Early Diagnosis of ASD In a Community Sample: Who Refers and Why? Lisa Shulman MD, Rosa Seijo MD, Kathryn Hottinger BA, Maria Valicenti-McDermott MD Children’s Evaluation and Rehabilitation Center-Kennedy Center, Albert Einstein College of Medicine, Bronx, NY ASD Symptoms by Referral Source based on DSM-IV-TR Physician Parent p Lack of Showing 45 (85%) 31 (65%) 0.058 Rigidity/Adherence to routine 3 (13%) 10 (22%) 0.016 Stereotyped patterns of interest 27 (50%) 12 (27%) 0.014 RESULTS Demographic/Clinical Characteristics Mean age at presentation (mo) 20.4 (12-24) Gender Male Female 81 (75%) 27 (25%) Ethnicity White Hispanic African American Other 29(27%) 53 (49%) 20 (19%) 6 (5%) Initial Cognitive Standard Score ≥ 70 < 70 N=83 (44%) (56%) SES Medicaid Private Insurance 67 (62%) 42 (38%) Maternal Education 35% college educated BACKGROUND Early diagnosis of autism spectrum disorder (ASD) has become an important clinical and public health goal. Efforts to increase early identification have been directed at pediatricians (AAP) as well as parents (CDC, Autism Speaks). In community settings, how do very young children with ASD come to attention? Are they being referred by their doctors, their parents, or other agencies? For specific concerns regarding autism or for other reasons? Demographic Factors Associated with Chief Concern of ASD** ASD-specific Concern N=40 No ASD-specific Concern N=67 p SES Medicaid Private Insurance 20 (50%) 46 (69%) 21 (31%) 0.05 Ethnicity White Hispanic Black 15 (42%) 16 (45%) 5 (13%) 14 (21%) 37 (56%) 15 (23%) 0.03 Maternal Education <High school High School Grad Some College College Grad Graduate Degree N=34 4 (12%) 3 (9%) 9 (26%) 7 (21%) 11 (32%) N=53 12 (23%) 10 (19%) 11 (21%) 13 (24%) 7 (13%) OBJECTIVE To examine referral source and chief concern for young children diagnosed with ASD in a community early intervention setting and to assess the relationship between referral source/chief concern and clinical presentation/demographics. Referral Source Physician 60 (56%) Parent 36 (33%) Other Agency 12 (11%) Chief Concern Language Delay 42 (39%) Autism-Specific 40 (37%) General Development Language and Behavior 9 (8%) High Risk Follow Up (Premie, cleft palette, etc) 4 (4%) DESIGN/METHODS Retrospective chart review of 108 children presenting by age 24 months (mo) to a University Affiliated early intervention program from 2003-2010 who received an ASD diagnosis based on multidisciplinary evaluation. Data included: age, demographics, year of referral and referral source, chief concern, autistic features (DSM-IV-TR, Childhood Autism Rating Scale-CARS), and cognitive level. Statistical analysis included chi-square, t-test, non-parametric tests and logistic regression. **These associations did not remain significant when adjusted for in a multivariate logistic regression model. Referral source and chief concern were not influenced by ASD severity, cognitive level, age, and year of referral. CONCLUSIONS Physician referral accounted for the majority of children with early ASD diagnosis. For most, referral was for general developmental concerns rather than specifically for ASD. Physician-referred children differed clinically from parent-referred. Demographic factors may impact the likelihood of an autism-specific referral concern. Of those with ASD-specific concerns, 63% of referrals came from physicians, 22% parents, 15% others.