Taylor Patrice Dorlack
Published: 2022
Total Pages: 0
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Early identification, referral, diagnosis, and intervention are critical to the promotion of lifelong positive developmental trajectories for individuals with autism spectrum disorders (ASD). Although psychometrically sound screening and diagnostic assessment measures exist and a reliable diagnosis of ASD can be made before children are two years of age, the average age of official diagnosis is well over four years. While research has shed some initial light on factors associated with delayed identification, referral, and diagnosis of ASD, all issues have been examined through population-level analyses based on retrospective caregiver self-report. Further, although suggested as an important research direction to confirm clinical information, no studies to date have analyzed factors associated with the pathway toward referral for ASD and subsequent diagnosis of ASD through examination of data reported in electronic health records. Thus, to address these limitations and develop a greater understanding of the pathway towards referral and diagnosis, the current exploratory study sought to examine clinical information from the electronic health records of all infants, children, and adolescents who were seen by a provider for an initial diagnostic visit in a specialty diagnostic clinic within a one-year period (September 12, 2019 - September 12, 2020). An array of child-related, family-related, and referring healthcare provider-related factors were examined as predictor variables to determine their association with match of referral for ASD and subsequent diagnosis of ASD, as well as to identify if there were specific factors that were consistently associated with early identification and referral of children at or under the age of three (younger than 47 months). Results indicated that 19 diagnostic (developmental, social-emotional, and medical disorders), demographic (race/ethnicity, sex, age, and geographic location), historical (caregiver-reported concerns), and professional licensure (provider practice type) factors and factor combinations predicted match of referral and diagnosis with ASD, while 35 separate diagnostic (developmental and social-emotional disorders), service provision (early and therapeutic supports), historical (caregiver-reported concerns), professional licensure (provider practice and role type), and clinical practice (screening conduction) factors and factor combinations were associated with timeliness of referral. These findings suggest important considerations for clinical practice and training, as well as highlight future research directions.