Autism diagnostic impressions in young children formed by primary care clinicians and through telemedicine expert assessments.
When doctors say 'definite autism' or telehealth experts feel highly confident, start services immediately—they are usually right.
01Research in Context
What this study did
Wieckowski et al. (2025) asked two groups to spot autism in toddlers. One group was local primary-care doctors. The other group was autism experts watching short videos on telehealth.
Both groups gave quick yes-or-no impressions. The study then checked if those early hunches matched the child’s final diagnosis.
What they found
When a primary-care doctor said 'definite autism,' the child always turned out to have autism. That is 100% accuracy.
Telehealth experts were right 88% of the time, but only when they felt highly confident. Low-confidence guesses were less reliable.
How this fits with other research
Christensen et al. (2024) saw the same pattern in person. Five-minute clips let clinicians spot autism with 100% specificity. Trubanova’s telehealth results match that speed and accuracy, so the method still works through a screen.
Older M-CHAT papers (T et al. 2001; L et al. 2001) showed parent questionnaires catch many cases at 18 months. Trubanova adds that expert eyes, not just forms, can act fast.
van der Miesen et al. (2024) warned that kids with spotty nonverbal signs are often missed by screens. Trubanova’s high-confidence rule helps catch those easy-to-miss toddlers because experts rely on clear social cues.
Why it matters
You can trust a local pediatrician who says 'definite autism.' Start services right away instead of waiting months for a full work-up. If you use telehealth, only act when the remote expert rates confidence as high. Pair this speed with later full assessments, but do not let red-flag kids sit on wait-lists.
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02At a glance
03Original abstract
Formal autism diagnosis is often critical for children to access early, autism-specific services and supports. However, barriers to traditional in-person evaluations, including long waitlists, delay diagnosis. The goal of the current study was to compare diagnostic impressions (i.e. clinical judgments) made by primary care clinicians and autism experts conducting brief telehealth sessions, with expert diagnosis from in-person gold-standard evaluations. Participants were toddlers (n = 32, age 12-36 months) referred for any developmental concerns by four primary care clinicians from one pediatric practice in the United States. Primary care clinicians indicated their diagnostic classification and families then completed telehealth evaluations and in-person evaluations with one of five autism diagnostic expert clinicians. When primary care clinicians classified a child as having definite autism (n = 11), they were 100% accurate, but only 57% accurate when they indicated a child definitely did not have autism. Experts providing classification after a telehealth evaluation accurately classified 72% of children and were confident in the diagnosis for 55% of cases. In high-confidence cases, telehealth diagnosis matched final diagnosis 88% of the time. These findings indicate that when primary care clinicians believe a toddler is autistic, or when autism experts indicate autism telehealth classification with confidence, the child should begin receiving autism-specific services and supports right away.Lay abstractThere are long waitlists for autism evaluations, which greatly delay the start of interventions that are known to improve children's outcomes. We tested the accuracy of primary care clinicians' impressions of autism versus other developmental delays during well-child visits, and of experts during brief telemedicine visits, and found that more than half of the children were accurately identified through these streamlined methods. These findings support a tiered approach in which children identified through these more efficient methods begin autism intervention immediately; this approach also benefits children with more complex differentials by shortening waitlists for comprehensive evaluations for those who require them prior to treatment entry.
Autism : the international journal of research and practice, 2025 · doi:10.1177/13623613251355257