Few Maryland and Delaware primary care pediatricians screen
patients regularly for autism and autism-spectrum disorders
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 autism-spectrum
disorders. 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, assistant professor in the School of
Medicine's 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 said.
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
lead to a higher number of new diagnoses.
In the Johns 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 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.
Co-investigators included Craig Newschaffer and
Lakeisha Johnson, both of the Center for Autism and
Developmental Disabilities Epidemiology at the Johns
Hopkins Bloomberg School of Public Health; and Courtney
Weiner, of the Children Center's Division of Child and
Adolescent Psychiatry.
The study was funded in part by the National Centers
on Birth Defects and Developmental Disabilities at the
Centers for Disease Control and Prevention.
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