235 - Outcomes of Autism Screening in an Urban Pediatric Clinic

Publication Number: 4231.235

Alyson Gutman, Weill Cornell Medicine, New York, NY, United States; Cindy Do, Weill Cornell Medicine, New York, NY, United States; Mary J. Ward, Weill Cornell Medicine, New York, NY, United States; Anjile An, Weill Cornell Medicine, New York, NY, United States; Evan Sholle, Weill Cornell Medicine, New York, NY, United States; Mangala Rajan, Weill Cornell Medicine, SO ORANGE, NJ, United States; Rachel Wirtshafter, Weill Cornell Medicine, Minneapolis, MN, United States; Cori Green, Weill Cornell Medicine, Long Island City, NY, United States

Background: Autism Spectrum Disorder (ASD) is increasing in prevalence, currently reported as 1 in 31 children. Early identification and interventions are associated with improved outcomes. The American Academy of Pediatrics recommends autism screening by primary care providers at 18 and 24 months, with referrals for evaluation for those screening positive. Prior studies have examined strategies to increase screening, yet it remains unclear what factors are related to appropriate referrals and evaluations for ASD.

Objective: To identify factors associated with referrals and completed evaluations by Early Intervention (EI), Audiology (AUD), and Child Development (CD) for children who screen positive on the Modified Checklist for Autism in Toddlers-Revised (M-CHAT-R) at an urban pediatric outpatient practice.

Design/Methods: Retrospective study of patients seen for an 18 or 24 month well visit from 9/1/2021 - 12/31/2023 who screened positive on the M-CHAT-R. Subjects were identified from an existing research repository of data from the electronic health record. Subjects with a prior diagnosis of ASD were excluded. Positive scores were either Moderate Risk (3-7) or High Risk (8 -20). Chi-square and Fisher's exact tests were used to compare demographic and clinical variables by referral and evaluation.

Results: Of 796 subjects, 174 (22%) screened positive and were eligible for analysis (62% male, 98% Medicaid, 86% English speaking). M-CHAT-R scores were Moderate Risk in 70% and High Risk in 30% of subjects. 81% of the subjects were referred to EI, 62% to AUD and 40% to CD. Of those referred, 86% were evaluated by EI, 66% by AUD, and 29% by CD. Scoring High Risk vs. Moderate Risk was significantly associated with EI referral (98% vs 73%), CD referral (58% vs.31%) and AUD referral (77% vs. 55%). Referral to EI was significantly associated with English language. Referral to CD was significantly associated with male sex. There were no associations between demographics and evaluations by EI, CD or AUD. Diagnosis of ASD after study entry (38% of 174) was associated significantly with all 3 referrals and EI evaluation.

Conclusion(s): The most common referrals for children with positive screens were to the state EI program. The majority of those referred to EI were evaluated. Still, only 70% of positive screens led to EI evaluation and 12% to CD evaluation. Subjects diagnosed with ASD after study entry were more likely to have been evaluated than children without ASD diagnosis, indicating risk of missed diagnoses among children with positive screens not evaluated. Further study should clarify barriers to completing evaluations.

Table 1
Subject Demographics

Figure 1
Number of Subjects Screening Positive Who Received Referral and Evaluation

Figure 2
Percentage of Referrals and Evaluations Stratified by M-CHAT-R Score Category