Although pediatricians screen for autism spectrum disorder (ASD) in children aged 18 to 24 months during routine health maintenance exams, this neurodevelopmental condition often eludes formal diagnosis until a child is 4 years or older. (1,2) One telehealth application is currently expediting the diagnosis of ASD by specialists. Another artificial intelligence (Al)-based diagnostic system, which recently received marketing approval by the US Food and Drug Administration (FDA), may facilitate the diagnosis by pediatricians. This article examines these technology-based tools and explores how they can aid pediatricians.
Children with ASD have communication and social impairments, frequently demonstrate repetitive or restrictive behaviors, and often have a wide range of comorbidities. The condition is common, affecting 1 in 59 children in the United States. (3) As most pediatricians are not able to diagnose children with developmental and speech delays as having ASD, they refer children to specialists, who include developmental pediatricians, child psychologists, pediatric neurologists, and pediatric psychiatrists. In many circumstances a child suspected of having ASD is referred to a multidisciplinary diagnostic team composed of one of the above specialists as well as educators, speech pathologists, occupational therapists, and physical therapists. There are often wait times of many months until an ASD evaluation is performed. Even after a child is evaluated, they may not meet threshold criteria for an ASD diagnosis, and the assessment is considered inconclusive. In such situations, parents and pediatricians must wait until the child is older and upon repeat assessment receive a diagnosis of ASD or have the diagnosis excluded. The diagnosis of ASD is very important for families (vs "developmental delay") as it assures that insurance companies and school systems will provide much-needed behavioral interventions and services, which are mandated by most states.
Many factors may delay the diagnosis of ASD. For instance, individuals in low-income communities and minorities have limited access to services necessary to diagnose ASD. (4) Only 60% of pediatricians screen children for developmental delays despite the recommendation from the American Academy of Pediatrics (AAP) to perform screenings at 18- and 24-month well visits. In one study, only two-thirds of those who failed screening were referred for a diagnostic ASD evaluation. (5,6) In addition, it was recently shown that the Modified Checklist for Autism in Toddlers Revised With Follow-Up (M-CHAT-R/F), used by most pediatricians to screen for ASD, has sensitivities as low as 39% in detecting children with ASD. (7) Lastly, the COVID-19 pandemic has resulted in significant delays in evaluating children with suspected ASD.BOX ASD DIAGNOSTIC CRITERIA ACCORDING TO DSM-5 (8) Persistent symptoms of social communication and interaction. Currently or by history. (all 3 symptoms are required) 1. Deficits in social-emotional reciprocity. Children manifest a failure of normal back and forth conversation and reduced sharing of interests or emotions, as well as failure to respond to social interactions. 2. Deficits...