Understanding Primary Care Clinicians’ Perspectives on Early Screening of Autism and Subsequent Referral Practices

06/11/2026

AI Summary

Primary care clinicians use surveillance, validated autism and developmental screens, and practice-developed questionnaires for toddler screening.
Multiple barriers impede screening and referral: insufficient payment, limited time, scarce community resources, and low clinician confidence.
Only 35.7% of clinicians follow AAP guidance to refer positive screens to both diagnostic evaluation and early intervention; clinician characteristics did not predict referrals.

TL;DR (AI Generated)

OBJECTIVES: To assess primary care clinicians' (PCCs; ie, pediatricians, nurse practitioners) perspectives on screening practices used to identify children with autism and other developmental delays, factors related to screening practices, and actions taken when a child screens positive for possible autism.

Descriptive statistics were used to summarize screening practices, factors related to screening, and steps taken after a positive screen.

Further research is needed to understand better PCCs' confidence in autism-specific screens, to address barriers to referral for diagnostic evaluation and early intervention, and to explore further the relationship between PCCs' characteristics and referral practices.

Basic summary

J Pediatr. 2026 Nov 5:115388. doi: 10.1016/j.jpeds.2026.115388. Online ahead of print.

ABSTRACT

OBJECTIVES: To assess primary care clinicians’ (PCCs; ie, pediatricians, nurse practitioners) perspectives on screening practices used to identify children with autism and other developmental delays, factors related to screening practices, and actions taken when a child screens positive for possible autism.

STUDY DESIGN: PCCs (n=303) were surveyed across 2 toddler autism screening studies. Descriptive statistics were used to summarize screening practices, factors related to screening, and steps taken after a positive screen. Logistic regression was used to examine PCC characteristics associated with adherence to the American Academy of Pediatrics (AAP) recommendation to refer children both for diagnostic evaluation and early intervention.

RESULTS: PCCs reported using surveillance techniques, validated developmental and autism screens, and practice-developed questionnaires. PCCs endorsed many screening barriers, including insufficient payment and time, limited community resources, and low confidence in caring for children with delays. Only 35.7% of PCCs reported following AAP’s recommendation of referring screen positive cases to both early intervention and diagnostic evaluation. PCC characteristics (eg, sex, years in practice) were not associated with referral practices following a positive screen.

CONCLUSIONS: Although PCCs reported using autism-specific screens, this did not translate into adherence to AAP-recommended guidelines for referrals following a positive screen. Further research is needed to understand better PCCs’ confidence in autism-specific screens, to address barriers to referral for diagnostic evaluation and early intervention, and to explore further the relationship between PCCs’ characteristics and referral practices.

PMID:42988321 | DOI:10.1016/j.jpeds.2026.115388

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