Early Autism Evaluation Hub System

Established in 2012, the Early Autism Evaluation (EAE) Hub system was developed by an interdisciplinary team in the Department of Pediatrics with the overall goal of lowering the age of autism spectrum disorder (ASD) diagnosis. The EAE Hub system is an innovative, tiered system of developmental screening and diagnostic evaluations within primary care settings to receive referrals of young children ages 14-48 months who have been identified to have an increased likelihood of ASD. The system currently has 17 hubs deployed across multiple health systems around the state from Gary and South Bend to New Albany and Evansville.

Outcomes

During the 2023 calendar year, 1,026 children with an average age of under 32 months were served across the EAE Hubs. Fifty-seven percent of evaluated children received a diagnosis of autism. In children not diagnosed with autism, other diagnoses included speech delay, developmental delay, and other conditions. The hub system’s average wait time for evaluation of under four months is dramatically lower than typically reported waits, thereby reducing the age of diagnosis and referral to intervention services.

graph shows autism evaluations steadily growing from 2012 to 2023. In 2013 there were fewer than 100 evaluations. Evaluations peak at nearly 900 in 2019, then drop down in 2020 to 500. By 2023 evaluations had grown to over 1,000..

pie chart shows diagnosis results at EAE hubs in 2023. 57% were diagnosed with autism, while 23% were diagnosed with a developmental disability without autism. 14% were diagnosed with a speech delay without autism, and 7% had other diagnoses.

1,026

children seen at 17 sites

57%

diagnosed with autism

32 months

average age of diagnosis

117 days

average wait time from referral to visit

83%

receive definitive diagnosis at EAE hub

465

primary care clinicians referred children from 63 counties

The goal of this initiative continues to be to improve localized access to early diagnostic evaluations for young children who are found to be at increased likelihood of autism and/or developmental delay based on developmental screening and/or parental caregiver or clinician concerns. Regardless of their diagnoses, eligible children are referred to receive subsequent evidence-based interventions at the earliest age possible.

a map of indiana shows EAE hubs in 15 counties: Lake, St. Joseph, Elkhart, Kosciusko, Allen, Tippecanoe, Madison, Marion, Morgan, Johnson, Shelby, Monroe, Dubois, Vaderburgh, and Floyd counties

Early Autism Evaluation Hub Locations

This map demonstrates the approximate geographic coverage of hub sites, in receiving referrals from surrounding counties.

The list of current sites and contact information can be found below.

Clinical Pathway

The following is an algorithm representing the evaluation procedure used during an EAE hub clinical evaluation. It incorporates a review of developmental screening results, a diagnostic interview including assessment of DSM-5 criteria for autism and a medical and developmental history, the administration of a structured observational assessment for autism (i.e., Screening Tool for Autism in Toddlers and Young Children; STAT), and physical examination, followed by integration of the data to formulate and present a clinical diagnosis to the family, and then the creation and dissemination of a clinical report which includes recommended next steps for care management.

Supporting Organizations

Our research is made possible by generous support from:

Riley Children’s Foundation
Kiwanis Indiana
Robert & Helen Haddad Family Foundation
National Institutes of Health
Indiana Clinical and Translational Sciences Institute
Indiana Department of Health
Purdue Big Ideas Competition 2.0
Society for Developmental Behavioral Pediatrics

Research

The EAE Hub system also serves as a laboratory to conduct health services research and a collaborative forum to promote idea development and innovation. Our goal is to develop and evaluate equitable service models that promote identification of autism and developmental disabilities and streamlined entry into interventions at the earliest point possible to improve child and family outcomes. The EAE team uses a variety of quality improvement and research methodologies to track performance and adherence to best practices as well as test innovative approaches to training, diagnosis, and care management of children with neurodevelopmental disabilities.

Recent and ongoing projects

Examination of diagnostic accuracy of the EAE Hub system.
Family satisfaction with the EAE hub model of evaluation.
Evaluation of racial and ethnic profiles and disparities of children evaluated across the system.
Development of EAE Hub-Spanish for Latine Spanish-speaking children at-risk for autism.
Innovative models of resident and clinician training in autism diagnosis.
Evaluation of eye-tracking biomarkers to improve accuracy of community-based autism diagnosis.
Tracking autism prevalence and age of first diagnosis in a central Indiana Medicaid cohort.

