ECHO (Extension for Community Healthcare Outcomes) Autism STAT: A Diagnostic Accuracy Study of Community-Based Primary Care Diagnosis of Autism Spectrum Disorder.

OBJECTIVE: Children can be reliably diagnosed with autism spectrum disorder (ASD) by a highly trained clinician as early as 12 to 24 months of age, but recent estimates indicate that the average age of diagnosis is 4.4 years. We hypothesized that trained primary care physicians and practitioners can reliably and accurately diagnose children 14 to 48 months with unambiguous symptoms of ASD. METHODS: Through this diagnostic accuracy study, 20 patients diagnosed with ASD by clinicians trained through the ECHO (Extension for Community Healthcare Outcomes) Autism STAT program participated in an independent gold-standard evaluation at a regional autism center. Caregiver perceptions of the diagnostic process were also assessed. RESULTS: Of the 20 patients who received a diagnosis of ASD by a trained clinician and completed the study, 19 diagnoses were confirmed by a gold-standard evaluation. Caregivers indicated that undergoing diagnosis in their local community rather than an autism specialty center was helpful (4.8/5 on a 5-point Likert scale, n = 19). Results of this study demonstrate that primary care clinicians can be trained to reliably diagnose ASD in children 14 to 48 months with unambiguous symptoms. CONCLUSION: Diagnosis in the primary care setting may lead to earlier diagnosis and quicker connection to evidence-based therapies and interventions. Given the potential impact of increasing access to high-quality diagnostic services, the role of primary care clinicians in the diagnosis of ASD should be further evaluated.

Sensitivity and specificity of the autism diagnostic inventory-telephone screening in Spanish.

We report on the development in Argentina of a screening questionnaire for autism administered over the telephone. The Autism Diagnostic Inventory-Telephone Screening in Spanish (ADI-TSS) is based on the Autism Diagnostic Interview-Revised (ADI-R), keeping its structure but including fewer questions, which were rephrased to assess them over the telephone. The ADI-TSS went through different versions, with each modification gaining in reliability. The final version of the ADI-TSS could be assessed in 20 to 40 minutes and demonstrated a high validity (using the ADI-R as the diagnostic gold-standard), high intrarater and interrater reliability (as measured with intraclass correlations), and high internal consistency (as measured with Cronbach's alpha). The validity of the ADI-TSS remained high when used by a health-related professional without formal training in the assessment of autistic patients. We believe the ADI-TSS is useful in field research studies as a screening instrument for patients with a potential diagnosis of autism, although future validation studies should include larger samples.