Screening for Autism Spectrum Disorders During Well-child Visits in a Primary Care Setting

Patricia L. Webb, DNP, CPNP-PC


Journal for Nurse Practitioners. 2011;7(3):229-235. 

In This Article

Abstract and Introduction


Early identification and intervention in children with autism spectrum disorders (ASDs) result in improved outcomes.[1] Screening for ASDs was implemented during well-child visits. The Iowa Model, the Chronic Care Model, and the DNP Systems Change Model were used as quality improvement frameworks. The Infant-Toddler Checklist[2] and the Modified Checklist for Autism in Toddlers[3] were used to screen 29 children 9 to 30 months old. Two children were identified who needed early childhood intervention. Buy-in, timing, electronic health records, and choice of screening tools should be considered for successful integration of ASD screening into well-child visits.


Autism spectrum disorders (ASDs) affect 1 of 150 US children.[4] Interventions for ASDs that begin in the toddler and preschool years are linked with improved outcomes in cognition, language, and educational achievement.[1,5] Early intervention also is associated with significant cost savings for families and society.[6]

The American Academy of Pediatrics (AAP) recommends universal screening for ASDs during the toddler years.[7] In spite of this recommendation, a recent survey of 257 pediatricians found that only 42% routinely screened for autism in young children.[8] Reported barriers to screening included lack of time, lack of familiarity with ASD screening tools, inadequate reimbursement for screening, and reliance on clinical observations instead of more reliable screening tools to detect ASDs.[7,8]

A quality improvement project to implement ASD screening was developed using the Doctor of Nursing Practice (DNP) Systems Change Model,[9] the Iowa Model for Evidence-Based Practice,[10] and the Chronic Care Model (CCM).[11] The purpose of the project was to evaluate the integration of ASD screening into well-child visits. Can ASD screening be successfully integrated into such visits in a primary care setting? Will ASD screening increase the number of children diagnosed with ASDs by 24 to 30 months old?


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