PT  - JOURNAL ARTICLE
AU  - Hansen, Robin L.
AU  - Blum, Nathan J.
AU  - Gaham, Amy
AU  - Shults, Justine
AU  - , 
TI  - Diagnosis of Autism Spectrum Disorder by Developmental-Behavioral Pediatricians in Academic Centers: A DBPNet Study
AID  - 10.1542/peds.2015-2851F
DP  - 2016 Feb 01
TA  - Pediatrics
PG  - S79--S89
VI  - 137
IP  - Supplement 2
4099  - http://pediatrics.aappublications.org/content/137/Supplement_2/S79.short
4100  - http://pediatrics.aappublications.org/content/137/Supplement_2/S79.full
SO  - Pediatrics2016 Feb 01; 137
AB  - OBJECTIVES: To describe the clinical practices of physicians in the Developmental-Behavioral Pediatrics Network (DBPNet) to (1) diagnose autism spectrum disorders (ASDs), identify comorbidities, and evaluate etiology and (2) compare actual practice to established guidelines.METHODS: A total of 56 developmental-behavioral pediatricians completed encounter forms, including demographic/clinical information, for up to 10 consecutive new-patient visits given a diagnosis of ASD. Data were summarized by using descriptive statistics. Analysis of the statistical significance of differences between sites (n = 10) used general estimating equations and mixed-effects logistic regression to adjust for clustering by clinician within site.RESULTS: A total of 284 ASD forms were submitted. Most assessments (56%) were completed in 1 visit (27.5% in 2 visits, 8.6% in 3 visits). Use of the Childhood Autism Rating Scale, Autism Diagnostic Observation Schedule, or Screening Tool for Autism in Toddlers and Young Children varied across sites from 28.6% to 100% of encounters (P < .001). A developmental assessment was reviewed/completed at 87.7% of encounters (range: 77.8%–100%; P = .061), parent behavior rating scales were reviewed/completed at 65.9% (range: 35.7%–91.4%; P = .19), and teacher behavior rating scales were reviewed/completed at 38.4% (range: 15%–69.2%; P = .19). Only 17.3% (95% confidence interval: 12.8%–21.7%) of evaluations were completed by an interdisciplinary team. A majority (71%) of patients had at least 1 comorbid diagnosis (31% had at least 2 and 12% at had least 3). Etiologic evaluations were primarily genetic (karyotype: 49%; microarray: 69.7%; fragile X: 71.5%).CONCLUSIONS: Despite site variability, the majority of diagnostic evaluations for ASD within DBPNet were completed by developmental-behavioral pediatricians without an interdisciplinary team and included a developmental assessment, ASD-specific assessment tools, and parent behavior rating scales. These findings document the multiple components of assessment used by DBPNet physicians and where they align with existing guidelines.