Abstract
The American Academy of Pediatrics recommends using an autism-specific screening tool for all young children at primary care well visits. Screening can detect risk of autism spectrum disorder (ASD) in young children whose parents and pediatrician may not otherwise have developmental concerns. The identification of children with or at-risk for ASD increases their access to early intervention services, which helps ameliorate skill deficits associated with ASD. Recent studies indicate pediatricians use autism-specific screening and diagnostic tools infrequently. Some research has been conducted to determine whether providing training to primary care providers increases screening practices; however, evidence-based practices for training pediatricians to conduct ASD screenings or use other ASD identification tools have not been identified. We conducted a review of the research on training primary care providers (e.g., pediatricians) on the use of ASD identification tools with young children and their families. The results of this review point to a lack of high-quality research in this area. The information can be used to advance research, policy, and practice.
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References
*Articles included in the review
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5). American Psychiatric Pub.
*Allen, S. G., Berry, A. D., Brewster, J. A., Chalasani, R. K., & Mack, P. K. (2010). Enhancing developmentally oriented primary care: an Illinois initiative to increase developmental screening in medical homes. Pediatrics, 126(Supplement 3), S160-S164. https://doi.org/10.1542/peds.2010-1466k.
Arunyanart, W., Fenick, A., Ukritchon, S., Imjaijitt, W., Northrup, V., & Weitzman, C. (2012). Developmental and autism screening: a survey across six states. Infants & Young Children, 25(3), 175–187. https://doi.org/10.1097/iyc.0b013e31825a5a42.
Baio, J., Wiggins, L., Christensen, D. L., Maenner, M. J., Daniels, J., Warren, Z., Kurzius-Spencer, M., Zahorodny, W., Rosenberg, C. R., White, T., Durkin, M. S., Imm, P., Nikolaou, L., Yeargin-Allsopp, M., Lee, L., Harrington, R., Lopez, M., Fitzgerald, R. T., Hewitt, A., Pettygrove, S., Constantino, J. N., Vehorn, A., Shenouda, J., Hall-Lande, J., Braun, K. V. N., & Dowling, N. F. (2018). Prevalence of autism spectrum disorder among children aged 8 years—autism and developmental disabilities monitoring network, 11 sites, United States, 2014. MMWR Surveillance Summaries, 67(6), 1. https://doi.org/10.15585/mmwr.ss6706a1.
*Barratt, M. S., & Moyer, V. A. (2000). Pediatric resident and faculty knowledge of the Denver II. Archives of Pediatrics & Adolescent Medicine, 154(4), 411–413. https://doi.org/10.1001/archpedi.154.4.411.
*Bauer, S. C., Smith, P. J., Chien, A. T., Berry, A. D., & Msall, M. (2009). Educating pediatric residents about developmental and social–emotional health. Infants & Young Children, 22(4), 309–320. https://doi.org/10.1097/iyc.0b013e3181bc4da0.
Boyd, B. A., Odom, S. L., Humphreys, B. P., & Sam, A. M. (2010). Infants and toddlers with autism spectrum disorder: early identification and early intervention. Journal of Early Intervention, 32(2), 75–98. https://doi.org/10.1177/1053815110362690.
Committee on Children with Disabilities. (2001). The pediatrician’s role in the diagnosis and management of autistic spectrum disorder in children. Pediatrics, 107(5), 1221–1226. https://doi.org/10.1542/peds.107.5.1221.
Dawson, G., Rogers, S., Munson, J., Smith, M., Winter, J., Greenson, J., Donaldson, A., & Varley, J. (2010). Randomized, controlled trial of an intervention for toddlers with autism: the Early Start Denver Model. Pediatrics, 125(1), e17–e23. https://doi.org/10.1542/peds.2009-0958.
Dosreis, S., Weiner, C. L., Johnson, L., & Newschaffer, C. J. (2006). Autism spectrum disorder screening and management practices among general pediatric providers. Journal of Developmental & Behavioral Pediatrics, 27(2), S88–S94. https://doi.org/10.1097/00004703-200604002-00006.
Dreyer, B. (2016). AAP statement on US Preventive Services Task Force final recommendation statement on autism screening. AAP. org/en-us/about-the-aap/aap-press-room/Pages/AAP-Statement-on-US-Preventive-Services-Task-Force-Final-Recommendation-Statement-on-Autism-Screening. Published February, 16.
