418 - Quantifying the Hurdles From Primary Care Concern to Specialty Care Autism Evaluation: A Retrospective Cohort Study

Poster Number: 418
Publication Number: 418.369

Background: Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder affecting 1 in 36 children in the United States. Early diagnosis and intervention for autistic children is crucial for improved long-term outcomes. However, barriers may exist in timely access to developmental and behavioral pediatric (DBP) evaluations, which may contribute to known racial, ethnic, socioeconomic and language-based disparities in autism diagnoses.

Objective: Identify potential sociodemographic barriers influencing the completion of a DBP evaluation after a positive autism screening in primary care

Design/Methods: We conducted a retrospective cohort study using data from a large academic pediatric primary care network. We analyzed the association between demographic factors and completing a DBP evaluation for children with a positive autism screen using chi-square, wilcoxon rank sum, and logistic regression analyses, then analyzed the association between demographic factors and the age at DBP evaluation using linear regression analysis. We examined sex, race, insurance payer, primary care site within the network, childhood opportunity index (COI), and Modified Checklist for Autism in Toddlers (M-CHAT) score to identify factors that may contribute to barriers to accessing DBP evaluations.

Results: Of the 2,582 children with a positive autism screen, only 16% received a DBP evaluation (see table 1). In adjusted models, girls, children with public insurance, and those with lower positive M-CHAT scores were less likely to reach DBP; a child’s primary care site was also an independent significant predictor of reaching DBP. Additionally, publicly insured children were evaluated by DBP at statistically significant older ages (median age at evaluation was 29 months versus 26 months for privately insured children).

Conclusion(s): Our findings suggest that girls and publicly insured children may face challenges in accessing evaluations for potential ASD, highlighting the need for further research into these sex-based and economic disparities as well as solutions to close these gaps. Primary care site differences indicate potential institutional factors affecting referrals and access to evaluations that may be addressed by implementing supports to promote access to diagnostic assessments for particular primary care sites. These disparities in access to ASD evaluations may have downstream effects for access to early autism-specific services that should be addressed. Lastly, there is potential to use this data to identify geographic hot and cold spots related to access to DBP evaluations in our community, to promote more equitable access.