606 - Predictors of Early Intervention Referral after a Positive Developmental Screen in Community Primary Care Clinics

Poster Number: 606
Publication Number: 606.310

Catrina A. Calub, Doernbecher Children's Hospital at Oregon Health & Science University, portland, OR, United States; Mohadeseh Solgi, Oregon Health and Science University, Portland, OR, United States; Alicia Feryn, Oregon Health & Science University School of Medicine, Portland, OR, United States; Eric J. Fombonne, Oregon Health & Science University, Portland, OR, United States; Cheryl Matushak, Oregon Pediatric Society, Portland, OR, United States; Abby Bush, Help Me Grow Oregon, Portland, OR, United States; Katharine Zuckerman, Oregon Health & Science University, Portland, OR, United States

Background: The American Academy of Pediatrics supports routine developmental and autism screening at well child visits in order to enhance early identification of children with disability. However, primary care physicians (PCPs) may rely on clinical judgement rather than screening test scores in making referral decisions.

Objective: This study investigated which patient and screening test factors predict a PCP’s IDEA Part C Early Intervention (EI) referral after a positive screening test result on the Ages & Stages Questionnaire, Third Edition (ASQ-3) and Modified Checklist for Autism in Toddlers-Revised (M-CHAT-R).

Design/Methods: Child developmental screening test results and EI referral decisions were collected via medical record review of 1,864 15-, 18-, 24- and 30-month well-child checks conducted at 7 community primary care clinics in 4 Oregon counties, in 2020-2021.  We created an ASQ-3 Composite score in which each failed, borderline and passed ASQ-3 domain score was given a score of 2, 1, and 0, respectively; ASQ-3 scores ≥ 2 (at least one fail or two borderlines) and/or M-CHAT-R scores ≥ 3 were considered positive screens. We then tested the association of receipt of EI referral with screening test scores and child demographic data (sex, language, race/ethnicity), using binary logistic regression. ASQ-3 domains and overall ASQ-3 and M-CHAT-R scores were considered separately.

Results: 59% of children with M-CHAT-R ≥3, and 47% of children with ASQ-3 ≥ 2 received EI referrals. 41% were not referred even after receiving an ASQ-3 cumulative score ≥ 5 (Figure 1). Multivariate analyses showed that M-CHAT-R score, ASQ-3 overall score, and all ASQ-3 domain scores except Problem Solving, predicted EI referral. The Communication domain accounted for the most variance in predicting EI referral (adjusted odds ratio [aOR]: 29.4, 95% confidence interval [CI]: 16.7–51.9). Child’s gender also predicted EI referral, such that boys with positive screening results were more likely to receive an EI referral than girls (aOR: 2.15, 95% CI: 1.5-3.3). No other demographic variables significantly predicted EI referral.Conclusion(s): Screening test thresholds and clinical thresholds for EI referral differ substantially. The majority of children who are at high risk for developmental concerns are not receiving EI referrals from PCPs. Girls and children with problem solving challenges are least likely to be referred. These findings may help inform physician training on developmental screening in primary care.
Number of Early Intervention Referrals by ASQ-3 and M-CHAT-R scoresASQ-3 = Ages & Stages Questionnaire, Third Edition; M-CHAT-R = Modified Checklist for Autism in Toddlers-Revised. EI = Early Intervention. ASQ-3 Composite Score is defined as the sum of scores from all ASQ-3 domains, in which each failed, borderline and passed ASQ-3 domain score was given a score of 2, 1, and 0, respectively.