Mental health screening in pediatric primary care for children with autism

Abstract

To report mental health screening rates in pediatric primary care as part of a larger program piloting Access to Tailored Autism INtegrated Care, a model promoting timely identification of mental health needs and care linkage for children with autism. Data were extracted from the Access to Tailored Autism INtegrated Care pilot in six pediatrics clinics within two organizations. Demographics and Pediatric Symptom Checklist-17 data were collected during well-child visit appointments over 4 months for 166 children with autism ages 4–16 years. 53% (n = 43) of 81 eligible children were screened in Organization 1 and 55% (n = 47) of 85 of eligible children were screened in Organization 2. In Organization 1, 47% screened positive, as evidenced by an elevated Pediatric Symptom Checklist-17 Total Score, while 36% screened positive in Organization 2. Children with positive screens had elevations on the Pediatric Symptom Checklist-17 Externalizing and Attention subscales but not on the Internalizing subscale, confirming typical trends in co-occurring challenging behavior presentations in children with autism. Slightly over half of eligible patients were Pediatric Symptom Checklist-17 screened. Positive screening rates were high, reinforcing the co-occurring nature of mental health needs in children with autism. Findings suggest opportunities to improve mental health screening in primary care for children with autism.

Lay abstract

Children with autism experience high rates of co-occurring mental health conditions like challenging behaviors and anxiety. However, these co-occurring mental health needs are often not identified when they first become problematic. Pediatricians and their care staff are in a good position to identify mental health needs early and support families to connect to needed services. This study describes a project focused on mental health screening for children with autism in pediatric primary care clinics. Over half of eligible patients were screened using the Pediatric Symptom Checklist-17. Many children with autism had clinically elevated scores, suggesting the need for mental health assessment or services. In particular, children with positive screens had clinical elevations on the challenging behavior and attention subscales of the Pediatric Symptom Checklist-17. This finding is consistent with typical trends in co-occurring challenging behavior presentations in children with autism. Mental health screening in primary care is feasible and offers a promising opportunity to identify co-occurring mental health needs for children with autism early. Screening rates varied between clinics, suggesting tailored to improve routine screening in pediatric primary care for children with autism.