Screening Guidelines for Autism in Primary Care Practice

Central California Alliance for Health (CCAH) – Primary Care Autism Screening Guide

American Academy of Pediatrics Screening Recommendations

• Surveillance at every visit – Routine autism-specific screening at 18 and 24 months old.
• Four key risk factors to monitor:
  • Sibling with Autism Spectrum Disorder (ASD).
  • Parental concerns (e.g., inconsistent hearing, responsiveness).
  • Concerns raised by caregivers.
  • Pediatrician concern.
• If 2+ risk factors: Refer for Early Identification, ASD Evaluation, and Audiology.
• If 1+ risk factor and child is over 18 months: Use M-CHAT screening and, if positive, refer for ASD Eval and Audiology.

M-CHAT – Modified Checklist for Autism in Toddlers

• Designed for children aged 16 to 48 months old.
• Parent/caregiver questionnaire (5–10 minutes).
• Free download: http://www.firstsigns.org/downloads/m-chat.PDF
• Scoring: http://bit.ly/1ID5o0v
• Sample items:
  • Does your child take interest in other children?
  • Does your child point with index finger to show interest?
  • Does your child imitate you?

Red Flags for Autism in 2nd Year of Life

• Developmental regression.
• Appears to be 'in their own world.'
• Lack of shared interest/enjoyment.
• Uses caregiver’s hands to communicate needs.
• Repetitive movement with objects.
• Inadequate eye contact.
• No response to name.
• Unusual vocal tone or pitch.
• Repetitive body movements or posture.

ASD

• Differentiated from high-functioning autism.
• Impaired social interaction and restricted interests/behaviors.
• Typically normal language development.
• No significant cognitive delays.
• Verbal IQ > Performance IQ.
• Often diagnosed later in childhood.

Common Behavioral and Medical Concerns in ASD

Behavioral:

• Aggression/disruption (15–64%).
• Self-injurious behavior (8–38%).
• Eating challenges (25–52%).
• Sleep problems (36%).
• Toilet training difficulties (40%).
• Anxiety (up to 80%).

Medical:

• GI problems (9–70%).
• Chronic constipation, diarrhea, abdominal pain.
• Seizures (11–39%), often with global delays.

Preventive Services Prompting

Include screening milestones in EHR or chart prompts:

• Routine well-child visits.
• Autism screening at 18 and 24 months old.
• Use of ASQ, M-CHAT, Lead screening, Hearing/Vision, etc.