592607

research-article2015

CPJXXX10.1177/0009922815592607Clinical PediatricsMonteiro et al

Original Article

Prevalence of Autism Spectrum Disorder in Children Referred for Diagnostic Autism Evaluation

Clinical Pediatrics 1­–6 © The Author(s) 2015 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/0009922815592607 cpj.sagepub.com

Sonia A. Monteiro, MD1, Adiaha Spinks-Franklin, MD1, Diane Treadwell-Deering, MD1, Leandra Berry, PhD1, Sherry Sellers-Vinson, MD1, Eboni Smith, MD1, Monica Proud, MD1, and Robert G. Voigt, MD1

Abstract Increased public awareness of autism spectrum disorders (ASD) and routine screening in primary care have contributed to increased requests for diagnostic ASD evaluations. However, given the scarcity of subspecialty autism diagnostic resources, overreferral of children suspected of having ASD may be contributing to long waiting lists at tertiary care autism centers and delaying diagnosis for those children who truly have ASD. To determine whether children are being excessively referred to ASD-specific diagnostic clinics, our objective was to determine the prevalence of true ASD diagnoses in children referred for diagnostic ASD evaluation. Charts of all patients referred to a regional autism center between April 2011 and August 2012 for suspicion of a possible ASD were retrospectively reviewed and demographic and clinical diagnoses abstracted. Only 214 of 348 patients evaluated (61%) received an ASD diagnosis. Thus, concerns about autism are not confirmed by an ASD diagnosis in a significant number of children. Keywords autism, autism spectrum disorder, autistic disorder, Asperger disorder, pervasive developmental disorder, not otherwise specified, developmental delay, developmental screening, autism screening, referral

Introduction In 2006, the American Academy of Pediatrics (AAP) published new guidelines for identifying children with developmental disorders in the medical home. These guidelines recommend that primary pediatric health care providers perform developmental surveillance at all well-child visits (assessing for both risk factors and parental concerns), standardized developmental screening at 9, 18, and 24 to 30 months, and an additional autism specific screen at the 18- and 24-month wellchild visits.1 Between 2002 and 2009, use of standardized screening tools among pediatricians doubled, from 23% to 47% of pediatricians using at least one screening tool.2 In 2007, the AAP published a clinical report for primary pediatric health care providers specifically on the identification and evaluation of children with autism spectrum disorders (ASD). This report recommended that all children who screen positive for a possible ASD be referred for a comprehensive ASD evaluation.3

The average age of initial ASD diagnosis has been reported at 5.7 years, although studies have shown diagnostic stability for children diagnosed as early as 2 years of age.4,5 Thus, the primary goal of the AAP guidelines and clinical reports is for primary pediatric health care providers to identify ASD earlier, especially as interventions, such as Applied Behavioral Analysis, are more likely to improve outcomes the earlier they are implemented.6 In 2014, the Centers for Disease Control and Prevention (CDC) estimated the prevalence of ASD to be 1 in 68, an increase from previous estimates of 1 in 88 in 2012, 1 in 110 in 2008, and 1 in 150 in 2007, thus providing evidence of increased autism identification 1

Baylor College of Medicine, Houston, TX, USA

Corresponding Author: Sonia Monteiro, Department of Pediatrics, Baylor College of Medicine, 8080 North Stadium Drive, Houston, TX 77054, USA. Email: [email protected]

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over time.7 However, a complication of this increased identification of children with ASD is the limited number of board-certified developmental-behavioral pediatricians and other qualified specialists (neurodevelopmental disability pediatricians, neurologists, psychiatrists, psychologists) to whom to refer for confirmation of an ASD diagnosis following failed screening. With regard to developmental-behavioral pediatricians specifically, currently 35 states have a developmental-behavioral pediatrician to population ratio of

Prevalence of Autism Spectrum Disorder in Children Referred for Diagnostic Autism Evaluation.

Increased public awareness of autism spectrum disorders (ASD) and routine screening in primary care have contributed to increased requests for diagnos...
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