From Indication to Action: Provider Attitudes as a Determinant of Genetic Testing for Individuals with Neurodevelopmental Disorders

Genetic testing is recommended for children with neurodevelopmental disorders (NDDs), yet referral and testing rates remain lower than expected. Provider attitudes and confidence are likely key determinants of whether eligible patients access genetic services. We conducted a cross-sectional survey of physicians and advanced practice providers in Developmental and Behavioral Pediatrics, Neurology, and Psychiatry at a large academic pediatric medical center. An 18-item survey, distributed electronically, assessed provider knowledge, attitudes, and experiences related to genetic testing and referral for patients with NDDs. Responses were rated on a 5-point Likert scale (1 = strongly disagree to 5 = strongly agree) and analyzed using descriptive statistics, Kruskal–Wallis tests, and Mann–Whitney U tests (significance set at p < 0.05, with Bonferroni-adjusted results also reported), with ordinal logistic regression as a sensitivity analysis adjusting for provider type. Thirty-one providers completed the survey (12 Developmental and Behavioral Pediatrics, 11 Psychiatry, 8 Neurology); response rate 20%. Most respondents agreed that genetic testing is valuable for patients with NDDs and felt comfortable initiating recommended genetic testing. However, fewer reported confidence in interpreting results, particularly psychiatry providers, who reported significantly lower comfort than Neurology and DDBP providers, a difference that persisted after adjustment for provider type. A greater preference among APRNs for Genetics providers to interpret results was not independent of specialty. Insurance coverage was widely perceived as a barrier, while family disinterest was not. Across specialties, providers consistently endorsed that genetic testing positively impacts patient care and medical management. While providers recognize the importance and utility of genetic testing for NDDs, limited confidence in interpreting results and concerns about insurance coverage may be barriers to implementation. Interventions such as enhanced access to genetics specialists, improved educational resources, and advocacy for insurance coverage may help bridge the gap between guideline recommendations and clinical practice. Because these data come from a small, single-institution sample, the findings should be considered preliminary.