The Autism Society Event and Education Recordings Archive

Autism spectrum disorders (ASD) are pervasive developmental disorders affecting as many as 1 in 170 births (Chakrabarti, Fombonne, 2005). A national survey of parents in 2007 indicated the prevalence of parent-reported diagnosis of ASD was approximately 1 in 91 U.S. children (Kogan, Blumberg, et al., 2009). Despite the differences in the reported prevalence figures, it is evident that the numbers of children diagnosed with ASD are rising. With the high prevalence rate of ASD, primary-care physicians and pediatricians, who are often the first point of contact for these children and their families, play a critical role in recognizing the early signs of ASD. A 2004 survey of primary-care pediatricians showed that 44% of them cared for at least 10 children with ASD, but only 8% of them routinely screened for ASD (Dosreis, Weiner, et al., 2006).

Early identification of ASD is essential as it allows for appropriate early intervention. It is important that children with ASD receive early intervention specifically designed for their unique learning needs. There are many advantages of early diagnosis of ASD, including earlier educational planning and treatment, provision for family supports and education, reduction of family stress and anguish, and delivery of appropriate medical care to the child (Filipek, Accardo, et al., 1999). Studies show that children who receive intervention by age 3 show significant developmental gains and significantly reduce associated deficits like impaired communication and social skills that affect their development (Robins & Dumont-Mathieu, 2006). Though there is widespread increase in the awareness of ASD and its early manifestations within the first 2 years of life, most children with ASD are not identified clinically at a very early age (Robins & Dumont-Mathieu, 2006).

In 2006, the American Academy of Pediatrics (AAP) issued a policy statement recommending physicians screen all children for developmental disorders during regular doctor visits at age 9, 18 and 24 months, respectively. This statement was released by the AAP in response to a national survey of AAP members that indicated that despite efforts to improve screening for early identification of developmental disorders, only 23% of surveyed pediatricians used standardized screening instruments to screen for developmental disorders. Additionally, a 2004 survey of Maryland and Delaware licensed pediatricians found that only 8% of these pediatricians routinely screened for ASD. In 2007, the AAP released a clinical report as a follow-up of the policy statement that urged that physicians conduct surveillance at every well-child visit and screen for ASD at 18 and 24 months and any other time when parents raise a concern about a possible ASD (Johnson & Meyers, 2007). Based on the AAP’s recommendation, this study was initiated to conduct a statewide survey of physicians in Kansas who regularly care for young children (i.e., family practice physicians, internal medicine physicians, pediatricians and psychiatrists) to identify their current screening and diagnostics practices for ASD.

Purpose:

The purpose of this study was to identify Kansas physicians’ professional training and continuing medical education (CME) in the area of ASD, as well as their screening and diagnostic practices specifically related to ASD. This study will help to identify the following: (1) the amount of training these physicians have accrued in the area of ASD; (2) if these physicians have been trained to screen/diagnose for ASD; (3) if they routinely screen children at 9, 18 and 24 months, according to AAP guidelines; (4) if they screen, what screening tools they use; (5) their knowledge and practices about use of complementary alternative medicine (CAM) for children with ASD; and (6) the amount of CME received in the area of ASD. The survey will also provide participants the opportunity to indicate what would help them be better prepared to screen children for ASD.

Method:

Participants:

The study instrument was a survey questionnaire consisting of 16 items regarding demographics, training and practice information specifically related to screening, diagnosis and treatment of ASD. The survey was mailed to physicians (family practice physicians, internal medicine physicians, pediatricians and psychiatrists) in Kansas who were randomly selected from the public mailing list acquired from the Kansas Medical Society. A random sample of 450 physicians was selected from a list of 1,350 physicians, and the survey was mailed to them. The surveys will be coded to monitor for those who have completed the survey and to allow for a follow-up survey to be mailed to the non-responders approximately one month following the first mailing.

Data analysis:

The data from the returned surveys will be aggregated and analyzed as group data. Demographic variables will be compared between physicians who routinely screen for ASD and those who do not, using chi square analyses, to identify if gender or years of practice or any other information contribute to the differences in their screening and diagnostic practices. Simple linear regression analysis will be used to identify the relationships between the training and practice information.

Summary:

Because primary-care physicians and pediatricians are often the first point of contact for parents, they play an important role in early recognition of ASD. Thus, it is imperative that these physicians are well trained and stay current with screening and diagnostic practices in the area of ASD. The results of this study may help us to understand the level of knowledge and training in the area of ASD, as well as the screening and diagnostic practices of physicians who regularly care for young children in one Midwestern state. This study may also help to identify the barriers to providing such assessments in routine clinical practice. Additionally, the need for any continuing medical education discovered through the survey responses will be discussed.