A review of: Golnik, A., Ireland, M., & Borowsky, I. (2009). Medical Homes for Children With Autism: A Physician Survey PEDIATRICS, 123 (3), 966-971 DOI: 10.1542/peds.2008-1321
I’m usually extremely political when talking about other disciplines (pediatricians, speech therapists, neurologists, etc) since I think all of these clinicians have an important role in the care of children with autism. But I wouldn’t be totally honest if I say that I’d never been frustrated with some pediatricians, specifically in regards to diagnostic issues. Too often I have seen pediatricians who had minimal understanding of developmental disorders keep parents from seeking much needed specialized assessments with the argument that “your child is fine; boys will be boys, etc” even in the face of blatant symptoms of ASD or other conditions.
In this very influential study, the authors conducted a survey of a national sample of pediatricians and family physicians regarding their self-perceived competency in autism and other developmental disorders. The study included 539 physicians (449 or 90% pediatricians).
Overall, the physicians felt significantly less competent to provide primary care services for children with autism, than for children with other neurodevelopmental or medical conditions. The physicians also reported significantly more desire for primary care training in autism than in other neurodevelopmental or medical condition.
Yet, when asked what barriers prevent better care for patients with autism, only 30% of the responders endorsed ‘lack of provider education about the disorder’. This compares to 60% endorsing “lack of coordination” and “lack of reimbursement.”
Therefore, it seems that there is a disconnect between a perceived limited competency, a perceived need for more primary care training in autism, but a limited acknowledgment of their own limited training as one of the obstacles to provide better care for children with autism.
The study also found that parents of children with autism had more limited trust and satisfaction with the primary care than did parents of children with other neurodevelopmental disorders. It is possible that parents can sense the perceived limited knowledge about autism and the realization than maybe the pediatrician may not be the most appropriate provider/coordinator of non-medical services for these children (specially in regards to diagnosis). I think that good pediatricians understand the need for a multidisciplinary approach to the assessment and treatment of children with autism, and understand that other specialists are much better prepared to conduct the comprehensive evaluations that are needed to reach the most accurate diagnosis.
However, in their defense, there
is a lack of are limited clinical guidelines on how to approach the issue of diagnostic evaluations for autism among pediatricians. I hope that when these guidelines are fully developed, they instruct pediatricians to refer all children who had early signs of autism for a comprehensive diagnostic evaluation at specialized settings.
UPDATE: Please read the comments for discussion on clinical guidelines for pediatricians.
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