O2099: Diagnosis of Autism in Primary Care using the RITA-T: System and Results.

Background: Currently, the wait time for an autism evaluation for a young child is 12 months in many areas of the US. The American Academy of Pediatrics (AAP) supports primary care (PC) providers in completing autism evaluations in their medical home so young children can access services in a timely manner. We report on a model integrating the RITA-T (Rapid interactive Screening Test for Autism in Toddlers). We have studied the integration of the RITA-T in a Primary Care training to facilitate the identification, evaluation and diagnosis of Autism in young children, ages 18 months to 3 years, at high risk for Autism. The RITA-T has clear autism risk cut off scores such as a score >16 is high risk.

Methods: Over 3 years, 17 PC providers (MD, Social Work, NP), participated in this training. They came from community health centers, private practices, and an academically based clinic. Training over 1 year included monthly meetings with shared material and resources to review. Initial 6 months included: 1- Training the group reliably on the RITA-T and on the behavioral observations for autism; 2- Training on the Childhood Autism Rating Scale (CARS-2ST) and the DSM-5 interview. 3-Review of report templates and discussion of service recommendations; 4- System changes such as scheduling and billing practices. Toddlers who receive a score >16 on the RITA-T are evaluated for Autism by this group in their respective settings. Those with moderate risk scores (12-16) are referred to an Autism specialist. Three practices collaborated with Early Intervention (EI) who completed the RITA-T for them. The remainder of the training (6-12 months) included discussion of cases, system issues, evaluation results, and the development of resources for families evaluated.

Results: This PC group administered the RITA-T to 256 toddlers over 3 years. A total of 186 toddlers had a score >16 on the RITA-T and met the criteria for an in-house Autism diagnostic evaluation. They were evaluated within 3 months of initial concerns, and all received a diagnosis of Autism. Providers reported increased comfort level with the integration of the RITA-T. Challenges reported were around the modification of clinic templates, understanding and implementing the CARS-2ST, billing, and difficulties in the identification of resources after the diagnosis.

Conclusion: The RITA-T integration in primary care can facilitate the identification, and evaluation of Autism in Toddlers in a timely manner.