Community General Paediatricians' Barriers to Providing Autism Spectrum Disorder Diagnoses
CPS ePoster Library. Penner M. Jun 25, 2015; 99231; 170
Melanie Penner
Melanie Penner
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Background: Wait times for diagnosis of autism spectrum disorders (ASD) may negatively impact outcomes by delaying access to early interventions. Community general pediatricians (CGPs) are often consulted in cases of suspected ASD, and may play a role in increasing ASD diagnostic capacity in the community setting.

Objective: The objective of this study was to explore the perspectives of CGPs regarding their role in the system of ASD diagnoses using qualitative methods.

Methods: We performed a phenomenological qualitative study of CGPs’ experiences with cases of suspected ASD. Two groups of CGPs were sampled to provide varying perspectives: CGPs that had referred patients with suspected ASD for a subspecialist assessment, and CGPs that regularly attended ASD educational events. Individual in-depth interviews were recorded and transcribed. Two investigators coded each interview. Thematic saturation was reached when two successive interviews did not generate new codes. Texts were analyzed using a grounded theory approach. A preliminary theoretical framework was developed, summarized and sent to participants with a request for feedback. This feedback was incorporated into the final theoretical framework.

Results: Eleven in-depth interviews were conducted (six males, five females; mean years in practice 17.1). Participants described three elements to the process of assessment: diagnostic determination, communication of the diagnosis, and management of the diagnosis. Each element contains potential barriers to assigning a diagnosis of ASD. Diagnostic determination is affected by patient factors (such as age, severity, and comorbidities), family factors (the reliability of the historian), and physician factors (such as training, access to informal expert consultation, and interest in ASD). When communicating the diagnosis, it is important that families know enough, but not too much, about ASD; families who know too much are perceived to need an “expert” opinion. Participants described a significant emotional burden and were very sensitive to the impact of the diagnosis. They feel ill equipped to deal with the fragmented service delivery system for ASD. Helping families to access services is time-consuming, poorly remunerated, and less satisfying than other areas of pediatric practice.

Conclusions: Though CGPs are frequently consulted on cases of suspected ASD, they experience many barriers to making a diagnosis, leading to increased subspecialist referrals. Efforts to improve diagnostic capacity in this group must focus not only on diagnostic determination, but also on communicating the diagnosis and efficiently connecting families to resources.
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