Perspectives of Non-Urban General Pediatricians on Diagnosing Autism Spectrum Disorders

Background: Long wait times for autism spectrum disorder (ASD) diagnosis contribute to delayed access to ASD interventions, which are most effective at young ages. General pediatricians (GPs) represent a potential resource for increasing diagnostic capacity and decreasing wait times for ASD diagnostic assessments. Previous work has described urban GPs’ opinions about their role in ASD diagnosis; however, no current research has solicited perspectives of non-urban GPs, whose practice realities may differ significantly.

Objectives: The objective of this project was to explore the perspectives of GPs practicing in smaller Ontario communities regarding their diagnostic processes and their role in ASD diagnostic assessment.

Methods: We performed a qualitative study using thematic analysis of GP's experiences with cases of suspected ASD. GPs from three small/medium-sized Ontario communities (population range: 14,000-64,000) were recruited to provide variation in perspectives. Semi-structured interviews were conducted, transcribed, and coded. A preliminary theoretical framework was developed and sent to participants with a request for feedback (member checking). Feedback did not necessitate any significant changes to the framework.

Results: 14 GPs participated in interviews (7 from Community A, 4 from Community B, 3 from Community C). All participants considered ASD diagnosis to be in the GP’s scope of practice and many considered it part of their service to their community. Many sought out and self-funded additional ASD training as necessitated by their practices. Our framework identified three stages in the diagnosis of ASD: pre-assessment (gathering information prior to the first clinic visit), diagnosis, and service access. All of these stages are influenced by ecological factors including the individual patient/family, individual physician factors, factors reflecting the GP’s community group practice (i.e., how the group has decided its members will approach cases of suspected ASD), and factors concerning the broader system of ASD care.

Conclusions: GPs practicing in small and medium-sized Ontario communities routinely diagnose ASD and see this as part of their scope of practice. Compared to their urban counterparts, they emphasized a stronger sense of responsibility to their colleagues and to their communities. Strategies aimed at increasing diagnostic capacity should target group practices, increase availability of ASD specific training programs, and improve efficiency of clinic visits through pre-clinic information gathering. Further research regarding accuracy of GP assessments as well as patient perspectives is required.