Gender bias: Boys are 1.5 times as likely as girls to be referred for treatment, no matter whether they screen positive for autism risk.
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Doctors twice as likely to miss girls as boys on autism screen

Pediatricians are failing to identify 80 percent of toddlers who need an evaluation for autism, and are missing nearly twice as many girls as boys.

By Hannah Furfaro
12 May 2017 | 3 min read
This article is more than five years old.
Neuroscience—and science in general—is constantly evolving, so older articles may contain information or theories that have been reevaluated since their original publication date.

Pediatricians are failing to identify 80 percent of toddlers who need an evaluation for autism, and are missing nearly twice as many girls as boys. The unpublished results were presented Friday at the 2017 International Meeting for Autism Research in San Francisco, California.

The results are based on the screening of 3,171 toddlers, about half of them girls, using the Modified Checklist for Autism in Toddlers (M-CHAT) screening tool.

Parents filled out the M-CHAT in 2014 and 2015 after bringing their toddlers to Children’s Mercy Kansas City hospital for well-child visits. Using the completed questionnaires, doctors deemed only 92 of the children as needing an evaluation for autism. But after rescoring these forms, the researchers found that 467 children met the criteria.

The results show doctors overlook girls who need an evaluation for autism 1.8 times as often as boys — which may help explain the relatively low apparent prevalence of autism in girls.

“That should scare everyone,” says Cy Nadler, a child psychologist at Children’s Mercy who presented the findings. Audience members gave an audible gasp when Nadler presented the results.

“If physicians are less likely to respond to females with positive screens, or even identify those positive screens, that could drive down our rates of observed female cases,” he says.

Nadler’s team also found that children with Spanish-speaking parents are more likely to be missed than those with English-speaking parents, but this result was not statistically significant.

Service gap:

It’s unclear how these errors arise. Doctors may be overwhelmed by the sheer number of M-CHAT forms they receive and so do not review them carefully. Common biases about who is at risk of autism (mostly boys, for example) also might help explain the mistakes.

Training pediatricians to better recognize autism features may be one solution, because some have little understanding of autism, says Joyce Bernheim, founding member of the Oregon Commission on Autism Spectrum Disorders.

Whatever the solution, finding one is critical, says Nadler, because M-CHAT screens can influence a child’s access to treatment. His team found that only 20 percent of children whom doctors deemed not at risk were referred for treatment. By contrast, 75 percent of children with a positive screen received a referral.

And boys were 1.5 times as likely as girls to receive help — whether or not their screen was positive.

For more reports from the 2017 International Meeting for Autism Research, please click here.


This article has been modified from the original. An earlier version did not specify that the finding about Spanish-speaking children is not statistically significant. The article also stated that more of the missed cases were girls, but no raw data was immediately available to confirm this.