Evidence for the EAE Hub Model

McNally Keehn, R., Minshawi, N. F., Tang, Q., Enneking, B., Ryan, T., Martin, A. M., Paxton, A., Monahan, P. O., Ciccarelli, M., & Keehn, B. (2024). Accuracy of the Screening Tool for Autism in Toddlers and Young Children in the primary care setting. Autism, 0(0). https://doi.org/10.1177/13623613241292850

Martin, A. M., Keehn, B., Ciccarelli, M., Paxton, A., & McNally Keehn, R. (2024). Associations among race, ethnicity, and clinical profiles of young children evaluated for autism in the primary care setting. Journal of Developmental and Behavioral Pediatrics. https://doi.org/10.1097/DBP.0000000000001298

McNally Keehn, R., Swigonski, N., Enneking, B., Ryan, T., Monahan., P., Martin., A.M., Hamrick, L., Kadlaskar, G., Paxton, A., Ciccarelli, M., Keehn., B. Diagnostic accuracy of primary care clinicians across a statewide system of autism evaluation. Pediatrics. Published online July 18, 2023. https://doi.org/10.1542/peds.2023-061188

*Connected Commentary highlighting this paper:
Hyman, S. & Kroening, A. Diagnosing autism spectrum disorders in primary care: When you know, you know. Pediatrics. Published online July 18, 2023. https://doi.org/10.1542/peds.2023-062279

Martin AM, Ciccarelli MR, Swigonski N, McNally Keehn, R. Evaluation of race and ethnicity across a statewide system of early autism evaluation. The Journal of Pediatrics, 2022. doi: 10.1016/j.jpeds.2022.10.023.

McNally Keehn R, Tang Q, Swigonski N, Ciccarelli M. Associations Among Referral Concerns, Screening Results, and Diagnostic Outcomes of Young Children Assessed in a Statewide Early Autism Evaluation Network. Journal of Pediatrics. 2021; 233: 74-81.e8 doi: 10.1016/j.jpeds.2021.02.063

McNally Keehn R, Ciccarelli M, Szczepaniak D, Tomlin A, Lock T, Swigonski N. A Statewide Tiered System for Screening and Diagnosis of Autism Spectrum Disorder. Pediatrics. 2020 Aug;146(2):e20193876. https://doi.org/10.1542/peds.2019-3876

Additional research affiliated with the EAE Hub System

Keehn B, Monahan P, Enneking B, Ryan T, Swigonski N, McNally Keehn R. Eye-Tracking Biomarkers and Autism Diagnosis in Primary Care. JAMA Netw Open. 2024;7(5):e2411190. doi:10.1001/jamanetworkopen.2024.11190 https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2818669

McNally Keehn, R., Enneking, B., Ryan, T., James, C., Tang, Q., Blewitt, A., Tomlin, A., Corona, L., & Wagner., L. Tele-assessment of young children referred for autism spectrum disorder evaluation during COVID-19: Associations among clinical characteristics and diagnostic outcome. Autism. July 2023. https://doi.org/10.1177/13623613221138642

McNally Keehn, R; Enneking, B; James, C; Tang, Q; Rouse, M; Hines, E; Raches, C; Etling, A. Telehealth Evaluation of Pediatric Neurodevelopmental Disabilities During the COVID-19 Pandemic: Clinician and Caregiver Perspectives. J Developmental Behavioral Pediatrics, Volume 43, Number 5, 7 June/July 2022, pp. 262-272(11) 10.1097/DBP.0000000000001043

McNally Keehn, R; Tomlin, A; Ciccarelli, MR. COVID-19 Pandemic Highlights Access Barriers for Children with Autism Spectrum Disorder. Journal of Developmental & Behavioral Pediatrics 42(7):p 599-601, September 2021. 10.1097/DBP.0000000000000988