In our first research round-up, we share research about improving early identification of autism spectrum disorder (ASD) in the primary care setting using different screening processes.
Utilizing Two-Tiered Screening for Early Detection of Autism Spectrum Disorder
In the primary care setting, many physicians use a parent questionnaire called the Modified Checklist for Autism in Toddlers (M-CHAT-R/F) as an initial screener for ASD. However, problems exist with the M-CHAT-R/F and other early screeners as they produce a high false positive rate for ASD, resulting in lengthened waiting lists for comprehensive evaluations and delayed interventions for children. This study measured the effectiveness of combining a level one screener, the M-CHAT-R/F, with a level two screener, the Screening Tool for Autism in Toddlers & Young Children (STAT), with the purpose of separating children at risk for ASD from those at risk for other developmental concerns. This would allow those at risk for ASD to receive diagnostic evaluations and interventions sooner. Results using the two-tiered approach in a sample of 109 toddlers were promising. They found that the rate of false positives decreased, sensitivity of the tests was improved, and identification of true positives was not adversely affected. These results suggest that referrals for ASD services can be streamlined, lowering the age of diagnosis and providing access to interventions earlier.
Improving Early Identification and Intervention for Children at Risk for Autism Spectrum Disorder
Challenges exist for many state-run systems in early identification of ASD. To combat these foundational, statewide issues in South Carolina (SC), researchers developed the South Carolina Act Early Team (SCAET). Under existing policies in SC, children deemed to be at risk using screening measures could only access intervention services with a formal diagnosis of ASD. The SCAET piloted policy changes to use a two-tiered screening process, including the M-CHAT and STAT, two parent-report questionnaires. Additionally, under this updated policy, children under the age of 3 found to be at risk using the two screening measures were provided the BabyNet Early Intensive Behavioral Intervention (EIBI) without a diagnosis of ASD. The implementation of presumptive eligibility rather than a formal diagnosis produced a fivefold increase of children who were eligible for EIBI, saving families years of waiting for an ASD diagnosis and earlier access to interventions. Through this study, the SCAET increased collaboration and efforts among services and leaders in SC, was able to improve early identification, and provided a successful policy that can be replicated in other states.
A Statewide Tiered System for Screening and Diagnosis of Autism Spectrum Disorder
Creating effective systems of ASD screening to lead to interventions is a public health priority, particularly in underserved areas with a greater need for these services and an overall lack of access to care. Indiana fell behind in developmental screenings for children nationally and was in need of a screening and diagnosis system due to a higher number of children with developmental disorders. Researchers created the statewide Early Autism Evaluation (EAE) Hub system comprised of three tiers: 1) children receive screening measures in a primary care setting; 2) 18 – 48 month old children who are found to be at risk for ASD are referred to the EAE Hub for further evaluation; and 3) children with severe or atypical clinical presentation are referred for thorough evaluations at a specialty diagnostic center. The results concluded that the average age at evaluation was 30 months, considerably lower than the national average of 4-5 years. The average wait time for the EAE Hub evaluation was 62 days, drastically different from the statewide average of 9-12 months. This system was widely successful in serving a disadvantaged area and has implications for use beyond Indiana in states facing similar issues.