title: Barriers to autism screening in family medicine practice: a qualitative study.
abstract: OBJECTIVE
  We explored potential barriers to adoption of recommended screening for autism by family physicians at 18- and 24-month well-child visits.
  
  
  BACKGROUND
  The American Academy of Pediatrics recommends early detection and intervention of autism through the use of a standardized autism-specific screening tool on all children at the 18- and 24-month well-child visits. However, not all family physicians screen for autism.
  
  
  METHODS
  Three focus groups and six semi-structured interviews were conducted with 15 family physicians in the Kansas City metropolitan area. Verbatim transcripts were inductively coded; data were analyzed using standard text analysis.
  
  
  RESULTS
  Participants had differing views on the increased incidence of autism. Most participants attributed the increase to changes in diagnostic criteria. There was no consensus on the benefit of implementing universal screening for autism during the 18- or 24-month visit. Many preferred to identify potential problems through general developmental assessments and observations. No participants used specific screening tools for autism, and only one participant was aware of such a tool (M-CHAT). Lack of adequate training on child development and screening methods as well as limited availability of community-based resources to manage children with autism was seen as major barriers to routine screening. Suggested solutions included working toward a stronger evidence base, improving physician training and continuing education, and making systemic changes in healthcare. In conclusion, universal screening for autism at the 18- and 24-month visits is not widely accepted, nor is it implemented by family physicians.
authors.affiliation: 1Department of Pediatrics,University of Kansas Medical Center,Kansas City,Kansas,USA.
authors.forename: Tsehaiwork Sunny
authors.initials: TS
authors.lastname: Fenikilé
authors.affiliation: 1Department of Pediatrics,University of Kansas Medical Center,Kansas City,Kansas,USA.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Ellerbeck
authors.affiliation: 3Department of Family Medicine,University of Kansas Medical Center,Kansas City,Kansas,USA.
authors.forename: Melissa K
authors.initials: MK
authors.lastname: Filippi
authors.affiliation: 3Department of Family Medicine,University of Kansas Medical Center,Kansas City,Kansas,USA.
authors.forename: Christine M
authors.initials: CM
authors.lastname: Daley
mesh_terms: D001321:Autistic Disorder / Q000175:diagnosis*; D002675:Child, Preschool; D005194:Family Practice / Q000706:statistics & numerical data*; D005260:Female; D017144:Focus Groups; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007407:Interviews as Topic; D007615:Kansas; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data*; D010372:Pediatrics / Q000706:statistics & numerical data*; D010821:Physicians, Family / Q000706:statistics & numerical data; D017410:Practice Guidelines as Topic; D036301:Qualitative Research; D011795:Surveys and Questionnaires
keywords: autism; autism screening; barriers; family medicine