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Child Psychiatrist /Adult Psychiatrist

The Role of Primary Care Providers in Diagnosing Autism Spectrum Disorder

Keypoint: On average, primary care providers diagnose ASD 1 year earlier than other health care providers.

Autism Spectrum Disorder

Although primary care providers (PCPs) diagnose children with autism spectrum disorder (ASD) 1 year earlier than psychiatrists and psychologists, the likelihood of a PCP diagnosing a child with ASD has decreased every year from 2004 to 2019, according to study findings published in Autism. Further research is needed to understand this discrepancy and improve efficient diagnoses among children with ASD.

An early diagnosis of ASD can be essential for initiating treatment during critical periods of development. Early interventions often lead to better long-term outcomes by addressing core challenges in childhood and connecting patients to necessary supports that improve their quality of life. A significant factor in achieving an earlier diagnosis is primary care appointment attendance, as PCPs are in a unique position to consistently monitor a patient’s development from infancy to childhood. Yet, the diagnostic tools required for an ASD diagnosis require extensive training and are often only used in specialized treatment centers.

To determine whether PCP diagnoses of ASD have changed over time, investigators conducted a secondary analysis of data from the National Survey of Children’s Health (NSCH), a caregiver-report survey of the health and well-being of United States children from birth to 17 years of age. The goal of the analysis was to determine the rate of PCPs diagnosing ASD over time and children’s ages at diagnosis. Caregivers reported if a health care professional had ever diagnosed their child with ASD and were then asked to retroactively report which type of provider was the first to diagnose their child with ASD. The investigators collapsed the responses of provider type into PCP and non-PCP.

A total of 5296 caregiver-reported diagnoses of ASD were included in the current study. On average, children were 5.13 (SD, 3.32) years of age at diagnosis, 76.8% of participants were White, 87.3% were non-Hispanic/Latinx, 80.0% of the children were boys, and 14.3% of the study group were first diagnosed with ASD by their PCP.

From 2004 to 2019, the investigators found the likelihood of a PCP diagnosing a child with autism decreased by about 2% every year (odds ratio [OR], 0.98; 95% CI, 0.96-1.00). In a binary logistic regression model that controlled for demographic characteristics, the year in which a child was diagnosed with ASD was a significant, negative predictor of being diagnosed by a PCP (β, –0.02; P =.02).

On average, children diagnosed with ASD by their PCP were about 1 year younger (4.10 years; SD, 2.67) than children diagnosed by a non-PCP (5.30 years; SD, 3.38; P <.001).

The investigators wrote, “The present findings support the role PCPs play in early access to diagnosis, as age at first diagnosis of [ASD] was approximately [1] year earlier among children whose [ASD] was first diagnosed by their PCP as compared with non-PCPs.” Study authors concluded, “Overall, the current results indicate that more widespread access to diagnosis in primary care settings may have the potential to greatly reduce diagnostic delays in the years to come.”

These study findings may be limited, as the investigators did not account for changes in ASD diagnostic criteria over the study period. Additionally, there was a lack of specificity in the survey questions and an inability to account for potential covariates (ie, living in an urban vs rural area, insurance type, and diagnostic features).

Note: This article originally appeared on Psychiatry Advisor

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