Primary Care Pediatricians' Perspectives on Autism Care.

This study interviewed 28 pediatricians about their experiences helping families with autism concerns. Doctors face challenges at every step: discussing autism worries with parents, finding specialists for diagnosis, and helping families access ongoing support services. The research identified needs for better doctor training in communicating with families, clearer referral systems, and more support to help families navigate autism services.

This qualitative study examined 28 pediatric primary care providers' experiences with autism identification and management through semi-structured interviews. Participants represented diverse clinic sites and varied clinical experience levels. Key themes emerged around the trajectory of autism care: initial identification challenges ("parent lens" and discussing the "A word"), referral difficulties ("autism labyrinth" and provider disempowerment), and long-term management issues ("black box" of services). The study identified three critical improvement areas: enhancing provider communication skills and confidence when discussing autism concerns with families, establishing clearer referral pathways to trusted diagnostic services, and improving family activation and capacity to navigate evaluation and treatment services.

Results suggest need for systematic improvements in primary care autism support including provider communication training, streamlined referral pathways, and enhanced family support systems. Addressing these barriers could improve early identification and reduce healthcare disparities in autism care access.

Small sample size from single Midwest academic medical center limits generalizability. Qualitative design provides insights but cannot establish causation or quantify prevalence of identified issues. Study methodology not fully detailed in abstract.

We aimed to explore pediatric primary care provider (PCP) experiences and needs around identification and management of autism spectrum disorder (ASD) in toddlers for the purpose of planning improved supports and services for ASD in the medical home. We recruited 28 PCPs to participate in semistructured interviews via Zoom. Probe questions elicited opinions about current screening and referral procedures, experiences obtaining services for patients, effective communication with parents, physician emotional experience when introducing ASD concerns, practice-based sources of disparities, and larger needs for ASD management in the primary care setting. Interview transcripts were analyzed qualitatively by a multispecialty research team for recurrent themes using grounded theory analysis.

Participants were 89% women, ranging in clinical experience from <1 year to >27 years, representing 8 diverse pediatric primary care clinic sites at a Midwest academic medical center. Dominant themes relating to PCPs' cognitive, emotional, and environmental experience of caring for patients with ASD were identified, which reflected the trajectory of ASD identification (the parent lens; the "A" word), referral (the autism labyrinth; provider disempowerment; parent activation as a source of inequities), and long-term management (the "black box"; provider emotional investment). Existing literature and results from this study suggest a need for targeted improvements in primary care to: (1) increase PCP capacity and confidence in communicating concerns of ASD with families; (2) refer for timely diagnostic evaluations in trusted and easy-to-navigate care systems; and (3) increase family activation and capacity to follow up on ASD evaluation and treatment services.