OBJECTIVES: To examine screening practices for autism spectrum disorder (ASD), subsequent referrals, and diagnostic outcomes within a large network of primary pediatric care practices. METHODS: Rates of ASD screening with the Modified Checklist for Autism in Toddlers (M-CHAT) at 18- and 24-month well-child visits were examined among 290 primary care providers within 54 pediatric practices between June 2014 and June 2016. Demographic, referral, and diagnostic data were abstracted from the medical records for all children who failed the M-CHAT (ie, score of ≥3) at either or both visits. RESULTS: Rates of M-CHAT screening were 93% at 18 months and 82% at 24 months. Among 23 514 screens, scores of 648 (3%) were ≥3 (386 at 18 months, 262 at 24 months) among 530 unique children who failed 1 or both screenings. Among screen-failed cases, 18% received a diagnosis of ASD and 59% received ≥1 non-ASD neurodevelopmental disorder diagnosis within the follow-up period. Only 31% of children were referred to a specialist for additional evaluation. CONCLUSIONS: High rates of ASD-specific screening do not necessarily translate to increases in subsequent referrals for ASD evaluation or ASD diagnoses. Low rates of referrals and/or lack of follow-through on referrals appear to contribute to delays in children’s receipt of ASD diagnoses. Additional education of primary care providers regarding the referral process after a failed ASD screening is warranted.

Increased public awareness of autism spectrum disorders (ASD) and routine screening in primary care have contributed to increased requests for diagnostic ASD evaluations. However, given the scarcity of subspecialty autism diagnostic resources, overreferral of children suspected of having ASD may be contributing to long waiting lists at tertiary care autism centers and delaying diagnosis for those children who truly have ASD. To determine whether children are being excessively referred to ASD-specific diagnostic clinics, our objective was to determine the prevalence of true ASD diagnoses in children referred for diagnostic ASD evaluation. Charts of all patients referred to a regional autism center between April 2011 and August 2012 for suspicion of a possible ASD were retrospectively reviewed and demographic and clinical diagnoses abstracted. Only 214 of 348 patients evaluated (61%) received an ASD diagnosis. Thus, concerns about autism are not confirmed by an ASD diagnosis in a significant number of children.

Purpose – This paper seeks to empirically examine the influence of the new Portuguese environmental accounting standard on the environmental information disclosed in the annual reports by a sample of large firms operating in Portugal during the period 2002-2004. Design/methodology/approach – The method used is the content analysis technique by developing an index (which consists of the 16 environmentally-related disclosure items) in order to assess the presence of the environmental disclosures and their breadth (number of items disclosed). Findings – The results indicate that, in spite of the fact that the level of environmental information disclosed during the period 2002-2004 is low, the extent of environmental disclosure has increased, as well as the number of Portuguese companies that disclose environmental information. The change in environmental disclosure behaviour between 2002 and 2004 is certainly consistent with the idea that the new accounting standard is starting to have an impact. Originality/value – The study adds to the international research on environmental disclosure by providing empirical data from a country, Portugal, where empirical evidence is still relatively limited. Moreover, the study provides empirical support for the contentions of other authors that mandatory reporting guidelines affect corporate reporting practices.

Purpose: The purpose of this paper is to explore the process of organizational change undergone by a large Portuguese business group within the context of the environmental agenda and the role of accounting as a mechanism for change.Design/methodology/approach: The paper reports the results of a case study conducted between 2006 and 2009. Information was obtained from semi‐structured interviews and secondary sources. Organizational changes were analyzed using Laughlin's model in order to identify which category reflected most of the changes introduced to address environmental matters.Findings: This paper offers evidence that change is not a homogeneous phenomenon. Additionally, it confirms previous studies' findings which found that accounting did not play a significant role in the process of organizational change within the context of the environmental agenda.Originality/value: This paper seeks to complement the research in this area by integrating observations from a case study into an existing model of levels of organizational change according to how a Portuguese business group incorporated environmental issues into its processes, policies and corporate culture.