Enhancing Diagnostic Follow-up and Care Coordination for Children with Autism in a Busy Resident Continuity Clinic: Leveraging the Electronic Health Record.
A five-minute glance can spot most autism cases but still misses one in four kids.
01Research in Context
What this study did
Doctors watched kids for just five minutes during a busy clinic visit.
They later checked if those quick guesses matched the final autism diagnosis.
The kids were toddlers and preschoolers seeing residents for regular care.
How this fits with other research
Canale et al. (2024) did almost the same thing with teens and adults. Both studies found the five-minute look works but misses some cases.
Eggleston et al. (2018) showed teacher checklists also miss over a third of kids. Quick tools—whether eyeball or form—share the same blind spot.
Meimei et al. (2022) reviewed telehealth screens. Their pooled miss rate lines up with the 24 % this study found. Fast screens help speed things up, but none are perfect.
Why it matters
You can use a five-minute scan to flag kids who need full testing. Never use it to say a child does not have autism. When in doubt, always refer for a complete evaluation.
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02At a glance
03Original abstract
Diagnosticians report that autism spectrum disorder (ASD) is immediately apparent in some, but not all, children ultimately diagnosed. Clinicians' initial diagnostic impressions have implications for ASD early detection, yet the literature raises questions about their accuracy. This study explores diagnostic impressions of ASD specialists made within the first 5 minutes of meeting a young child and investigates factors associated with the match between initial impressions and final diagnoses. Participants were children (n = 294, aged 12-53 months) referred for an ASD evaluation as part of multi-site ASD screening studies. After 5 minutes observing each child, clinicians with expertise diagnosing ASD recorded if they thought the child would meet criteria for ASD following a complete evaluation, and recorded their confidence in this impression. Clinicians' initial impressions matched the final diagnosis in 81% of cases. Ninety-two percent of cases initially thought to have ASD met criteria following a full evaluation; however, 24% of cases initially thought not to have ASD also met criteria, suggesting a high miss rate. Clinicians were generally confident in their initial impressions, reporting highest confidence for children initially thought correctly not to have ASD. ASD behavioral presentation, but not demographic characteristics or developmental level, were associated with matching initial impression and final diagnosis, and confidence. Brief observations indicating ASD should trigger referral to intervention services, but are likely to under-detect positive cases and should not be used to rule out ASD, highlighting the need to incorporate information beyond initial clinical impression. LAY SUMMARY: When children come in for an autism evaluation, clinicians often form early impressions-before doing any formal testing-about whether the child has autism. We studied how often these early impressions match the final diagnosis, and found that clinicians could not easily rule out autism (many children who initially appeared not to have autism were ultimately diagnosed), but were generally accurate ruling in autism (when a child appeared to have autism within 5 minutes, they were almost always so diagnosed).
Journal of autism and developmental disorders, 2025 · doi:10.1371/journal.pone.0232335