Resident training program helps expand autism evaluations in primary care, with Brittany Perry, DO

Long waits for autism evaluations continue to delay diagnosis and early intervention for many children. A program at Nemours Children's Health is seeking to address that challenge by training pediatric residents to perform autism diagnostic assessments within the primary care setting, allowing some families to receive evaluations much sooner than they otherwise might.

Results from the educational initiative, published in the Journal of Developmental & Behavioral Pediatrics, found that participating residents reported greater confidence in recognizing autism symptoms and conducting evaluations while helping children gain earlier access to autism services.^1,2

How can primary care help reduce delays in autism diagnosis?

According to Nemours Children's Health, families concerned that a child may have autism frequently wait 6 to 12 months for an initial specialty evaluation. Recognizing that primary care pediatricians are often the first clinicians to identify developmental concerns, physicians at Nemours launched a program in 2021 that incorporated autism diagnostic evaluations into primary care clinics while simultaneously training pediatric residents.

"At Nemours Children's Health, we are in collaboration with our Swank Autism Center at Nemours Children's Hospital, we have been expanding access to primary care autism assessments for quite some time," said Brittany Perry, DO, clinical assistant professor of pediatrics at Nemours Children's Health.

"We know that families wait a really long time for autism assessments, sometimes upwards of a year, and so completing these evaluations in the primary care setting, the primary care pediatrician is often the first to identify an autism concern."

Perry said children participating in the program were often evaluated within weeks rather than many months.

"So, for example, in our primary care clinic, we have been getting children in within a few weeks to two months," she said.

How were pediatric residents trained to perform autism evaluations?

Between March 2022 and June 2024, residents participated in 30 autism evaluations involving children referred because of parental concerns, pediatrician suspicion of autism, or positive screening results. During the 80-minute visits, residents obtained patient histories, completed interviews guided by DSM-5 criteria, performed behavioral observations, and participated in a standardized ASD-PEDS assessment alongside supervising pediatricians.

Before conducting evaluations, residents completed structured educational activities focused on autism recognition, diagnostic assessment, intervention planning, and communication with families. They also received instruction using guidance from the American Academy of Pediatrics and learned how to administer a play-based autism assessment.

Did the resident training program improve confidence and access to care?

Investigators found that residents reported improved confidence in identifying autism symptoms and completing evaluations after participating in the program. Families also received recommendations for developmental therapies, early intervention services, and other community resources following the assessment.

"This hands-on training program helped residents gain confidence in assessing patients for autism," Perry said in the study announcement. "We are hopeful that programs like ours can build the community's capacity for conducting autism evaluations, especially for children with clearer symptom presentation."

She added that improving physician training may ultimately increase access to diagnostic services.

"By providing more comprehensive training to future physicians, we can help more children and families get the support they need when they need it most. That can make all the difference in their long-term health and well-being."

Why is a strengths-based approach important when discussing autism with families?

Beyond teaching diagnostic skills, the curriculum emphasized communicating with families using a neurodiversity-affirming, strengths-based approach rather than focusing primarily on deficits.

"We met with the residents, we provided education on how to conduct the evaluation, and I think, most importantly, how to talk to families using a neurodiversity affirming approach, and focusing on strengths," Perry said.

"So, that to me was one of the most important things that we did through this evaluation process."

Perry noted that these communication skills remain valuable regardless of whether residents ultimately pursue primary care or a pediatric subspecialty.

What role do pediatricians play in identifying autism early?

The American Academy of Pediatrics recommends routine autism screening at 18- and 24-month well-child visits, placing primary care pediatricians at the forefront of early identification.

"The American Academy of Pediatrics recommends routine autism screening at 18 and 24 months, so our primary care pediatricians are the ones screening for autism," Perry said. "Being able to identify an autism question at a well visit and have the knowledge and strategies to support families while they're waiting for a diagnosis or waiting for an evaluation is really important."

She added that involving residents in diagnostic evaluations strengthens their ability to recognize autism, communicate effectively with families, and connect children with appropriate services.

Could this model expand access to autism evaluations?

The investigators believe residency-based autism training could help expand diagnostic capacity, particularly for children with more straightforward presentations, while reducing reliance on already overburdened specialty clinics.

"We have an opportunity," Perry said. "We are screening for autism in our primary care offices, right? And so every medical resident will be participating in screening in their primary care clinic, so taking that a step further, as more primary care providers are conducting autism evaluations in primary care, including the medical residents in that process, helps to strengthen their skills, not only for screening and diagnosis, but communicating with families, sharing intervention recommendations, and utilizing a strength-based approach."

References

1. Nemours Children’s Health. Nemours Children’s Health Program Taught Medical Residents to Conduct Autism Evaluations in Primary Care Setting. Nemours Children’s Health. May 26, 2026. Accessed June 25, 2026. https://nemours.mediaroom.com/news-releases?item=123225

2. Perry B, Cooper J, Zhang R, Harrison M. Pediatric Resident Participation in Primary Care Autism Evaluations: A Novel Continuity Clinic Training Opportunity. J Dev Behav Pediatr. 2026;47(2):e182-e185. doi:10.1097/DBP.0000000000001442