How Do Primary Care Physicians Identify Young Children with Developmental Delays? A National Survey

Sices, Laura; Feudtner, Chris; McLaughlin, John F.; Drotar, Dennis; Williams, Michelle

doi:10.1097/00004703-200312000-00002

Cited by 144 publications

(124 citation statements)

References 23 publications

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“…A number of studies suggest that more physicians rely on clinical judgment or a few questions more than on standardized measures. [46][47][48][49][50] Unless validated measures are implemented in a reliable manner, it may be more effective for physicians to rely on parental concern as a measure of need. 51,52 Limitations A number of study limitations should be considered.…”

Section: Discussionmentioning

confidence: 99%

Factors Associated With Age of Diagnosis Among Children With Autism Spectrum Disorders

2005

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Objective-Early diagnosis of children with autism spectrum disorders (ASD) is critical but often delayed until school age. Few studies have identified factors that may delay diagnosis. This study attempted to identify these factors among a community sample of children with ASD.Methods-Survey data were collected in Pennsylvania from 969 caregivers of children who had ASD and were younger than 21 years regarding their service experiences. Linear regression was used to identify clinical and demographic characteristics associated with age of diagnosis.Results-The average age of diagnosis was 3.1 years for children with autistic disorder, 3.9 years for pervasive developmental disorder not otherwise specified, and 7.2 years for Asperger's disorder. The average age of diagnosis increased 0.2 years for each year of age. Rural children received a diagnosis 0.4 years later than urban children. Near-poor children received a diagnosis 0.9 years later than those with incomes >100% above the poverty level. Children with severe language deficits received a diagnosis an average of 1.2 years earlier than other children. Hand flapping, toe walking, and sustained odd play were associated with a decrease in the age of diagnosis, whereas oversensitivity to pain and hearing impairment were associated with an increase. Children who had 4 or more primary care physicians before diagnosis received a diagnosis 0.5 years later than other children, whereas those whose pediatricians referred them to a specialist received a diagnosis 0.3 years sooner.Conclusion-These findings suggest improvements over time in decreasing the age at which children with ASD, especially higher functioning children, receive a diagnosis. They also suggest a lack of resources in rural areas and for near-poor families and the importance of continuous pediatric care and specialty referrals. That only certain ASD-related behaviors, some of which are not required to satisfy diagnostic criteria, decreased the age of diagnosis suggests the importance of continued physician education.Early diagnosis of autism spectrum disorders (ASD) is critical for a number of reasons, 1, 2 perhaps most important because interventions to improve the functioning of children with ASD may be more effective with younger children.3 -6 Evidence suggests that early treatment optimizes long-term prognosis, 7 and treatment yields diminishing returns as children get older. 8 Several studies have estimated that the gains in functioning associated with early treatment will result in considerable cost savings to both families of children with ASD and the systems in which they are served. [9][10][11]

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Section: Discussionmentioning

confidence: 99%

Factors Associated With Age of Diagnosis Among Children With Autism Spectrum Disorders

2005

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“…Physician estimates of the developmental status of children are much less accurate when only clinical impressions, rather than formal screening tools, are used, 256,257 yet a minority of PCPs use formal developmental screening instruments, 258,259 and few pediatricians specifically screen for ASDs. 5 A standardized screening tool should be administered at any point when concerns about ASDs are raised spontaneously by a parent or as a result of clinician observations or surveillance questions about social, communicative, and play behaviors (Steps 5a and 5b).…”

Section: Screening For Asds (Steps 5a-5c)mentioning

confidence: 99%

Identification and Evaluation of Children With Autism Spectrum Disorders

Johnson

Myers²

2007

Pediatrics

1,660

1,038

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Autism spectrum disorders are not rare; many primary care pediatricians care for several children with autism spectrum disorders. Pediatricians play an important role in early recognition of autism spectrum disorders, because they usually are the first point of contact for parents. Parents are now much more aware of the early signs of autism spectrum disorders because of frequent coverage in the media; if their child demonstrates any of the published signs, they will most likely raise their concerns to their child's pediatrician. It is important that pediatricians be able to recognize the signs and symptoms of autism spectrum disorders and have a strategy for assessing them systematically. Pediatricians also must be aware of local resources that can assist in making a definitive diagnosis of, and in managing, autism spectrum disorders. The pediatrician must be familiar with developmental, educational, and community resources as well as medical subspecialty clinics. This clinical report is 1 of 2 documents that replace the original American Academy of Pediatrics policy statement and technical report published in 2001. This report addresses background information, including definition, history, epidemiology, diagnostic criteria, early signs, neuropathologic aspects, and etiologic possibilities in autism spectrum disorders. In addition, this report provides an algorithm to help the pediatrician develop a strategy for early identification of children with autism spectrum disorders. The accompanying clinical report addresses the management of children with autism spectrum disorders and follows this report on page 1162 [available at www.pediatrics.org/cgi/content/full/120/5/1162]. Both clinical reports are complemented by the toolkit titled “Autism: Caring for Children With Autism Spectrum Disorders: A Resource Toolkit for Clinicians,” which contains screening and surveillance tools, practical forms, tables, and parent handouts to assist the pediatrician in the identification, evaluation, and management of autism spectrum disorders in children.

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“…This delay may be due to inadequate screening practices (Dearlove & Kearney, 1990;Dobos, Dworkin, & Bernstein, 1994;Sices, Feudtner, McLaughlin, Drotar, & Williams, 2003), pediatricians' slow response to parental concerns (Glascoe, 1997;Shevell, Majnemer, Rosenbaum, & Abrahamowicz, 2001), the low sensitivity of screening instruments for autism (Dumont-Mathieu & Fein, 2005), and a general lack of awareness of symptoms (Shah, 2001). Some researchers have suggested that the similarity of the features of autism with other disorders can lead to misdiagnosis Noterdaeme, Amorosa, Mildenberger, Sitter, & Minow, 2001;Ohta, Nagai, Hara, & Sasaki, 1987).…”

mentioning

confidence: 99%

Disparities in Diagnoses Received Prior to a Diagnosis of Autism Spectrum Disorder

Mandell

Ittenbach

Levy

et al. 2006

J Autism Dev Disord

358

224

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This study estimated differences by ethnicity in the diagnoses assigned prior to the diagnosis of autism. In this sample of 406 Medicaid-eligible children, African-Americans were 2.6 times less likely than white children to receive an autism diagnosis on their first specialty care visit. Among children who did not receive an autism diagnosis on their first visit, ADHD was the most common diagnosis. African-American children were 5.1 times more likely than white children to receive a diagnosis of adjustment disorder than of ADHD, and 2.4 times more likely to receive a diagnosis of conduct disorder than of ADHD. Differences in diagnostic patterns by ethnicity suggest possible variations in parents' descriptions of symptoms, clinician interpretations and expectations, or symptom presentation.

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How Do Primary Care Physicians Identify Young Children with Developmental Delays? A National Survey

Cited by 144 publications

References 23 publications

Factors Associated With Age of Diagnosis Among Children With Autism Spectrum Disorders

Factors Associated With Age of Diagnosis Among Children With Autism Spectrum Disorders

Identification and Evaluation of Children With Autism Spectrum Disorders

Disparities in Diagnoses Received Prior to a Diagnosis of Autism Spectrum Disorder

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