Concordance of diagnosis of autism spectrum disorder made by pediatricians vs multidisciplinary specialist teams

1. High accuracy of concordance of autism spectrum disorder (ASD) diagnosis between general pediatricians and expert multidisciplinary teams when pediatricians felt confident about autism assessment

2.  Lower accuracy was seen when ruling out ASD

Evidence Rating Level: 2 (Good)

Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by challenges in social communication and interaction, and the presence of restrictive and repetitive behaviors, interests, and activities. Currently, many guidelines recommend that multidisciplinary teams (MDTs) be involved in all ASD diagnostic assessments, however with increased demand and wait times, this may delay therapies for ASD. It is known that timely ASD diagnosis facilitates access to support sooner, positively impacting development and improving outcomes and allowing general pediatricians to diagnose ASD may help with facilitating time to therapy. This prospective study aimed to identify agreement between general pediatricians and subspecialist MDT ASD assessment. Patients were allocated into two groups, one who had their MDT visits before pediatrician assessment and one who had their MDT visits after pedestrian assessments to reduce in bias in parental reports of symptoms. Both general pediatricians and MDT completed a decision on whether they believed the child met diagnostic criteria for ASD, as well as a Likert scale indicating level of certainty of diagnosis. Sensitivity and specificity of pediatrician assessments versus MDT were 0.75 (95% CI, 0.67-0.83) and 0.79 (95% CI, 0.62-0.91), respectively. The positive predictive value pediatrician assessments was 0.89 and the negative predictive value was 0.60. Higher pediatrician certainty was associated with increased diagnostic accuracy. This study shows that general pediatricians have a high likelihood of correctly diagnosing ASD, especially in conditions in which they feel certain. Limitations to this study include that pediatricians were self-selected, thus likely more interested in ASD and not representative of all general pediatricians. Future studies involving more general pediatricians and development of guidelines for the diagnosis of ASD within general practices may help those with ASD reach earlier diagnoses and seek earlier treatment.

Click to read the study in JAMA Network Open

Image: PD

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