Embedding Autism Spectrum Disorder Diagnosis Within the Medical Home: Decreasing Wait Times Through Streamlined Assessment
Long waits for diagnostic assessment prevent early identification of children suspected of having autism spectrum disorder. We evaluated the benefit of embedded diagnostic consultation within primary care clinics. Using a streamlined diagnostic model, 119 children with concerns for autism spectrum disorder were seen over 14 months. Diagnostic clarity was determined through streamlined assessment for 59% of the children, while others required follow-up. Latency from first concern to diagnosis was 55 days and median age at diagnosis was 32 months: considerably lower than national averages or comparable tertiary clinics. Findings support that embedded processes for effective triage and diagnosis within the medical home is a viable mechanism for efficient access to diagnostic services and assists in bypassing a common barrier to specialized services.
KeywordsAutism spectrum disorder Diagnosis Screening Medical home Primary care
This project was completed with support from the Katherine Dodd Faculty Scholars Program in the Department of Pediatrics at Vanderbilt University Medical Center, support from the Vanderbilt Kennedy Center Eunice Kennedy Shriver National Institute of Child Health and Human Development Intellectual and Developmental Disabilities Center U54 HD08321, as well as support from the Vanderbilt University Medical Center CTSA award No. UL1TR000445 from the National Center for Advancing Translational Sciences. Contents are solely the responsibility of the authors and do not necessarily represent official views of any funding agency.
JFH, CGH, AMR, RLM, BLP, KLC, and ZEW conceived of the study and participated in aquisition of data. JFH, AMR, RLM, BLP, KLC, and ZEW provided oversight of study implementation across Vanderbilt sites. JFH, CGH, and ZEW helped design and implement the rapid diagnostic procedure and assisted with data collection and analysis for manuscript preparation. JFH and ZEW significantly participated in drafting the article. All authors revised it critically and provided final approval of the manuscript. All authors are in agreement with accountability for all aspects of the work.
Compliance with Ethical Standards
Conflict of interest
The authors declare that they have no conflict of interest.
- Christensen, D. L., Bilder, D. A., Zahorodny, W., Pettygrove, S., Durkin, M. S., Fitzgerald, R. T., et al. (2016). Prevalence and characteristics of autism spectrum disorder among 4-year-old children in the autism and developmental disabilities monitoring network. Journal of Developmental & Behavioral Pediatrics, 37(1), 1–8.CrossRefGoogle Scholar
- Foss-Feig, J., & Stone, W. L. (2007). Use of the STAT as an autism screen for children 36–47 months. Paper presented at the International Meeting for Autism Research (IMFAR), Seattle, WA.Google Scholar
- Juàrez, A. P., Weitlauf, A. S., Nicholson, A., Pasternak, A., Broderick, N., Hine, J. F., Stainbrook, J. A., & Warren, Z. (2018). Early identification of ASD through telemedicine: Potential value for underserved populations. Journal of Autism and Developmental Disorders. https://doi.org/10.1007/s10803-018-3524-y.PubMedGoogle Scholar
- Lord, C., Rutter, M., DiLavore, P., Risi, S., Gotham, K., & Bishop, S. (2012). Autism diagnostic observation schedule (ADOS-2), (2nd ed.). Los Angeles, CA: Western Psychological Corporation.Google Scholar
- Macari, S. L., Campbell, D., Gengoux, G. W., Saulnier, C. A., Klin, A. J., & Chawarska, K. (2012). Predicting developmental status from 12 to 24 months in infants at risk for autism spectrum disorder: A preliminary report. Journal of Autism and Developmental Disorders, 42(12), 2636–2647.CrossRefPubMedPubMedCentralGoogle Scholar
- Ozonoff, S., Iosif, A. M., Baguio, F., Cook, I. C., Hill, M. M., Hutman, T., et al. (2010). A prospective study of the emergence of early behavioral signs of autism. Journal of the American Academy of Child & Adolescent Psychiatry, 49(3), 256–266.Google Scholar
- Schopler, E., Van Bourgondien, M. E., Wellman, G. J., & Love, S. R. (2010). The childhood autism rating scale, (CARS2). Los Angeles: WPS.Google Scholar
- Voress, J. K., & Maddox, T. (2013). Developmental assessment of young children: DAYC-2. Los Angeles: Pro-Ed.Google Scholar
- Wetherby, A. M., Lord, C., Wood, J., Pierce, K., Shumway, S., Thurm, A., et al. (2009, May). The Early Screening for Autism and Communication Disorders: Preliminary field-testing of an autism-specific screening tool for children 12 to 36 months of age. Paper presented at the International Meeting for Autism Research (IMFAR), Chicago, IL.Google Scholar