TY - JOUR
T1 - Do Referral Factors Predict a Probable Autism Spectrum Disorder Diagnosis? A DBPNet Study
AU - the DBPNet Steering Committee
AU - High, Pamela
AU - Silver, Ellen J.
AU - Stein, Ruth E.K.
AU - Roizen, Nancy
AU - Augustyn, Marilyn
AU - Blum, Nathan
N1 - Funding Information:
Funding source: DBPNet is supported by cooperative agreement UA3MC20218 from the Maternal and Child Health Bureau, Health Resources and Services Administration, US Department of Health and Human Services . This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by the Health Resources and Services Administration, US Department of Health and Human Services, or the US Government.
Funding Information:
Financial statement: The authors have no financial relationships relevant to this article to disclose. Funding source: DBPNet is supported by cooperative agreement UA3MC20218 from the Maternal and Child Health Bureau, Health Resources and Services Administration, US Department of Health and Human Services. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by the Health Resources and Services Administration, US Department of Health and Human Services, or the US Government. Authorship statement: Dr High, Dr Silver, Dr Stein, Dr Roizen, Dr Augustyn, and Dr Blum all conceptualized and designed the study, carried out the data analyses, drafted the initial manuscript, and reviewed and revised the manuscript. All authors approve the final manuscript as submitted and agree to be accountable for all aspects of the work.
Publisher Copyright:
© 2021 Academic Pediatric Association
PY - 2022/3
Y1 - 2022/3
N2 - Objective: To determine the proportion of children referred to academic medical centers with concerns about autism spectrum disorders (ASDs) who received a probable ASD diagnosis, identify factors predicting ASD diagnosis, and describe the children with ASD concerns who were not found to have autism. Methods: A total of 55 developmental-behavioral pediatricians (DBP) at 12 academic sites in the DBPNet research network recorded data on ≤15 consecutive new patients. They coded presumed diagnoses after their first visit with the child. Results: Of 784 new visits, 324 (41%) had concern for ASD; of these, 221 (68%) were presumptively ASD+; 103 (32%) were ASD−. In a mixed model accounting for clustering within site and covariates significant in bivariate analysis, significant predictors of receiving a presumptive ASD diagnoses were socialization concerns, languages other than English spoken in the home, and coming for second opinion. Also concern for “other behavior problems” (not mood, oppositionality, anxiety, attention, or repetitive behaviors) predicted not receiving ASD diagnoses. This model was not clinically useful because it misclassified 26.9% of children. ASD− children <4 years old had more language delay and less cognitive impairment and socialization concern than their ASD+ age peers. ASD− children ≥4 years old were more likely to have attention-deficit /hyperactivity disorder (ADHD) and learning disability with normal cognition than their ASD+ age peers. Conclusions: Two thirds of children referred to academic centers with concern for ASD received a presumptive diagnosis of ASD. While those with ASD were not easily distinguished from those without ASD at referral, virtually all children with ASD concerns had multiple DBP diagnoses made and required DBP follow-up care.
AB - Objective: To determine the proportion of children referred to academic medical centers with concerns about autism spectrum disorders (ASDs) who received a probable ASD diagnosis, identify factors predicting ASD diagnosis, and describe the children with ASD concerns who were not found to have autism. Methods: A total of 55 developmental-behavioral pediatricians (DBP) at 12 academic sites in the DBPNet research network recorded data on ≤15 consecutive new patients. They coded presumed diagnoses after their first visit with the child. Results: Of 784 new visits, 324 (41%) had concern for ASD; of these, 221 (68%) were presumptively ASD+; 103 (32%) were ASD−. In a mixed model accounting for clustering within site and covariates significant in bivariate analysis, significant predictors of receiving a presumptive ASD diagnoses were socialization concerns, languages other than English spoken in the home, and coming for second opinion. Also concern for “other behavior problems” (not mood, oppositionality, anxiety, attention, or repetitive behaviors) predicted not receiving ASD diagnoses. This model was not clinically useful because it misclassified 26.9% of children. ASD− children <4 years old had more language delay and less cognitive impairment and socialization concern than their ASD+ age peers. ASD− children ≥4 years old were more likely to have attention-deficit /hyperactivity disorder (ADHD) and learning disability with normal cognition than their ASD+ age peers. Conclusions: Two thirds of children referred to academic centers with concern for ASD received a presumptive diagnosis of ASD. While those with ASD were not easily distinguished from those without ASD at referral, virtually all children with ASD concerns had multiple DBP diagnoses made and required DBP follow-up care.
KW - autism spectrum disorder comorbidities
KW - autism spectrum disorder diagnostic evaluation
KW - autism spectrum disorders
KW - developmental-behavioral pediatric workforce
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U2 - 10.1016/j.acap.2021.05.025
DO - 10.1016/j.acap.2021.05.025
M3 - Article
C2 - 34098175
AN - SCOPUS:85114765172
SN - 1876-2859
VL - 22
SP - 271
EP - 278
JO - Academic Pediatrics
JF - Academic Pediatrics
IS - 2
ER -