Autism Screening in Pediatric Primary Care

Background: Autism spectrum disorder (ASD) is a neurodevelopmental condition impacting communication, social interaction, and independence, with an estimated prevalence of 1 in 36 children in the United States (Maenner et al., 2023). Despite guidelines recommending ASD screening at 18 and 24 months, the average diagnosis age remains significantly delayed at over four years, underscoring the need for improved early identification methods (Van ’t Hof et al., 2020). Delays are further compounded by gender differences, symptom variability, and co-occurring conditions (Kentrou et al., 2019). Objective: To implement and evaluate the effectiveness of a universal screening protocol using the Autism Spectrum Screening Questionnaire (ASSQ) in a pediatric primary care setting, targeting youth aged 6–17 years during well-child visits. Methods: This quality improvement project integrated the ASSQ into routine pediatric well visits across two practice locations over eight weeks. Screening data were captured via electronic medical records, and referrals for formal ASD evaluation were initiated for positive screens. Screening rates, positive cases, and referral adherence were assessed. Results: Of 998 eligible patients, 869 (87.07%) were screened using the ASSQ, identifying 52 positive screens. After excluding 11 patients with pre-existing ASD diagnoses, 41 youth (4.72%) were newly identified with probable ASD. Positive screens were more common in boys (60.98%) and white youth (73.17%) aged 8–9 years. However, only 41.46% of positive cases resulted in referrals, with barriers such as stigma and caregiver comprehension of the screening tool contributing to under-referral. Conclusion: The implementation of the ASSQ successfully increased ASD screening rates and identified probable cases, demonstrating its feasibility in pediatric primary care. To optimize outcomes, addressing referral barriers and enhancing caregiver and provider education is crucial. Future research should explore long-term diagnostic impacts and expand screening across diverse populations.