Autism
Pediatricians fail to screen for autism
By Johns Hopkins Medical Institutions
May 10, 2006, 12:59

Few Maryland and Delaware primary care pediatricians screen patients regularly for autism and autism-spectrum disorders (ASD) as part of their overall look at possible developmental delays, according to results of a joint study from Johns Hopkins Children's Center and the Johns Hopkins Bloomberg School of Public Health.

Of the 255 pediatricians who participated in the study, 209 (82 percent) said they regularly screen their patients for general developmental delays, but only 20 of the 255 (8 percent) said they do so for ASD. Of those who do not screen routinely for ASD, almost two-thirds (62 percent) said they failed to do so because they weren't familiar with the screening tools.

"Lack of familiarity with ASD screening tools appears to be the single greatest barrier to routine screening," said Susan dosReis, Ph.D., of the Children's Center Division of Child and Adolescent Psychiatry and lead author of the paper, which appears in a May 11 supplement of the April issue of the Journal of Developmental and Behavioral Pediatrics.

The findings suggest that screening for ASD remains largely opportunistic rather than systematic, researchers say.

Screening is essential, as delay in diagnosis and treatment generally leads to poorer outcomes in children with developmental disorders.

"This study suggests that current national efforts may not be sufficient to actively promote the use of ASD screening tools in the general pediatric practice," dosReis added. "So it is important to learn what some obstacles might be and what needs to be done to overcome those barriers."

Previous research suggests that another factor might be that many pediatricians do not feel well-trained in general developmental and behavioral issues, researchers say.

Enhancement of residency training, complemented by introduction and training in ASD screening tools, might boost ASD screening in the general pediatric practice, dosReis added.

Almost half (47 percent) of the physicians who did not screen routinely said they preferred to send the child to a clinical specialist, whereas nearly one-third (32 percent) cited lack of time as a major reason for not screening. Of those who reported screening regularly for ASD, 90 percent said they were usually prompted to do so by parental concern and/or suspicion of ASD during routine examination.

Of the 18 percent who reported not screening routinely for any developmental delays, 73 percent cited lack of time as their top reason.

The prevalence of autism, estimated to be between 12 and 40 cases per 10,000 children, has grown over the last decade. The reasons behind the higher prevalence have flamed an ongoing debate. Some researchers attribute the increase to an actual jump in the incidence of the disorder, while others claim it is because of more aggressive screening and new diagnostic criteria, which leads to a higher number of new diagnoses.

In the Hopkins study, 99 percent of the pediatricians who believed there is an increase in ASD prevalence attributed it, at least in part, to new diagnostic criteria. At the same time, 38 percent said that underlying risk factors, other than new diagnostic guidelines, have played a role. Of these, one-third believed that environmental factors played a role, while only 7 percent attributed the increase to genetic factors, and 1 percent attributed it to vaccinations.

Researchers caution that the findings cannot be generalized beyond Maryland and Delaware because screening practices might vary by geographic area.

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