Eapen, V., Črnčec, R., & Walter, A. (2013). Clinical outcomes of an early intervention program for preschool children with autism spectrum disorder in a community group setting. BMC Pediatrics, 13(1), 3. https://doi.org/10.1186/1471-2431-13-3.
*Earls, M. F., & Hay, S. S. (2006). Setting the stage for success: implementation of developmental and behavioral screening and surveillance in primary care practice—the North Carolina Assuring Better Child Health and Development (ABCD) Project. Pediatrics, 118(1), e183-e188. https://doi.org/10.1542/peds.2006-0475.
Esler, A. N., Bal, V. H., Guthrie, W., Wetherby, A., Ellis Weismer, S., & Lord, C. (2015). The Autism Diagnostic Observation Schedule, Toddler Module: standardized severity scores. Journal of Autism and Developmental Disorders, 45(9), 2704–2720. https://doi.org/10.1007/s10803-015-2432-7.
Estes, A., Munson, J., Rogers, S. J., Greenson, J., Winter, J., & Dawson, G. (2015). Long-term outcomes of early intervention in 6-year-old children with autism spectrum disorder. Journal of the American Academy of Child & Adolescent Psychiatry, 54(7), 580–587. https://doi.org/10.1016/j.jaac.2015.04.005.
Frankenburg, W. K., Dodds, J., Archer, P., Shapiro, H., & Bresnick, B. (1992). The Denver II: a major revision and restandardization of the Denver Developmental Screening Test. Pediatrics, 89(1), 91–97.
Gilliam, J. E. (2013). Gilliam Autism Rating Scale (Third ed.). Inc: Pearson Education.
Gillis, J. M. (2009). Screening practices of family physicians and pediatricians in 2 southern states. Infants & Young Children, 22(4), 321–331. https://doi.org/10.1097/iyc.0b013e3181bc4e21.
Glascoe, F. P. (1997). Parents’ evaluation of developmental status (PEDS). Ellsworth & Vandermeer Press, Ltd.
Guedeney, A., & Fermanian, J. (2001). A validity and reliability study of assessment and screening for sustained withdrawal reaction in infancy: the Alarm Distress Baby Scale. Infant Mental Health Journal: Official Publication of The World Association for Infant Mental Health, 22(5), 559–575. https://doi.org/10.1002/imhj.1018.
*Hathorn, C., Alateeqi, N., Graham, C., & O’Hare, A. (2014). Impact of adherence to best practice guidelines on the diagnostic and assessment services for autism spectrum disorder. Journal of Autism and Developmental Disorders, 44(8), 1859–1866. https://doi.org/10.1007/s10803-014-2057-2.
Higgins, J. P., Altman, D. G., Gøtzsche, P. C., Jüni, P., Moher, D., Oxman, A. D., Savovic, J., Schulz, K. F., Weeks, L., & Sterne, J. A. (2011). The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ, 343, d5928. https://doi.org/10.1136/bmj.d5928.
*Honigfeld, L., Chandhok, L., & Spiegelman, K. (2012). Engaging pediatricians in developmental screening: the effectiveness of academic detailing. Journal of Autism and Developmental Disorders, 42(6), 1175–1182. https://doi.org/10.1007/s10803-011-1344-4.
Johnson, C. P., & Myers, S. M. (2007). Identification and evaluation of children with autism spectrum disorders. Pediatrics, 120(5), 1183–1215.
Kerstjens, J. M., Bos, A. F., ten Vergert, E. M., de Meer, G., Butcher, P. R., & Reijneveld, S. A. (2009). Support for the global feasibility of the Ages and Stages Questionnaire as developmental screener. Early Human Development, 85(7), 443–447. https://doi.org/10.1016/j.earlhumdev.2009.03.001.
Kobak, K. A., Stone, W. L., Ousley, O. Y., & Swanson, A. (2011). Web-based training in early autism screening: results from a pilot study. Telemedicine and e-Health, 17(8), 640–644. https://doi.org/10.1089/tmj.2011.0029.
Landa, R. J., & Kalb, L. G. (2012). Long-term outcomes of toddlers with autism spectrum disorders exposed to short-term intervention. Pediatrics, 130(Supplement 2), S186–S190. https://doi.org/10.1542/peds.2012-0900q.
