Pediatricians can help speed up autism diagnoses
By Louise Kinross
Children in Ontario can wait over a year to be diagnosed with autism. A new Holland Bloorview study shows the process can be sped up by having pediatricians make some of the diagnoses in the community, rather than referring patients to a team of specialists.
The study, published in JAMA Network Open, looked at how accurate 17 Ontario pediatricians were at assessing 106 children for autism when compared with a multidisciplinary team that includes a developmental pediatrician.
“When the pediatrician thought the child met the diagnostic criteria for autism the expert team agreed 89 per cent of the time,” says Dr. Melanie Penner, a developmental pediatrician and senior scientist at Holland Bloorview. “This tells us that when the pediatrician thinks the child is autistic it’s very likely to be the case, and we want these children to be diagnosed in the community so they can hopefully access services faster.” Autism Ontario says children wait to get services between three months and two years after receiving the diagnosis.
On the other hand, when pediatricians in the study ruled autism out, the expert team agreed with them 60 per cent of the time. “Our message to community practitioners is that if you don’t think this is autism, but the parent or others still have concerns, refer that child on for a more advanced level of assessment,” Melanie says. “For some children it can take a bit more time to get a clear picture.”
The pediatricians in the study were told to do what they typically do to evaluate a child for possible autism, and a specialist team at Holland Bloorview did a rigorous assessment. The evaluations were blinded, so that neither the pediatrician nor the team knew what the other had determined. Half of the children were seen by the pediatrician first and half were seen by the team first. The children, up to the age of five-and-a-half, had come to their doctor with concerns such as language delay or possible ADHD.
“This is an all-hands-on-deck strategy to try to keep pace with the demand for assessments and reduce the wait,” Melanie says. “I hope our study encourages pediatricians who might be interested in this kind of work to think about the steps they can take to help some of these kids along. We are happy to help them feel more confident with our Echo Ontario Autism Program.”
ECHO Ontario Autism is a virtual Holland Bloorview program that teaches Ontario doctors and nurse practitioners to diagnose and manage autism, so children can receive care close to home. “Sometimes the question isn’t how do I figure out if this is autism, but how can I tell the family the diagnosis in a sensitive and confident manner, and how can I connect them with resources,” Melanie says.
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