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.
Clinical Pathway
The EAE Hub standard clinical evaluation pathway involves administration or review of standard developmental and autism screening tools, an autism-focused diagnostic interview and medical history conducted with the child’s caregiver, physical examination, and administration of an observational assessment tool. The EAE Hub clinician synthesizes all assessment data to determine diagnosis, and the family is counseled on the diagnosis and next step recommendations and resources. The clinical report with diagnosis and tailored care plan is disseminated to the child’s family and referring PCP. When autism diagnostic outcome cannot be determined in the EAE Hub evaluation (e.g., due to complex clinical presentation), children are referred to an autism diagnostic specialist. For details on the EAE Hub Clinical Pathway, click below:
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
Capacity Building & Education
To facilitate the early diagnosis and improve care of young children at increased likelihood for autism, the EAE Hub system is committed to building capacity of primary care clinicians through education and ongoing support. Our initial training course prepares PCPs for independent competency in autism diagnostic evaluation of young children. The course includes three phases of training, completed flexibly in either live or virtual format, and is hosted on Canvas (an online educational learning platform). Training typically takes approximately 30 hours to complete.
Following training, EAE Hub clinicians and teams are closely supported in launching their evaluation site and participate in our monthly virtual learning collaborative. The learning collaborative is offered twice monthly via Zoom (12:10-12:40 PM) with repeated content to maximize opportunities for busy PCPs and their teams to participate. The goal of the learning collaborative is to support community clinicians in applying quality improvement methods within their primary care practices. This approach enhances developmental screening and referral processes for children at increased likelihood of autism as well as supporting methods for connecting families to appropriate evaluations, therapies, and services. We often offer American Board of Pediatrics Maintenance of Certification (MOC) courses as part of the learning collaborative curriculum.
To learn more about our training efforts, click below:
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.
Cameron Pediatrics
306 Maumee St Ste 303
Angola, IN 46703
(260) 667- 5690
Riley Pediatric Care Center - Avon
1111 N Ronald Reagan Pkwy, Suite C1600
Avon, IN 46123
(317) 217-3120
Riley Pediatric Care Center - Bedford
1614 25th St.
Bedford, IN 47404
(812) 277-0118
IU Health Riley Physicians
4935 W. Arlington Rd.
Bloomington, IN 47404
812-353-3785
Riley Pediatric Primary Care – Fishers
11530 Allisonville Rd, Ste 190
Fishers, IN 46038
463-251-3937
*IU Health referrals only
The Bowen Center
2100 Goshen Road
Fort Wayne, IN 46808
260-471-3500
Marram Health Center
3229 Broadway, #115
Gary, IN 46409
219-806-3000
Kids First Pediatrics
5300 IN-64 Suite 105
Georgetown, IN 47122
(812) 366-0012
Maple City Health Care Center
808 N 3rd St
Goshen, IN 46528
(574) 534-0088
Community Physician Network Family
Medicine And Pediatric Care
3000 S. State Rd. 135, Ste. 310
Greenwood, IN, 46143
317-497-2400
* Community Health Network referrals only
Marram Health Center
704 S State Road 2
Hebron, IN 46341
(219) 996-2641
Riley Pediatric Care Center
1002 Wishard Blvd, Suite 2000
Indianapolis, IN 46202
317-944-4846
Eskenazi Health Center Pecar
6940 Michigan Rd.
Indianapolis IN 46268
317-266-2901
*Eskenazi referrals only
Riley Pediatric Primary Care
1002 Wishard Blvd, Suite 2001
Indianapolis, IN 46202
317-944-2801
*IU Health referrals only
Riley Pediatric Primary Care - Indianapolis
9650 E. Washington St., Suite 245
Indianapolis, IN 46229
(317) 890-5552
Jasper Primary Care Physicians
1950 St Charles Street, Suite 4
Jasper, IN 47546
(812) 482-9555
IU Health Arnett
2600 Greenbush
Lafayette, IN 47904
765-448-8000 (ask for Peds triage)
* IU Heath Arnett referrals only
Riley Physicians Pediatrics
820 Samuel Moore Pkway, Suite C
Mooresville, IN 46158
ALL IN Pediatrics
2305 Green Valley Rd.
New Albany, IN 47150
812-949-0405
*ALL IN Pediatrics referrals only
Growing Kids Pediatrics
3321 Ballard Ln.
New Albany, IN 47150
812-944-4575
Deaconess Riley Children’s
Specialty Center
4209 Gateway Blvd., MOB 2
Suite 1100
Newburgh, IN 47630
812-858-3131
MHP Pediatrics
2451 Intelliplex Drive, Suite 240
Shelbyville, IN 46176
(317) 398-7337
Primary Care Partners of South Bend
300 South St. Louis, Suite 204
South Bend, IN 46617
574-251-1200
Lutheran Health Physicians
Pediatric Healthcare
902 Provident Drive, Ste A
Warsaw, IN 46580
574-269-8338
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
EAE Hub system in the media
Eye-tracking tool to spot autism sets sights on commercialization
Eye-tracking techniques could help primary care providers diagnose autism sooner, more accurately
Purdue researcher focuses on early detection for, strengths within individuals with autism
Blog: Insurers adding to access barriers for autism evaluations
Video Abstract: A Statewide Tiered System for Screening and Diagnosis of Autism Spectrum Disorder
Blog: Early Autism Evaluation Hubs are Changing the Diagnosis of Autism in Indiana
Article: New System Shown to Improve Early Diagnosis of Autism
IU School of Medicine study paves way for earlier autism diagnosis in Indiana