Confidence of Pediatric Primary Care Clinicians in Autism Screener Score and Their Own Diagnostic Impressions

Autism-specific screening and developmental surveillance in primary care aid identification of autism. In this study, we assessed primary care clinicians' (PCCs') reported confidence in screening scores from the Modified Checklist for Autism in Toddlers, Revised (M-CHAT-R) and in their own diagnostic impressions. Four PCCs provided data for 50 children aged 16-36 months for whom they had any developmental concern. PCCs' diagnostic impressions were "Definitely Autism" for 15 children (30%), "Unsure-Needs Further Evaluation" for 25 children (50%) and "Definitely Not Autism" for 10 children (20%). They reported High Confidence on the screener score in 33 cases (66%). Of the 17 cases for whom PCCs reported having Low Confidence on the M-CHAT-R, 14 children (82.3%) had a Low Likelihood score, with no significant association between M-CHAT-R likelihood and PCC's confidence in the screening score. PCCs' diagnostic impressions were concordant with the M-CHAT-R autism likelihood in 42% of cases, with a significantly higher mean in confidence rating when compared to the non-concordant cases. Language development and social engagement were the most frequently endorsed concerns by PCCs, with significant associations between these concerns and M-CHAT-R likelihood. Our results suggest that, when developmental concerns exist, PCCs may place greater confidence in the M-CHAT-R when scores indicate a higher likelihood of autism, and that confidence in their own diagnostic impressions may be associated with concordance with the screener score.