Journal
JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS
Volume 49, Issue 6, Pages 2304-2319Publisher
SPRINGER/PLENUM PUBLISHERS
DOI: 10.1007/s10803-019-03913-5
Keywords
Autism spectrum disorder; Screening; Costs; Decision-making; Process assessment
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Funding
- HRSA
- NIMH [R01MH104400]
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U.S. guidelines for detecting autism emphasize screening and also incorporate clinical judgment. However, most research focuses on the former. Among 1,654 children participating in a multi-stage screening protocol for autism, we used mixed methods to evaluate: (1) the effectiveness of a clinical decision rule that encouraged further assessment based not only on positive screening results, but also on parent or provider concern, and (2) the influence of shared decision-making on screening administration. Referrals based on concern alone were cost-effective in the current study, and reported concerns were stronger predictors than positive screens of time-to-complete referrals. Qualitative analyses suggest a dynamic relationship between parents' concerns, providers' concerns, and screening results that is central to facilitating shared decision-making and influencing diagnostic assessment.
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