A Qualitative Analysis of Pediatricians’ Perspectives Regarding Barriers, Facilitators, and Strategies for Providing Timely Autism Spectrum Disorder Screening and Diagnosis

Background: Autism spectrum disorder (ASD) is a developmental disorder that has increased in prevalence over the years. Diagnosis and subsequent intervention by the age of 3 is essential for development. However, recent estimates indicate that less than 50% of children receive an evaluation by age 3. Underserved populations are more likely to receive an evaluation at an older age. Several barriers in the diagnostic process have been identified; however, limited studies have aimed at understanding the specifics of these barriers among underserved populations and whether current strategies are beneficial for all children. Objectives: The aim of this study was to identify barriers and strategies, as reported by pediatricians serving underserved populations, to enhance timely screening and diagnosis of ASD. Design: A qualitative study was conducted. Methods: Semi-structured interviews were conducted with general pediatricians and subspecialists (N = 14) practicing in the Greater Houston area, Texas. Thematic analysis was conducted using inductive reasoning. Results: Participants were majority White (50%), female (79%), practicing in hospital-based settings (64%), with 3 to 5 years of professional experience (64%) and a mean age of 50 years. Three themes were identified (1) barriers causing delays in ASD screening and diagnosis; (2) individualized approaches in pediatric care to address barriers, and (3) recommendations to improve timely ASD screening and diagnosis. Conclusion: The results of this study identified potential strategies to overcome access, availability, and knowledge barriers; however, the lack of standardization across the health system results in the continued reporting of significant barriers. Using a health equity approach is key to ensure improvements in timely screening and diagnosing by tailoring strategies to the population being served. Health systems should work on expanding and evaluating identified strategies. Additionally, improve education for providers and parents to address parental hesitancy, increase attendance with routine well-child checks, and improve ASD evaluation referrals.