Community General Pediatricians' Perspectives on Providing Autism Diagnoses in Ontario, Canada: A Qualitative Study

OBJECTIVE: Community general pediatricians (CGPs) are a potential resource to increase capacity for autism spectrum disorder (ASD) diagnostic assessments. The objective of this study was to explore factors influencing CGPs' perspectives on and practices of providing ASD diagnoses. METHODS: This qualitative study used a constructivist modified grounded theory approach. Participants included CGPs who had attended ASD educational events or had referred a child with suspected ASD to a tertiary rehabilitation center. Individual in-depth interviews with CGPs were recorded, transcribed, and coded. An explanatory framework was developed from the data. A summary of the framework was sent to participants, and responses indicated that no changes were needed. RESULTS: Eleven CGPs participated. Assessment for ASD consists of 3 stages: (1) determining the diagnosis; (2) communicating the diagnosis; and (3) managing next steps after diagnosis. Each of these stages of ASD diagnostic assessment exists within an ecological context of child/family factors, personal CGP factors, and contextual/systems factors that all influence diagnostic decision making. CONCLUSION: Community general pediatrician ASD diagnostic capacity must be considered within the larger context of ASD care. Suggestions to improve diagnostic capacity include preparing families for the diagnosis, changing CGP perceptions of ASD, providing community-based training, improving financial remuneration, and providing service navigation. Further study is needed to ensure that CGPs are providing accurate, high-quality assessments.