The paucity of specialists in developmental and behavioral pediatrics to help with autism diagnostic evaluations has led to long wait-times for interventional services. McNally Keehn et al (10.1542/peds.2023-061188), in a study being early released, report on a strategy to help improve timeliness of accurate diagnosis.
The Early Autism Evaluation (EAE) Hub system trained primary care clinicians in a variety of settings ranging from large health group systems to federally qualified health centers to private practices using specialized diagnostic training including a clinical practicum, coaching and a longitudinal learning collaborative, to help primary care pediatricians better diagnose autism spectrum disorder (ASD), bill and code for these services, and arrange services after diagnosis. Of 126 children referred by EAE Hub providers, there was 82% agreement between the primary care EAE hub clinicians and autism specialists in the diagnosis of ASD. Of importance, the primary care clinicians were sensitive, meaning they did not miss true positive cases, and although specificity was lower, meaning they referred some to specialists who did not have autism, it significantly reduced the number of children waiting for subspecialists and could increase the timeliness of care.
Should the EAE Hub approach be spread? To answer that question, we invited a commentary from Drs. Susan Hyman and Abigail Kroening, behavioral and developmental pediatricians from the University of Rochester (10.1542/peds.2023-062279). While they point out how reassuring it is that pediatricians without fellowship training in developmental and behavioral pediatrics (DBP) can with training more accurately diagnose autism, they also raise concerns that the medical system may point out systems gaps for those diagnosed with ASD earlier. Such services may not be available for those patients that are referred earlier. This can lead to inequities in care and outcomes for children with ASD. Link to both the study and commentary and reflect on what you and your colleagues might need to improve the ability to accurately diagnose and intervene children with ASD.
