Executive Summary: Increasing Autism Spectrum Disorder Screening and Referrals in a Pediatric Clinic

 

 

 

 

 

Executive Summary: Increasing Autism Spectrum Disorder Screening

and Referrals in a Pediatric Clinic

 

Amber Barney, RN, MSN, MBA, APRN, CPNP

School of Nursing, Purdue University

 

Chair: Azza H. Ahmed, DNS, RN, IBCLC, CPNP

Committee Member: Karen J. Foli, MSN, PhD, RN, FAAN

Committee Member: Rose Mason, Ph.D., BCBA-D

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Problem Statement and Significance

According to the Centers for Disease Control and Prevention (CDC) (2019), developmental delays occur in approximately 5% to 15% of all children. Without the use of standardized screening tools, 70% of those with developmental delays are not properly diagnosed. This also postpones intervention and treatments for those patients with developmental concerns (Agarwal et al., 2020). There has been a marked increase over the last ten years of patients with developmental delays given a concurrent diagnosis on the autism spectrum.  According to the most recent estimates, 1 out of 59 children has a diagnosis of autism spectrum disorder (ASD) (CDC, 2019). 

The earlier the ASD diagnosis can be made, the earlier intervention, therapies, and support can be provided for the child. The development of the Modified Checklist for Autism in Toddlers, Revised with Follow-up (MCHAT-R/F; Robins, et al., 2014) has shown to be statistically reliable in helping to diagnose children as young as 18-months of age with ASD. The utilization of the MCHAT-R/F screening tool has allowed for diagnosis to occur two years ahead of the national median diagnostic age for ASD, which has provided the opportunity for earlier intervention and support for these patients and their families (Robins et al., 2014). An additional screening tool, the Ages and Stages Questionnaire (ASQ 3; Agarwal, et al., 2020) is also encouraged at 18- and 24-months in conjunction with the MCHAT-R/F to further assess the presence of developmental delay and behavioral concerns. 

The screening process can be considered logistically cumbersome. The MCHAT-R/F and ASQ 3 assessments have multiple, detailed developmental questions for the parents to answer about their child’s current abilities and behaviors. There are also open-ended questions regarding family history and any other concerns the parents may have about their growing child’s development and behaviors (Yuen et al., 2018).  The parents are typically given these tools to complete while waiting for the healthcare provider (i.e., physician or nurse practitioner) to come into the room for their well-child exam. The task of concentrating on these questions and responding, all while caring for a toddler often prove difficult, with the parent frequently leaving the tool unfinished when the healthcare provider enters the room for the examination (Fenikile et al., 2015). Optimally, the MCHAT-R/F and ASQ 3 data would be available during the visit with the healthcare provider so that scoring can be completed and areas of concern addressed with the parent during the visit. According to a study by Salisbury et al. (2017), when the tools are completed prior to the examination, education and dialogue can occur in real time with the healthcare provider and the parent.

Therefore, the primary purpose of this project was to improve the current MCHAT-R/F and ASQ 3 screening process; to facilitate early screening of children for autism and developmental delays at 18-months and 24-months at their well-child exams; and to support necessary referrals for those children who score as borderline on developmental milestones or score as high risk for autism on the MCHAT-R/F and/or ASQ 3 screening.

Methodology

Setting

This study took place at North Central Indiana Pediatric Center, the largest pediatric clinic affiliated with Community Hospital Network in Central Indiana. The pediatric office employs four pediatricians, four certified pediatric nurse practitioners, eight medical assistants, four front office staff, four triage nurses, a clinical nurse supervisor, a front office supervisor, and a practice administrator. This pediatric office is a growing practice, currently caring for over 11,000 pediatric patients in the North-Central Indiana region. 

Study Design

A quality improvement (QI) approach was utilized to address the proposed outcome measures for this study. Edward Deming’s Plan-Do-Study-Act model provided a framework for the quality improv

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