The diagnosis of autism in community pediatric settings: does advanced training facilitate practice change?

The increased prevalence of autism spectrum disorder and documented benefits of early intensive intervention have created a need for flexible systems for determining eligibility for autism-specific services. This study evaluated the effectiveness of a training program designed to enhance autism spectrum disorder identification and assessment within community pediatric settings across the state. Twenty-seven pediatric providers participated in regional trainings across a 3.5-year period. Trainings provided clinicians with strategies for conducting relatively brief within-practice interactive assessments following positive autism spectrum disorder screenings. Program evaluation was measured approximately 1.5 years following training through (a) clinician self-reports of practice change and (b) blind diagnostic verification of a subset of children assessed. Pediatric providers participating in the training reported significant changes in screening and consultation practices following training, with a reported 85% increase in diagnostic identification of children with autism spectrum disorder within their own practice setting. In addition, substantial agreement (86%-93%) was found between pediatrician diagnostic judgments and independent, comprehensive blinded diagnostic evaluations. Collaborative training methods that allow autism spectrum disorder identification within broader community pediatric settings may help translate enhanced screening initiatives into more effective and efficient diagnosis and treatment.

A training model for the diagnosis of autism in community pediatric practice.

OBJECTIVE: Early diagnosis of autism spectrum disorders (ASD) currently represents a critical public health and clinical practice issue. Waits for diagnostic services are quite lengthy and hinder the start of early intervention services thought to be crucial for optimizing functional developmental outcomes for children and their families. In this study, we present data from a newly developed training program (Screening Tools and Referral Training-Evaluation and Diagnosis training) designed to help pediatricians diagnose young children with ASD in the context of traditional community practice settings. METHODS: A small, targeted group of community pediatricians participated in an intensive training, conducted specialized ASD evaluations within their own practices, and then referred a consecutive series of children to a medical center diagnostic clinic for an independent assessment of ASD. CONCLUSION: Results of this small pilot study indicate good agreement (71%) between pediatrician judgments and independent diagnostic ASD evaluations, but a significant trend toward overidentification when a diagnostic decision is forced. We discuss the implications of this study with regard to revisiting traditional service models of diagnostic assessment for young children with ASD.