Early Autism Detection and Referral

1
Early Autism Detection and Referral
2
1. Autism Spectrum Disorders - Basics
3
What is Autism?

• Neurodevelopmental disorder with a spectrum of
  clinical conditions
• 3 areas of dysfunction
• Social interaction/social relatedness difficulty
• Communication impairment
• Restrictive/repetitive behaviors and interests

4
ASD Facts Epidemiology

• Conservative prevalence 1 in 500 recent
  estimates 1 in 150
• ASD more prevalent in pediatric population than
• Cancer
• Diabetes
• Downs Syndrome
• Male to female ratio 4 to 1

5
Autism Myths
6
DSM-IV ClassificationPervasive Developmental
Disorders
7
ASD Causes

• Autism does NOT result from
• Poor parenting
• MMR vaccine
• Thimerosal preservative in vaccines

• Causation unknown
• Strong genetic influence
• Evidence supports polygenic inheritance
• Recurrence risk is 5-8 in siblings

8
AAP Policy

• Due to recent evidence that early diagnosis and
  intervention are associated with better long-term
  outcomes, the AAP Committee on Children with
  Disabilities recommends that pediatricians
  increase their knowledge on autism
• Pediatrics Vol. 107 No. 5 May 2001

9
ASD Facts

• Present at birth, with onset of symptoms before
  36 months
• Accurate diagnosis possible at 18-24 months
• Parents first voice concerns around 18 months,
  but diagnosis is typically not until 3 years or
  older

10
Part 1 SummaryAutism Spectrum Basics

• Autism is a neurodevelopmental disorder with a
  broad spectrum of behavioral manifestations
• Autism is not rare! At 1 in 500, each
  pediatrician should have up to 3 or 4 affected
  children in their practice

11
2. Overview of Child Social Development
12
What are the earliest signs of Autism?

• Delays or abnormalities in
• Joint Attention
• Social Interaction
• Play Behavior

13
Social Symptoms

• Lack of
• Use of eye contact to regulate social interaction
• Orienting to name
• Joint attention behaviors pointing showing
• Pretend play
• Imitation
• Nonverbal communication
• Language development

14
Language Delay Need for immediate referral

• 9 months No babbling
• 12 months No pointing or other gestures
• 16 months No single words
• 24 months No functional 2-word phrases
• (not echolalic)
• Any age Any loss of language or social
  skills

15
Behavioral Red Flags

• Investigate further and consider autism if the
  child
• Doesnt know how to play with toys in a typical
  fashion
• Restricted patterns of interest
• Toe walks
• Has unusual attachments
• Lines things up
• Presents with sensory symptoms
• Has odd movement patterns and/or very repetitive
  behaviors
• Demonstrates echolalia
• Throws prolonged or frequent tantrums
• Is hyperactive

16
Joint Attention
17
Part 2 SummaryChild Social Development

• Delays or abnormalities in
• Social Interaction
• Language Delay
• Restricted or Repetitive Behavior

18
3. Autism Identification
19
AAP PolicyDevelopmental Screening

• AAP Committee on Children with Disabilities
  recommends routine standardized developmental and
  behavioral screening
• Pediatrics Vol. 108 No. 1 July 2001

20
Listen to Parents

• Parents
• Are aware of the possibility of autism
• Do have concerns when something is wrong
• Do give accurate and reliable information about
  their children
• Need your questions to generate discussion about
  their childs development
• Child care providers are also a good resources
  when addressing developmental concerns of a child

21
Autism Assessment18 36 months

• Autism screening tools are not recommended for
  primary care setting
• At 18-month visit use parent questioning and
  direct observation to assess child for
• Refer for further evaluation if concerned

22
Developmental Screening

• Consider using a standardized parent report tool
  at every well child visit
• Examples include
• Parental Evaluation of Developmental Status
  (PEDS) www.pedstest.com
• Ages and Stages Questionnaire (ASQ)
• www.pbrookes.com/store/books/bricker-asq/
• Child Development Review
• www.childdevrev.com

23
Autism Screening Tools

• CHecklist for Autism in Toddlers (CHAT)
• Modified CHecklist for Autism in Toddlers
  (M-CHAT)
• Quick and Quantitative CHecklist for Autism in
  Toddlers (Q-CHAT)

24
Part 3 SummaryAutism Identification

• Developmental screening is recommended
• The disorder can be recognized by 18-24 months
  when familiar with the early signs
• Screening for autistic spectrum disorders either
  formally or informally at the 18 month visit is
  recommended

25
4. Referral Process
26
Referrals for children who show signs of autism

• A.L.A.R.M.
• Under 3 years refer to Early Intervention
• 3 years or above refer to School District
• For diagnostic confirmation consider
• Developmental behavioral pediatrician
• Child psychologist
• Pediatric neurologist
• Child psychiatrist

27
0 3 Early Intervention

• Different in each state
• Babies Cant Wait Programs
• Autism Centers of Excellence
• University Based Developmental Disorders
• Check with State Office

Call 1-800-323-GROW for nearest CFC
28
Special Education

• Mandated by federal IDEA legislation
• Programs managed and vary by school district
• Make referrals in writing!
• Individualized Education Plan (IEP) for each
  child
• Services for children with autism may include
• Speech therapy
• Occupational therapy
• Communication assistance (PECS)
• Teacher education on classroom management

29
Treatment Options

• Issues to consider when choosing a treatment
  plan
• Evidence-based
• Cost
• Time
• Family involvement

30
Insurance Issues

• Autism assessment with observation and parental
  discussion falls under the general well child
  visit code
• Implement standardized developmental screening to
  increase reimbursement

31
Encouraging Next Steps

• Acknowledge parents fear and grief
• Provide information on how to tell others
• Provide parent with
• information on the
• referral sources
• Encourage communication
• Set a follow-up appointment

32
Part 4 SummaryReferral

• Physician plays the role of gatekeeper
• Diagnosis requires a TEAM evaluation
• Early intervention makes a difference!
• Advances in effective treatments