Recent studies from Drexel University’s A.J. Drexel Autism Institute reveal that implementing standardized autism screening during regular pediatric visits allows for early identification of children at high risk for autism, including those exhibiting less obvious symptoms. This research is groundbreaking, being the first extensive, randomized trial aimed at assessing the effects of standardized autism screening on the proactive detection of autism in children’s primary healthcare.
A study published in the Journal of the American Academy of Child & Adolescent Psychology aimed to determine if employing a standardized autism screening tool for toddlers—the Modified Checklist for Autism in Toddlers, Revised, with Follow-Up (M-CHAT-R/F)—during well-child visits would lead to earlier autism diagnoses in comparison to standard care practices.
Standard care typically involves a mix of non-standardized screening methods or infrequent use of screening tools combined with clinician judgment to decide if a child should be referred for further assessment and early intervention.
The research involved 31 pediatric practices across three locations: near Philadelphia, Pennsylvania; Storrs, Connecticut; and Sacramento, California. These practices were randomly divided into two groups: one received specialized training and supervision for consistent and proper use of the M-CHAT-R/F, while the other group continued with standard care.
Both groups referred toddlers displaying autism-related signs during their 18-month well-child visits to the research team for diagnostic evaluations.
According to Giacomo Vivanti, PhD, an associate professor at the Autism Institute and the lead author, “The practices assigned to standardized screening identified children with a high likelihood of autism more regularly and timely than the usual care group. This led to 186 children being referred for diagnostic evaluation, with an average age of 20.6 months, versus 39 children from the usual care group whose average age was 23.6 months.”
The evaluation results showed that a majority of children from both groups received autism diagnoses. However, those referred from practices utilizing standardized screening displayed a broader spectrum of clinical presentations, encompassing milder issues in areas such as language and cognitive development, compared to those from standard care practices. This suggests that standardized screening can help in identifying children who might otherwise be overlooked due to less apparent challenges.
The findings recommend that regular, standardized screenings for all toddlers during well visits, along with prompt referrals for those showing autism potentials, are far more effective than depending on non-standardized screening methods or clinician discretion alone.
Diana Robins, PhD, director of the Autism Institute and creator of the M-CHAT-R/F, stated, “Identifying autism earlier enables specific early intervention strategies to begin at a younger age, significantly enhancing long-term outcomes.”
The research team hopes that their findings will encourage policy changes to advocate for routine, standardized autism screenings for all toddlers during their well visits.
Despite the American Academy of Pediatrics advocating for universal, standardized autism screenings at 18- and 24-month well visits for nearly two decades, the actual application in community practices still falls short of these recommended standards, noted Vivanti and Robins.
Their goal is to highlight the necessity of adhering to the standardized processes for administering, scoring, and appropriately following up based on the screener instructions, rather than utilizing non-standardized practices or allowing clinical judgment to influence whether toddlers are referred for autism evaluations and early interventions, especially when screeners indicate a need for such referrals.
