3.36 The Prevalence and Nature of Developmental Concerns Evident Prior to Receiving a Positive ASD Screening in Primary Care

ObjectivesThe Modified Checklist for Autism in Toddlers, Revised with Follow-up (M-CHAT-R/F) is a common ASD screener. However, the US Preventive Services Task Force has concluded that the evidence for universal ASD screening is insufficient to assess the harms and benefits in those for whom no concerns of ASD have been raised by parents or healthcare providers. This study aims to determine the prevalence and nature of developmental concerns prior to a positive M-CHAT-R/F, to understand how concern frequency and type change with age, and to determine whether prior concerns differ based on demographic characteristics.MethodsWe conducted a retrospective review of the electronic health records (EHRs) of 243 children seen in the Duke University Health System who screened positive using the M-CHAT-R/F between July 26, 2018 and August 11, 2021. The reviewers were 2 medical students and 2 clinical psychologists who met reliability. Analyses were done using R. A longitudinal, multilevel, Poisson model was used to examine the number of concerns prior to the positive screen.ResultsParticipants had on average 3 (M = 2.9; SD = 1.58) concerns prior to a positive M-CHAT-R/F. Patients averaged 2 concerns by 12 months of age and 3 by 24 months: e(0.43+ 0.001∗365) and e(0.43+ 0.001∗365∗2), respectively. Premature children had an increased number of concerns (interrater reliability [IRR] = 1.32; p < .0001). White children had a higher number of concerns than Black families (IRR = 1.21; p = .02), as did non-Hispanic/Latino children compared to Hispanic/Latino families (IRR = 1.15; p = .04). The mean age for signs of ASD was 19.16 months (SD = 5.7), while language concerns appeared at 16.36 months (SD = 4.61). Notably, age at motor concern was 6.09 months (SD = 5.37); 95.04% of children had any prior concern.ConclusionsWe found prior developmental concerns for most children with a positive ASD screen. Patients often had multiple concerns, and this number increased over time. This reinforces the value of universal ASD screening. Motor concerns were evident by 6 months, suggesting that motor skills are an early-appearing delay associated with ASD. Demographic differences in the number of concerns may reflect cultural differences in expectations or biases in EHR recordings. Limitations include that data were collected from an academic network and that the EHR may not be fully representative.ASD, RCR, DEV ObjectivesThe Modified Checklist for Autism in Toddlers, Revised with Follow-up (M-CHAT-R/F) is a common ASD screener. However, the US Preventive Services Task Force has concluded that the evidence for universal ASD screening is insufficient to assess the harms and benefits in those for whom no concerns of ASD have been raised by parents or healthcare providers. This study aims to determine the prevalence and nature of developmental concerns prior to a positive M-CHAT-R/F, to understand how concern frequency and type change with age, and to determine whether prior concerns differ based on demographic characteristics. The Modified Checklist for Autism in Toddlers, Revised with Follow-up (M-CHAT-R/F) is a common ASD screener. However, the US Preventive Services Task Force has concluded that the evidence for universal ASD screening is insufficient to assess the harms and benefits in those for whom no concerns of ASD have been raised by parents or healthcare providers. This study aims to determine the prevalence and nature of developmental concerns prior to a positive M-CHAT-R/F, to understand how concern frequency and type change with age, and to determine whether prior concerns differ based on demographic characteristics. MethodsWe conducted a retrospective review of the electronic health records (EHRs) of 243 children seen in the Duke University Health System who screened positive using the M-CHAT-R/F between July 26, 2018 and August 11, 2021. The reviewers were 2 medical students and 2 clinical psychologists who met reliability. Analyses were done using R. A longitudinal, multilevel, Poisson model was used to examine the number of concerns prior to the positive screen. We conducted a retrospective review of the electronic health records (EHRs) of 243 children seen in the Duke University Health System who screened positive using the M-CHAT-R/F between July 26, 2018 and August 11, 2021. The reviewers were 2 medical students and 2 clinical psychologists who met reliability. Analyses were done using R. A longitudinal, multilevel, Poisson model was used to examine the number of concerns prior to the positive screen. ResultsParticipants had on average 3 (M = 2.9; SD = 1.58) concerns prior to a positive M-CHAT-R/F. Patients averaged 2 concerns by 12 months of age and 3 by 24 months: e(0.43+ 0.001∗365) and e(0.43+ 0.001∗365∗2), respectively. Premature children had an increased number of concerns (interrater reliability [IRR] = 1.32; p < .0001). White children had a higher number of concerns than Black families (IRR = 1.21; p = .02), as did non-Hispanic/Latino children compared to Hispanic/Latino families (IRR = 1.15; p = .04). The mean age for signs of ASD was 19.16 months (SD = 5.7), while language concerns appeared at 16.36 months (SD = 4.61). Notably, age at motor concern was 6.09 months (SD = 5.37); 95.04% of children had any prior concern. Participants had on average 3 (M = 2.9; SD = 1.58) concerns prior to a positive M-CHAT-R/F. Patients averaged 2 concerns by 12 months of age and 3 by 24 months: e(0.43+ 0.001∗365) and e(0.43+ 0.001∗365∗2), respectively. Premature children had an increased number of concerns (interrater reliability [IRR] = 1.32; p < .0001). White children had a higher number of concerns than Black families (IRR = 1.21; p = .02), as did non-Hispanic/Latino children compared to Hispanic/Latino families (IRR = 1.15; p = .04). The mean age for signs of ASD was 19.16 months (SD = 5.7), while language concerns appeared at 16.36 months (SD = 4.61). Notably, age at motor concern was 6.09 months (SD = 5.37); 95.04% of children had any prior concern. ConclusionsWe found prior developmental concerns for most children with a positive ASD screen. Patients often had multiple concerns, and this number increased over time. This reinforces the value of universal ASD screening. Motor concerns were evident by 6 months, suggesting that motor skills are an early-appearing delay associated with ASD. Demographic differences in the number of concerns may reflect cultural differences in expectations or biases in EHR recordings. Limitations include that data were collected from an academic network and that the EHR may not be fully representative.ASD, RCR, DEV We found prior developmental concerns for most children with a positive ASD screen. Patients often had multiple concerns, and this number increased over time. This reinforces the value of universal ASD screening. Motor concerns were evident by 6 months, suggesting that motor skills are an early-appearing delay associated with ASD. Demographic differences in the number of concerns may reflect cultural differences in expectations or biases in EHR recordings. Limitations include that data were collected from an academic network and that the EHR may not be fully representative.