title: Diagnosis of Autism Spectrum Disorder by Developmental-Behavioral Pediatricians in Academic Centers: A DBPNet Study.
abstract: To describe the clinical practices of physicians in the Developmental-Behavioral Pediatrics Network (DBPNet) to (1) diagnose autism spectrum disorders (ASDs), identify comorbidities, and evaluate etiology and (2) compare actual practice to established guidelines.
  
  
  
  A total of 56 developmental-behavioral pediatricians completed encounter forms, including demographic/clinical information, for up to 10 consecutive new-patient visits given a diagnosis of ASD. Data were summarized by using descriptive statistics. Analysis of the statistical significance of differences between sites (n = 10) used general estimating equations and mixed-effects logistic regression to adjust for clustering by clinician within site.
  
  
  
  A total of 284 ASD forms were submitted. Most assessments (56%) were completed in 1 visit (27.5% in 2 visits, 8.6% in 3 visits). Use of the Childhood Autism Rating Scale, Autism Diagnostic Observation Schedule, or Screening Tool for Autism in Toddlers and Young Children varied across sites from 28.6% to 100% of encounters (P < .001). A developmental assessment was reviewed/completed at 87.7% of encounters (range: 77.8%-100%; P = .061), parent behavior rating scales were reviewed/completed at 65.9% (range: 35.7%-91.4%; P = .19), and teacher behavior rating scales were reviewed/completed at 38.4% (range: 15%-69.2%; P = .19). Only 17.3% (95% confidence interval: 12.8%-21.7%) of evaluations were completed by an interdisciplinary team. A majority (71%) of patients had at least 1 comorbid diagnosis (31% had at least 2 and 12% at had least 3). Etiologic evaluations were primarily genetic (karyotype: 49%; microarray: 69.7%; fragile X: 71.5%).
  
  
  
  Despite site variability, the majority of diagnostic evaluations for ASD within DBPNet were completed by developmental-behavioral pediatricians without an interdisciplinary team and included a developmental assessment, ASD-specific assessment tools, and parent behavior rating scales. These findings document the multiple components of assessment used by DBPNet physicians and where they align with existing guidelines.
authors.affiliation: Department of Pediatrics, University of California-Davis School of Medicine, Davis, California; MIND Institute, University of California-Davis, Sacramento, California; rlhansen@ucdavis.edu.
authors.forename: Robin L
authors.initials: RL
authors.lastname: Hansen
authors.affiliation: Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Nathan J
authors.initials: NJ
authors.lastname: Blum
authors.affiliation: Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and.
authors.forename: Amy
authors.initials: A
authors.lastname: Gaham
authors.affiliation: Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Justine
authors.initials: J
authors.lastname: Shults
mesh_terms: D000046:Academic Medical Centers; D000067877:Autism Spectrum Disorder / Q000175:diagnosis*; D002648:Child; D002657:Child Development; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D010348:Patient Care Team; D010372:Pediatrics; D010818:Practice Patterns, Physicians'; D011795:Surveys and Questionnaires; D014481:United States