1. 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 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.