Training Pediatricians to Implement Autism-Specific Screening Tools: A Review of the Literature

Background: The American Academy of Pediatrics recommends using an autism-specific screening tool for all young children at primary care well visits. Screening can detect risk of Autism Spectrum Disorder (ASD) in young children whose parents and pediatrician may not have developmental concerns. The identification of children with or at-risk for ASD increases their access to early intervention services, which helps ameliorate skill deficits associated with Autism. Recent studies indicate pediatricians use autism-specific screening tools infrequently. Some research has been conducted to determine whether providing training to primary care providers increases screening practices; however, evidence-based practices for training pediatricians to conduct ASD-screenings have not been identified. We conducted a review of the research on training primary care providers (e.g., pediatricians) to conduct ASD-screenings with young children and their families. This information can be used to advance research, policy, and practice.

Objectives: The purpose of this review was to systematically review the research on training primary care providers to conduct ASD screenings including challenges related to their use and describe the findings.

Methods: Our literature search included terms for participants (pediatrician* OR doctor* OR physician* OR clinic* OR primary care), intervention (professional development OR training* OR workshop* OR course OR teaching), and outcome (screen* OR diagnos* OR intervention* OR ADOS* OR M-CHAT* OR Autis*). Article screening was conducted in three steps: title screening, abstract screening, and full-text screening. Two coders extracted data related to population, design, independent variable characteristics, and study outcomes. All studies were evaluated using Cochrane’s Risk of Bias tool.

Results: Few studies reported characteristics of participants. Five of the 12 studies reported inclusion criteria for providers. Most studies reported the setting; all reported on-site training. >50% of the studies reported objectives; they included goals related to knowledge/education and practice improvement. A variety of screening tools were used across studies. 75% of the studies reported an increase in the use of the screening tools following training. 66% included surveys, which reported increases in provider confidence and likelihood to use the tool. Knowledge consistently increased while the resulting referral rates varied by study and age group. All studies were rated as having a high risk of bias.

Conclusions: Overall, there is a lack of high-quality research in this area. Few research groups have conducted studies examining the effect of training primary care providers to implement Autism-specific screening tools. Methodological details in several studies were insufficient for replication. Furthermore, several studies included more than one training method, making it difficult to determine which parts of the training package were effective. Several directions for future research are suggested. Component analyses should be conducted to determine the most effective parts of training. Future studies should be held to higher rigor standards and work to decrease bias. Additionally, given changes in provider confidence, knowledge, and practice were observed, future research should investigate the cause of the increase in screenings. Finally, given the limited availability of resources for evaluations and early intervention, future research should investigate the costs and benefits associated with universal screening for Autism.