Legoff, D. B., & Sherman, M. (2006). Long-term outcome of social skills intervention based on interactive LEGO© play. Autism, 10(4), 317–329. https://doi.org/10.1177/1362361306064403.
Leyfer, O. T., Folstein, S. E., Bacalman, S., Davis, N. O., Dinh, E., Morgan, J., Tager-Flusberg, H., & Lainhart, J. E. (2006). Comorbid psychiatric disorders in children with autism: interview development and rates of disorders. Journal of Autism and Developmental Disorders, 36(7), 849–861. https://doi.org/10.1007/s10803-006-0123-0.
Lord, C., Rutter, M., DiLavore, P. C., Risi, S., Gotham, K., & Bishop, S. L. (2012). Autism diagnostic observation schedule, (ADOS-2), Part 1: modules 1–4 (2nd ed.). Los Angeles: Western Psychological Services.
*Malik, F., Booker, J. M., Brown, S., McClain, C., & McGrath, J. (2014). Improving developmental screening among pediatricians in New Mexico: findings from the developmental screening initiative. Clinical Pediatrics, 53(6), 531–538. https://doi.org/10.1177/0009922814527499.
*McKay, K. (2006). Evaluating model programs to support dissemination: an evaluation of strengthening the developmental surveillance and referral practices of child health providers. Journal of Developmental & Behavioral Pediatrics, 27(1), S26-S29. https://doi.org/10.1097/00004703-200602001-00008.
Moher, D., Liberati, A., Tetzlaff, J., Altman, D. G., & Prisma Group. (2009). Reprint—preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Physical Therapy, 89(9), 873–880. https://doi.org/10.1371/journal.pmed.1000097.
*Oosterling, I. J., Wensing, M., Swinkels, S. H., Van Der Gaag, R. J., Visser, J. C., Woudenberg, T., Minderaa, R., Steenhuis, M.P., & Buitelaar, J. K. (2010). Advancing early detection of autism spectrum disorder by applying an integrated two-stage screening approach. Journal of Child Psychology and Psychiatry, 51(3), 250–258. https://doi.org/10.1111/j.1469-7610.2009.02150.x.
Peters-Scheffer, N., Didden, R., Korzilius, H., & Sturmey, P. (2011). A meta-analytic study on the effectiveness of comprehensive ABA-based early intervention programs for children with autism spectrum disorders. Research in Autism Spectrum Disorders, 5(1), 60–69. https://doi.org/10.1016/j.rasd.2010.03.011.
Remington, B., Hastings, R. P., Kovshoff, H., Degli Espinosa, F., Jahr, E., Brown, T., Alsford, P., Lemaic, M., & Ward, N. (2007). Early intensive behavioral intervention: outcomes for children with autism and their parents after two years. American Journal on Mental Retardation, 112(6), 418–438. https://doi.org/10.1352/0895-8017(2007)112[418:eibiof]2.0.co;2.
Roberts, M. Y., Kaiser, A. P., Wolfe, C. E., Bryant, J. D., & Spidalieri, A. M. (2014). Effects of the teach-model-coach-review instructional approach on caregiver use of language support strategies and children’s expressive language skills. Journal of Speech, Language, and Hearing Research, 57(5), 1851–1869. https://doi.org/10.1044/2014_jslhr-l-13-0113.
Robins, D. L., Fein, D., & Barton, M. (2009). Modified checklist for autism in toddlers, revised with follow-up. Retried from http://www.mchatscreen.com.
Robins, D. L., Fein, D., Barton, M. L., & Green, J. A. (2001). The modified checklist for autism in toddlers: an initial study investigating the early detection of autism and pervasive developmental disorders. Journal of Autism and Developmental Disorders, 31(2), 131–144.
*Schonwald, A., Huntington, N., Chan, E., Risko, W., & Bridgemohan, C. (2009). Routine developmental screening implemented in urban primary care settings: more evidence of feasibility and effectiveness. Pediatrics, 123(2), 660–668. https://doi.org/10.1542/peds.2007-2798.
Sices, L. (2007). Developmental screening in primary care: the effectiveness of current practice and recommendations for improvement. The Commonwealth Fund.
