Mobile Autism Screening Tool Could Improve Primary Care Diagnoses

Credit: Unsplash / Caleb Woods

An interactive measure designed to screen for autism in children aged 2 – 3 years old may help primary care clinicians to improve their attitudes, knowledge and intentions to diagnose and treat families.

The Tennessee STAT (Screening Tool for Autism in Toddlers & Young Children)‚ a mobile, 12-item, empirically based measuring tool designed for community service providers working in assessment or intervention settings—was associated with improved capability and intention to diagnose autism in young children and toddlers. The implementation of such a practice in other primary care settles may help to address the persistent bottleneck of specialty clinic referrals to adequately and timely diagnose autism spectrum disorder.

Investigators led by Norah Johnson, PhD, CPNP-PC, of the Marquette University College of Nursing, conducted an analysis of the Tennessee STAT test in a Wisconsin-based training cohort for primary care providers and family navigators. As they noted, the typical practice in primary care is an initial autism spectrum disorder screening at 18 and 24 months via Modified Checklist for Autism in Toddlers (M-CHAT).

This, Johnson and colleagues noted, is often followed by long wait lists for actual diagnostic assessment at referred specialty clinics.

“Efforts to train primary care physicians in streamlined autism spectrum disorder diagnosis within primary care are growing but not yet widely implemented,” they wrote.

The team applied Tennessee STAT to a yearlong autism spectrum disorder learning community, including monthly meetings providing autism educating and case conceptualization. Primary care providers and family navigators were trained and assessed at baseline, 6 and 12 months, and following the conclusion of the trial. Training and assessment components included:

• Knowledge of screening and diagnosis of autism
• Current practice and intention to diagnose autism
• Attitutdes on appropriateness of autism diagnosis in the primary care setting
• Comfort level with autism spectrum disorder

The final analysis included 9 primary care providers and 7 family navigators. Mean years in practice among providers was 11.67 years; among navigators, it was 9.57 years. Among the primary care providers, 4 were a pediatrics / family medicine specialist; 3 were nurse practitioners; 2 were clinical psychologists. A majority of providers and navigators stated a desire to better serve patients with autism spectrum disorder.

Over the span of the year, providers and navigators reported a mean shift in attitude to rating in-house autism diagnoses as more appropriate than screening-to-referral practices (P = .05). In general, providers and navigators reported feeling more comfortable identifying characteristics of autism (P = .05) as well as more comfortable discussing the diagnosis with family members (P <.001).

Most notably, the trainees were more likely to endorse attempts at in-house autism diagnosis than to refer a patient to a specialist following Tennessee STAT training (P = .05). The rate of trainees who said they would be likely to attempt an in-house diagnosis improved from 40% at baseline to 100% at trial’s end.

Johnson and colleagues concluded that primary care providers and family navigators improved their autism spectrum disorder attitudes, knowledge and intent to diagnose in their own setting once completing Tennessee STAT implementation.

“Examination of longer-term longitudinal data from these participants will gauge number of families served and document screening to diagnosis lag times,” they concluded. “Austism spectrum disorder diagnosis and care within primary care, in place of the bottleneck of specialty clinic wait-lists, has potential for improving and streamlining diagnostic flows.”

Reference

1. ^{Johnson N, Carlson M, Jepson L, Lehman S, et al. Primary Care Autism Spectrum Disorder diagnosis for obvious signs: An innovative training model.Paper presented at: NAPNAP National Conference on Pediatric Health Care. March 13 - 16, 2024. Denver, CO.}
2. ^{Vanderbilt Kennedy Center. Screening Tool for Autism in Toddlers and Young Children (STAT™). Website page. https://vkc.vumc.org/vkc/triad/stat/}