASD can be accurately recognized in a variety of community settings.…”

“…Consistently, there appears to be a sizeable portion of young children for whom marked social communication impairments and restrictive and repetitive behaviors clearly indicative of ASD can be accurately recognized in a variety of community settings. In addition, these novel assessment models may be quite capable of identifying children who ultimately need more specialized assessments to resolve ambiguity, identified either on review of the initial referral or following a community evaluation (Hine et al, 2020; Mazurek et al, 2019). In these contexts, such expert evaluation can represent an important ‘safety net’ that can mitigate against misclassification.…”

Artificial intelligence for precision medicine in neurodevelopmental disorders

“…As such, early diagnosis and targeted therapeutic interventions to those who are most likely to benefit are universally agreed public health priorities. 16,17…”

A Statewide Tiered System for Screening and Diagnosis of Autism Spectrum Disorder

“…A second strategy for decreasing the age of ASD diagnosis is to improve access to diagnostic evaluations. The field has seen an emergence of promising research on training primary care providers (PCPs), [22][23][24][25] embedding behavioral health providers in primary care, 26,27 and using telemedicine-based diagnostic procedures. 28,29 Many studies employ an evaluation model in which diagnosis is based on developmental history as well as administration of the Screening Tool for Autism in Toddlers and Young Children (STAT), 30 a level 2 ASD screening measure.…”