Health care extension project enables community-based physicians to diagnose autism in young children

As the number of children in need of access to timely evaluation and intervention for autism spectrum disorder (ASD) continues to rise, new research is showing how barriers to diagnoses and treatment can be reduced through an innovative training program first developed at the University of Missouri.

ASD can be identified and diagnosed in young children by a well-trained clinician, and early diagnosis is vital to quickly establishing access to evidence-based therapies and interventions. However, long specialty center waitlists, distance, and cost often hinder early diagnosis.

The Extension for Community Healthcare Outcomes (ECHO) Autism STAT model shows promise at eliminating these barriers. The program leverages the existing Project ECHO model to build the capacity of primary care physicians and clinicians to evaluate and diagnose children in local communities.

The University of Missouri's ECHO program uses video-conferencing technology to create learning communities that promote best practices among primary care clinicians through case-based learning and guided practice. The ECHO Autism STAT model builds on the existing ECHO Autism framework by adding more intensive training elements specifically focused on the diagnostic assessment of young children.

"By adding to and using the skills of community-based primary care doctors and advanced practice providers, there exists the potential to drastically increase critical access to diagnostic assessment for ASD among children in underserved areas," said lead researcher Kristin Sohl, MD, professor, Department of Child Health at the University of Missouri School of Medicine and the founder of ECHO Autism.

"This accelerates the process for these children to receive the essential therapies and services, while allowing autism specialty centers to focus on care for those with more complex diagnostic needs."

Through an evaluation of participants in the program, the researchers found that the ECHO Autism STAT primary care physician diagnoses were congruent with gold-standard evaluations completed at autism specialty centers. Likert scale surveys showed families were overwhelmingly pleased with their experiences and preferred to undergo diagnostic assessments in their local communities with local doctors.

"These results support the ECHO Autism STAT model as an effective means to advance the skills of community doctors and strengthen their confidence to diagnose young children with obvious signs of autism," said Alexandra James, MD, assistant professor of clinical child health University of Missouri School of Medicine.

"Training and supporting primary care clinicians to diagnose ASD builds capacity and expertise in underserved areas, such as rural communities, which in turn decreases wait times at specialty centers and speeds access to care."

The findings are published in the Journal of Developmental & Behavioral Pediatrics.