Autism Screening Disparities Persisted During First Year of COVID-19 Pandemic

Researchers from Children’s Hospital of Philadelphia (CHOP) found that while autism screening rates during the first year of the COVID-19 pandemic may not have dropped sharply, many routine screenings may have been missed due to routine well-child visits being canceled and postponed. The findings suggest that strategies for ensuring these children are caught up on routine screening are critical for early diagnosis and intervention. The findings were published today in the journal Academic Pediatrics.

Ongoing surveillance and routine screening for autism spectrum disorder at 18- and 24-month well-child visits are recommended to promote early detection and initiation of helpful treatment services. Prior to the COVID-19 pandemic, rates of autism screening across the CHOP Care Network were high, with 91% of children screened at least once between 2011 and 2015. However, even before the pandemic began, there were disparities in who completed these screenings, with lower rates of at least one screening observed in children of Black, Asian, or multi-racial groups, as well as children from lower-income families.

Given that well-child care visits declined early in the pandemic as hospitals restricted appointments and parents avoided non-urgent healthcare visits, researchers wanted to assess the COVID-19 pandemic’s impact on screening for autism as well as screening equity for children within a large pediatric network.

“While we maintained a high level of screening during this challenging time, we suspected some children could have been missed,” said Kate E. Wallis, MD, MPH, a developmental behavioral pediatrician in the Division of Developmental and Behavioral Pediatrics at CHOP, and lead author of the study. “With multiple studies stressing the importance of early intervention, we want to make sure that any children who were missed still complete these vital screenings.”

The study compared 24,549 patients between 16 and 26 months old who came in for in-person well-child care between March 1, 2020 and February 28, 2021 (COVID-19 cohort) to a group of 26,779 patients who came in for well-child care between March 1, 2019 and February 29, 2020 (pre-COVID-19 cohort). The total number of eligible well-child visits decreased by 8.3% in the COVID-19 cohort, with a greater decline seen in Black and children whose families receive public insurance (17% and 10.5%, respectively). Additionally, significant declines in screening completion were seen across all socio-demographic groups except among Asian children, with the sharpest declines seen among non-Hispanic White children, which suggests that well-child visits declined the most among this group, or that the ASD screening portion of well-child visits may have been skipped.

Prior studies from CHOP have identified autism screening disparities, and while the pandemic  impacted the number of well-child visits where many routine screenings take place, those disparities persisted after the pandemic began. Therefore, the authors suggest developing strategies to catch up with children who may not have completed screening during this time. One possible strategy could involve text messages to complete screening or reminding families to complete a screen questionnaire on a personal device while in their pediatrician’s office. Another more population-based approach would be to send out screening questionnaires to all patients at 18 and 24 months, even those without a scheduled visit, and prioritizing scheduling patients for visits who screen positive.

Wallis et al, “Autism Spectrum Disorder Screening during the COVID-19 Pandemic in a Large Primary Care Network.” Acad Pediatr. Online April 22, 2022. DOI: 10.1016/j.acap.2022.04.005.