Autism Spectrum Disorder Screening and Management Practices Among General Pediatric Providers

Division of Child and Adolescent Psychiatry, Johns Hopkins University School of Medicine, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21287, USA.
Journal of Developmental & Behavioral Pediatrics (Impact Factor: 2.13). 05/2006; 27(2 Suppl):S88-94. DOI: 10.1097/00004703-200604002-00006
Source: PubMed


It is unclear to what extent general developmental/behavioral assessments are performed, if screening for autism spectrum disorders (ASDs) is being conducted, and what the barriers to providing such assessments are in routine pediatric practice. Therefore, this study examines (1) the factors influencing the use of general developmental and autism-specific screening tools in primary care pediatric practice, (2) the barriers to providing these assessments, and (3) pediatricians' beliefs regarding ASD prevalence. A cross-sectional survey was mailed in June 2004 to a 60% (n = 1119) random sample of Maryland and Delaware licensed pediatricians. In August 2004, a second mailing was sent to non-respondents. A total of 471 (42%) of the surveys were returned, and of those, 255 (54%) who practiced in general primary care were eligible. The sample was 47% male, 69% had more than 14 years' experience, 71% were in private practices, and 56% had fewer than 10 ASD patients. Most (82%) routinely screened for general developmental delays, but only 8% screened for ASD. The main reasons reported for not screening for ASD were lack of familiarity with tools (62%), referred to a specialist (47%), or not enough time (32%). Most specialist referrals (77%) were to a developmental pediatrician. Most pediatricians (71%) believed that ASD prevalence has increased, and nearly all attributed this to changes in diagnostic criteria and treatment. Service system limitations must be overcome to increase awareness and familiarity with screening tools, provide sufficient time and resources, improve screening, and enhance provider education.

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Available from: Susan Dosreis, Jul 12, 2015
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    • "The core symptoms consist of reduced language skills and social interaction, as well as the presence of repetitive and stereotypic behaviors (American Psychiatric Association, 2013; Weitlauf et al., 2014). In contrast, secondary symptoms include complications such as self-injury, hyperactivity, aggression, and co-occurring psychiatric disorders such as anxiety and major depression (Dosreis et al., 2006; Kaat et al., 2013; Kim et al., 2011). These symptoms often change depending on the age of the affected individual. "
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    ABSTRACT: Autism spectrum disorder (ASD) is a set of neurodevelopmental disorders that is among the most severe in terms of prevalence, morbidity and impact to the society. It is characterized by complex behavioral phenotype and deficits in both social and cognitive functions. Although the exact cause of ASD is still not known, the main findings emphasize the role of genetic and environmental factors in the development of autistic behavior. Environmental factors are also likely to interact with the genetic profile and cause aberrant changes in brain growth, neuronal development, and functional connectivity. The past few years have seen an increase in the prevalence of ASD, as a result of enhanced clinical tests and diagnostic tools. Despite growing evidence for the involvement of endogenous biomarkers in the pathophysiology of ASD, early detection of this disorder remains a big challenge. This paper describes the main behavioral and cognitive features of ASD, as well as the symptoms that differentiate autism from other developmental disorders. An attempt will be made to integrate all the available evidence which point to reduced brain connectivity, mirror neurons deficits, and inhibition-excitation imbalance in individuals with ASD. Finally, this review discusses the main factors involved in the pathophysiology of ASD, and illustrates some of the most important markers used for the diagnosis of this debilitating disorder. Copyright © 2015. Published by Elsevier Ltd.
    International journal of developmental neuroscience: the official journal of the International Society for Developmental Neuroscience 04/2015; 43. DOI:10.1016/j.ijdevneu.2015.04.003 · 2.58 Impact Factor
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    • "Studies from the United States (US) have identified practitioner barriers to the US system of ‘well-child care.’ These include knowledge gaps, lack of confidence using validated tools [14,15], insufficient understanding of early intervention [16] (which hinders detection of developmental delays), inadequate office staff and poor remuneration [12]. For parents in Australia, our previous research showed that parent decision-making around accessing preventive care for their children was influenced by the birth order of the child, cultural health beliefs, healthcare costs, and limited knowledge about early intervention [17]. "
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    ABSTRACT: Background More than a fifth of Australian children arrive at school developmentally vulnerable. To counteract this, the Healthy Kids Check (HKC), a one-off health assessment aimed at preschool children, was introduced in 2008 into Australian general practice. Delivery of services has, however, remained low. The Theoretical Domains Framework, which provides a method to understand behaviours theoretically, can be condensed into three core components: capability, opportunity and motivation, and the COM-B model. Utilising this system, this study aimed to determine the barriers and enablers to delivery of the HKC, to inform the design of an intervention to promote provision of HKC services in Australian general practice. Methods Data from 6 focus group discussions with 40 practitioners from general practices in socio-culturally diverse areas of Melbourne, Victoria, were analysed using thematic analysis. Results Many practitioners expressed uncertainty regarding their capabilities and the practicalities of delivering HKCs, but in some cases HKCs had acted as a catalyst for professional development. Key connections between immunisation services and delivery of HKCs prompted practices to have systems of recall and reminder in place. Standardisation of methods for developmental assessment and streamlined referral pathways affected practitioners’ confidence and motivation to perform HKCs. Conclusion Application of a systematic framework effectively demonstrated how a number of behaviours could be targeted to increase delivery of HKCs. Interventions need to target practice systems, the support of office staff and referral options, as well as practitioners’ training. Many behavioural changes could be applied through a single intervention programme delivered by the primary healthcare organisations charged with local healthcare needs (Medicare Locals) providing vital links between general practice, community and the health of young children.
    Implementation Science 05/2014; 9(1):60. DOI:10.1186/1748-5908-9-60 · 4.12 Impact Factor
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    • "Reported rates of developmental screening by pediatricians using validated screening tools vary widely (Bethell et al., 2011; Zuckerman et al., 2013). Even when pediatricians report screening for developmental delays, few screen specifically for ASD (Dosreis et al., 2006), and autism screening instruments are neither widely nor systematically used in pediatric practices or early intervention programs (Sices, 2007). "
    2013 International Meeting for Autism Research; 05/2013
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