Autism Rapid Diagnosis Clinic: a New Model for Efficient Early Diagnosis and Referral

Background: Demand for early autism diagnostic evaluations continues to grow. Long waits for qualified clinical services delay access to crucial services in toddlers with Autism Spectrum Disorders (ASD). 

Objectives:  We describe here a new clinic model we have pioneered for children younger than 3 years 

Methods: We reviewed the number of children seen between January 2009 and September 2010 in a new clinical model including gender, age, diagnosis, and average latency before appointment. We also looked at the rates of no shows and of follow-ups.

Results:  The clinic is staffed by a neurodevelopmental pediatrician and a receptionist.  Evaluations follow this protocol:  a 90 minutes diagnostic visit that includes neurodevelopmental and medical history; review of a parental intake form and of Early Intervention evaluation; neurodevelopmental testing including ADOS and/or Mullen administration based on presenting concerns and behavioral observations; physical examination. Diagnosis and recommendations are discussed during the same session and families are provided with a letter to their Early Intervention Program or school system describing the diagnosis and recommended services. A full report describing the full visit follows afterwards. Other medical referrals are made as needed. When there is a diagnosis of ASD, the family is given extensive information about the disorder and contact information to access an autism resource specialist. All children are scheduled for a follow-up in 2-3 months. During the period January 2009 to September 2010, 91 children were evaluated; 59 (64.8%) were males and 32 (35.2%) were females. Five (5.5%) did not keep their appointment. Age ranged between 7 and 36 months with an average of 28 months. Duration of wait between parental referral and evaluation visit varied between 2 and 4 months with an average of 3 months. A diagnosis of ASD was provided in 55 (60.4%), Language Delay in 18 (19.8%), Developmental Delay in 16 (17.6%), Behavioral Disorder, NOS in 1 (1.1%) and At Risk in 1 (1.1%). Forty-Four (48.4%) came for at least 1 follow-up within 6 months and of these 4 (4.4%) changed diagnosis: 3 changed from developmental delay or language delay to PDD,NOS and one from PDD,NOS to language disorder.

Conclusions:  The clinical protocol described was successful in providing quick and efficient diagnostic evaluations for children younger than 3 years with concerns suggesting an autism spectrum disorder or developmental delay.