Simonoff, E., Pickles, A., Charman, T., Chandler, S., Loucas, T., & Baird, G. (2008). Psychiatric disorders in children with autism spectrum disorders: prevalence, comorbidity, and associated factors in a population-derived sample. Journal of the American Academy of Child & Adolescent Psychiatry, 47(8), 921–929. https://doi.org/10.1097/chi.0b013e318179964f.
Smith, T., Groen, A. D., & Wynn, J. W. (2000). Randomized trial of intensive early intervention for children with pervasive developmental disorder. American Journal on Mental Retardation, 105(4), 269–285. https://doi.org/10.1002/9780470755778.ch6.
*Smith-Nielsen, J., Lønfeldt, N., Guedeney, A., & Væver, M. S. (2017). Implementation of the Alarm Distress Baby Scale as a universal screening instrument in primary care: feasibility, acceptability, and predictors of professionals’ adherence to guidelines. International Journal of Nursing Studies, 79, 104–113. https://doi.org/10.1016/j.ijnurstu.2017.11.005.
Snow, A. V., & Lecavalier, L. (2008). Sensitivity and specificity of the Modified Checklist for Autism in Toddlers and the Social Communication Questionnaire in preschoolers suspected of having pervasive developmental disorders. Autism, 12(6), 627–644. https://doi.org/10.1177/1362361308097116.
Squires, J., Bricker, D., Twombly, E., Nickel, R., Clifford, J., Murphy, K., Hoselton, R., Potter, L., Mounts, L., & Farrell, J. (2009). Ages & Stages Questionnaires, Third Edition (ASQ-3). Baltimore: Brookes Publishing.
Squires, J., Bricker, D., Twombly, E., Hoselton, R., Murphy, K., Dolata, J., Yockelson, S., Davis, M. S., & Kim, Y. (2015a). Ages & Stages Questionnaires: Social-Emotional, Second Edition (ASQ:SE-2). Baltimore: Brookes Publishing.
Squires, J., Bricker, D., Twombly, E., Murphy, K., & Hoselton, R. (2015b). ASQ: SE-2 technical report. Baltimore: Brookes Publishing.
Stone, W. L., Coonrod, E. E., & Ousley, O. Y. (2000). Brief report: screening tool for autism in two-year-olds (STAT): development and preliminary data. Journal of Autism and Developmental Disorders, 30(6), 607–612.
Stone, W. L., Coonrod, E. E., Turner, L. M., & Pozdol, S. L. (2004). Psychometric properties of the STAT for early autism screening. Journal of Autism and Developmental Disorders, 34(6), 691–701. https://doi.org/10.1007/s10803-004-5289-8.
*Swanson, A. R., Warren, Z. E., Stone, W. L., Vehorn, A. C., Dohrmann, E., & Humberd, Q. (2014). The diagnosis of autism in community pediatric settings: does advanced training facilitate practice change? Autism, 18(5), 555–561.
Swinkels, S. H., Dietz, C., van Daalen, E., Kerkhof, I. H., van Engeland, H., & Buitelaar, J. K. (2006). Screening for autistic spectrum in children aged 14 to 15 months. I: the development of the Early Screening of Autistic Traits Questionnaire (ESAT). Journal of Autism and Developmental Disorders, 36(6), 723–732.
Tennessee Department of Education (n.d.). TEIS Eligibility. Retrieved from https://www.tn.gov/education/early-learning/tennessee-early-intervention-system-teis/teis-eligibility.html.
U.S. Department of Education (n.d.). Sec. 303.13 Early intervention services. Retrieved from https://sites.ed.gov/idea/regs/c/a/303.13.
Zwaigenbaum, L., Bauman, M. L., Stone, W. L., Yirmiya, N., Estes, A., Hansen, R. L., McPartland, J. C., Natowicz, M. R., Choueiri, R., Fein, D., & Kasari, C. (2015). Early identification of autism spectrum disorder: recommendations for practice and research. Pediatrics, 136(supplement 1), S10–S40.
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Murray, R.E., Barton, E.E. Training Pediatricians to Implement Autism Screening Tools: a Review of the Literature. Rev J Autism Dev Disord 8, 108–117 (2021). https://doi.org/10.1007/s40489-020-00206-x
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DOI: https://doi.org/10.1007/s40489-020-00206-x