Practice patterns and determinants of wait time for autism spectrum disorder diagnosis in Canada

Abstract

Background: Inefficient diagnostic practices for autism spectrum disorder (ASD) may contribute to longer wait times, delaying access to intervention. The objectives were to describe the diagnostic practices of Canadian pediatricians and to identify determinants of longer wait time for ASD diagnosis.

Methods: An online survey was conducted through the Canadian Paediatric Society's developmental pediatrics, community pediatrics, and mental health sections. Participants were asked for demographic information, whether they diagnosed ASD, and elements of their diagnostic assessment. A multiple linear regression of total wait time (time from referral to communication of the diagnosis to the family) as a function of practice characteristics was conducted.

Results: A total of 90 participants completed the survey, of whom 57 diagnosed ASD in their practices (63.3%). Respondents reported varied use of multi-disciplinary teams, with 53% reporting participation in a team. No two identically composed teams were reported. Respondents also had varied use of diagnostic tools, with 21% reporting no use of tools. The median reported total wait for ASD diagnosis time was 7 months (interquartile range 4-12 months). Longer time spent on assessment was the only variable that remained significantly associated with longer wait time in multiple regression (p = 0.002). Use of diagnostic tools did not significantly affect wait time.

Conclusion: Canadian ASD diagnostic practices vary widely and wait times for these assessments are substantial-7 months from referral to receipt of diagnosis. Time spent on the assessment is a significant determinant of wait time, highlighting the need for efficient assessment practices.

Keywords: Autism spectrum disorder; Diagnosis; Early detection; Health services research; Pediatrics.

Conflict of interest statement

Ethics approval was granted by the Hospital for Sick Children in Toronto, Ontario.Not applicable.MP and WU have no competing interests to declare. EA has served as a consultant to Roche, has received grant funding from SanofiCanada and SynapDx, has received royalties from APPI and Springer, and has received in kind support from AMO Pharmaceuticals.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1

These figures show a the referrals and wait times for a child with suspected ASD from a primary care physician to a pediatrician who diagnoses ASD; and b the referrals and wait times for a child suspected ASD initially referred from a primary care physician to a pediatrician who does not diagnose ASD and subsequently refers to a subspecialist. Note that the total wait time does not include the pre-assessment wait time (time for consultation with pediatrician who does not diagnose ASD). # = number; * = multiplied by

Fig. 2

This figure shows the number of respondents indicating participation of each type of clinician available to the MDT for involvement in diagnostic assessments (blue bars) and those that participate in the majority of assessments (red bars). SLP = speech language pathology; OT = occupational therapy; Dev Peds = developmental pediatrics; Gen Peds = general pediatrics; BT = behavior therapy; ECE = early childhood educator; other is comprised of clinicians reported only once: ASD service provider, audiology, clinical genetics, dietician, family liaison, gastroenterology, neurology, neuropsychology, and nursing

Fig. 3

This figure shows the predicted total wait time from referral to completion of the ASD diagnostic assessment based on assessment time. Assessment time in minutes is plotted on the horizontal axis and wait time in days on the vertical axis. The blue line represents the mean adjusted value, with the shaded zone representing the 95% confidence interval