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Canadian pediatricians may miss many children with autism

by  /  11 May 2018
Rookie mistake: Pediatricians in Canada incorrectly ruled out autism in 14 children who have the condition.

SeventyFour / iStock

‘General pediatricians’ in Canada disagree with specialists 25 percent of the time on whether a child should receive an autism diagnosis. In particular, they incorrectly flag a significant proportion of children with autism as not having the condition. The unpublished results were presented yesterday at the 2018 International Society for Autism Research (INSAR) annual meeting in Rotterdam, the Netherlands.

The work suggests that Canadian pediatricians can accurately assess some children for autism — and help cut down waiting times to see a specialist.

Other children may require an expert evaluation — say, if their autism features are subtle, says Melanie Penner, who presented the results. Pediatricians are still making mistakes, she says.

“What will we decide is a good number? I think that my answer is: I don’t know if there will ever be a number that’s less than 100 percent that people would really get behind,” says Penner, a clinician investigator and developmental pediatrician at the Bloorview Research Institute in Toronto. “The false negatives are the most concerning part of this to me.”

If certain features predict a pediatrician’s accuracy, children with those traits would not need to see a specialist. But no one knows yet which features are predictive, Penner says.

Team effort:

In Canada, children typically first visit a family doctor — who cares for a person of any age and provides most of the primary care — before being referred to a general pediatrician. A pediatrician can refer a child to a team of specialists if necessary.

Little research has focused on the autism diagnostic practices among this second tier of clinicians, Penner says. “Nobody really knew what they were doing.”

Last year, Penner and her colleagues published a qualitative study of 11 urban pediatricians, showing many of them think diagnosing autism is part of their responsibility1. Penner presented separate unpublished results at INSAR yesterday replicating those findings in another 14 pediatricians.

In the new work, Penner and her colleagues investigated whether pediatrician diagnoses are correct. She compared the diagnostic decisions of 13 pediatricians with those of 2 expert clinicians.

Using standard diagnostic methods, the expert team determined that 48 of 64 children aged 17 to 68 months have autism.

Using various procedures, the pediatricians correctly diagnosed 34 children with autism, but also flagged 3 children without the condition. They correctly identified 13 children — and incorrectly identified 14 — as not having the condition. The pediatricians recorded that they would not have referred 6 of those 14 for additional evaluation.

“Taken together, it seems that the ‘ruling in’ of autism seems to be less challenging, or easier, than the ‘ruling out’ piece,” Penner says. “I think that can help to refine and direct some of our future education with this group of providers.”

Penner and her colleagues plan to expand the study by recruiting 13 additional pediatricians and 196 children to get more robust results.

For more reports from the 2018 International Society for Autism Research annual meeting, please click here.


References:
  1. Penner M. et al. J. Dev. Behav. Pediatr. 38, 593-602 (2017) PubMed
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