TY - JOUR
T1 - What Drives Detection and Diagnosis of Autism Spectrum Disorder? Looking Under the Hood of a Multi-stage Screening Process in Early Intervention
AU - Sheldrick, R. Christopher
AU - Frenette, Elizabeth
AU - Vera, Juan Diego
AU - Mackie, Thomas I.
AU - Martinez-Pedraza, Frances
AU - Hoch, Noah
AU - Eisenhower, Abbey
AU - Fettig, Angel
AU - Carter, Alice S.
N1 - Funding Information:
Acknowledgments The ABCD Project Team gratefully acknowledges the numerous people who helped shape our learning over the past several years and who provided specific statements on this article, as well as support from HRSA and from NIMH grant R01MH104400. We also thank our Early Intervention collaborators for their enduring partnership and the caregivers who participated in this study for so generously sharing both their time and their experiences with us.
Funding Information:
This research was supported in part by a NIMH grant to Drs. Carter and Sheldrick (R01MH104400). Dr. Sheldrick is the co-creator of the POSI, which is one of the two screeners used in this study. He conducts research related to this instrument but receives no royalties. Dr. Carter is the co-creator of the BITSEA, which is one of the two screeners used in this study. She receives royalties related to the licensing of this instrument.
Publisher Copyright:
© 2019, Springer Science+Business Media, LLC, part of Springer Nature.
PY - 2019/6/15
Y1 - 2019/6/15
N2 - U.S. guidelines for detecting autism emphasize screening and also incorporate clinical judgment. However, most research focuses on the former. Among 1,654 children participating in a multi-stage screening protocol for autism, we used mixed methods to evaluate: (1) the effectiveness of a clinical decision rule that encouraged further assessment based not only on positive screening results, but also on parent or provider concern, and (2) the influence of shared decision-making on screening administration. Referrals based on concern alone were cost-effective in the current study, and reported concerns were stronger predictors than positive screens of time-to-complete referrals. Qualitative analyses suggest a dynamic relationship between parents’ concerns, providers’ concerns, and screening results that is central to facilitating shared decision-making and influencing diagnostic assessment.
AB - U.S. guidelines for detecting autism emphasize screening and also incorporate clinical judgment. However, most research focuses on the former. Among 1,654 children participating in a multi-stage screening protocol for autism, we used mixed methods to evaluate: (1) the effectiveness of a clinical decision rule that encouraged further assessment based not only on positive screening results, but also on parent or provider concern, and (2) the influence of shared decision-making on screening administration. Referrals based on concern alone were cost-effective in the current study, and reported concerns were stronger predictors than positive screens of time-to-complete referrals. Qualitative analyses suggest a dynamic relationship between parents’ concerns, providers’ concerns, and screening results that is central to facilitating shared decision-making and influencing diagnostic assessment.
KW - Autism spectrum disorder
KW - Costs
KW - Decision-making
KW - Process assessment
KW - Screening
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U2 - 10.1007/s10803-019-03913-5
DO - 10.1007/s10803-019-03913-5
M3 - Article
C2 - 30726534
AN - SCOPUS:85061214940
SN - 0162-3257
VL - 49
SP - 2304
EP - 2319
JO - Journal of Autism and Developmental Disorders
JF - Journal of Autism and Developmental Disorders
IS - 6
ER -