Understanding General Practitioners’ Knowledge, Attitudes and Experiences in the Recognition and Management of Individuals on the Autism Spectrum
In many countries, the general practitioner (GP) or primary care physician plays a key role in the identification and management of children, young people and adults on the autism spectrum. In the United Kingdom (UK), they are often the first port of call for those seeking assistance for a suspected autism diagnosis. However, changing definitions of autism, the substantial heterogeneity both between and within individuals, and the prevalence of co-occurring conditions in many autistic children and adults all present serious difficulties to non-specialist clinicians. Indeed parents of autistic children, and autistic individuals themselves, often report dissatisfaction with their healthcare experiences, especially regarding the diagnostic process.
In the UK, there have been recent calls for increased autism training for GPs and other frontline professionals, yet there is a paucity of research on what GPs currently know about autism and how confident they feel in making clinical decisions for their patients. We therefore conducted the first study to our knowledge to determine GPs’ level of existing autism knowledge and experience, and their perceived confidence in working with autistic patients.
An online survey was sent to registered GPs based in the UK. The survey collected responses on participants’ (1) background, training and experience as a GP, (2) a 22-item knowledge of autism questionnaire and (3) a 14-item self-efficacy scale targeting GPs’ confidence in their abilities around the diagnosis and management of autism, and (4) an open question eliciting participants’ experiences on working with autism.
304 participants completed all three parts of the survey, with 91% indicating that in the past year they had been approached by at least 1 patient about a suspected autism diagnosis, with the majority (78%) being approached by up to 5 people. GPs generally scored highly on the knowledge of autism scale (mean=19.4 out of 22) – despite 40% reporting never having received formal training about autism. Nevertheless, participants reported remarkably limited confidence in their abilities to identify and manage their autistic patients, with many citing a number of barriers including unclear referral pathways and limited local support services. Perceived self-efficacy was also significantly associated with personal experience of autism and the amount of autism training received.
GPs’ confidence may well play a role in their decisions to refer – or not to refer – children or adults for further diagnostic assessment for autism. Efforts to enhance perceived self-efficacy are therefore much needed. Our findings suggest that initiatives targeted towards training on autism and greater clarity around referral pathways for diagnosis of autism should be key priorities in order to improve both GPs’ confidence in caring for their autistic patients and autistic people’s experiences with GPs. In England, local clinical commissioning groups (CCGs) are best served to assist GPs in ensuring that they can reliably detect the condition and make appropriate provisions for support.