Early Autism Detection and Referral 1.Autism Spectrum Disorder (ASD) 2.Signs & Symptoms 3.Autism...
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Transcript of Early Autism Detection and Referral 1.Autism Spectrum Disorder (ASD) 2.Signs & Symptoms 3.Autism...
Early Autism Detection and Referral
1. Autism Spectrum Disorder (ASD)
2. Signs & Symptoms
3. Autism Identification
4. Referral Process
1. Autism Spectrum Disorders - Basics
What is Autism?
Neurodevelopmental disorder with a spectrum of clinical conditions3 areas of dysfunction:
Social interaction/social relatedness difficultyCommunication impairmentRestrictive/repetitive behaviors and interests
ASD Facts: Epidemiology
Conservative prevalence: 1 in 500; recent estimates: 1 in 150 ASD more prevalent in pediatric population than:
CancerDiabetesDowns Syndrome
Male to female ratio: 4 to 1
Autism MythsMyth Truth
Children with autism …
Make no eye contact. Look at or through you, but eye contact has no social purpose.
Are not affectionate. Are affectionate on their own terms.
Do not talk. Can use advanced words, but they have no function.
Do not point. Usually develop the pointing skill later.
Are geniuses. Can have intellectual functioning that ranges from severe mental retardation to normal intelligence.
Have no hope for improvement.
Can experience positive outcomes with early and intensive intervention.
DSM-IV Classification:Pervasive Developmental Disorders
Pervasive Developmental Disorders
AutismAsperger’s Syndrome
PDD – NOS(not otherwise
Specified)
Rett’sSyndrome
ChildhoodDisintegrative
Disorder
ASD Causes:
Causation unknownStrong genetic influenceEvidence supports polygenic inheritanceRecurrence risk is 5-8% in siblings
Autism does NOT result from:
Poor parentingMMR vaccineThimerosal preservative in vaccines
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
ASD Facts
Present at birth, with onset of symptoms before 36 monthsAccurate diagnosis possible at 18-24 monthsParents first voice concerns around 18 months, but diagnosis is typically not until 3 years or older
Part 1 SummaryAutism Spectrum Basics
Autism is a neurodevelopmental disorder with a broad spectrum of behavioral manifestationsAutism is not rare! At 1 in 500, each pediatrician should have up to 3 or 4 affected children in their practice
2. Overview of Child Social Development
What are the earliest signs of Autism?Delays or abnormalities in:
Joint AttentionSocial InteractionPlay Behavior
Social Symptoms
Lack of:Use of eye contact to regulate social interactionOrienting to nameJoint attention behaviors: pointing & showingPretend playImitationNonverbal communicationLanguage development
Language Delay – Need for immediate referral
9 months: No babbling
12 months: No pointing or other gestures16 months: No single words24 months: No functional 2-word phrases
(not echolalic) Any age: Any loss of language or social
skills
Behavioral Red Flags
Investigate further and consider autism if the child:Doesn’t know how to play with toys in a typical fashionRestricted patterns of interest“Toe walks”Has unusual attachmentsLines things upPresents with sensory symptomsHas odd movement patterns and/or very repetitive behaviorsDemonstrates echolaliaThrows prolonged or frequent tantrumsIs hyperactive
Interaction Age
Reciprocal smiling 2 months
Gaze monitoring 8 months
Follows a point 9 months
Showing objects 10 months
Pointing to obtain an object 12 months
Pointing to indicate to another an object of interest
14 months
Social referencing 14 months
Joint Attention
Part 2 SummaryChild Social DevelopmentDelays or abnormalities in:
Social InteractionLanguage DelayRestricted or Repetitive Behavior
3. Autism Identification
AAP PolicyDevelopmental ScreeningAAP Committee on Children with Disabilities recommends routine standardized developmental and behavioral screening
Pediatrics Vol. 108 No. 1 July 2001
Listen to ParentsParents:
Are aware of the possibility of autismDo have concerns when something is wrongDo give accurate and reliable information about their childrenNeed your questions to generate discussion about their child’s development
Child care providers are also a good resources when addressing developmental concerns of a child
Autism Assessment:18 – 36 monthsAutism screening tools are not recommended for primary care settingAt 18-month visit use parent questioning and direct observation to assess child for:
Refer for further evaluation if concerned
Social Language Play
Using gestures: pointing waving shaking head
Using 7-10 wordsUnderstanding1-step command
Engaging in simple pretend play
Developmental ScreeningConsider using a standardized parent report tool at every well child visitExamples include:
Parental Evaluation of Developmental Status (PEDS) www.pedstest.com
Ages and Stages Questionnaire (ASQ)www.pbrookes.com/store/books/bricker-asq/
Child Development Reviewwww.childdevrev.com
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)
Part 3 SummaryAutism Identification
Developmental screening is recommendedThe disorder can be recognized by 18-24 months when familiar with the early signsScreening for autistic spectrum disorders either formally or informally at the 18 month visit is recommended
4. Referral Process
Referrals for children who show signs of autism
A.L.A.R.M.Under 3 years – refer to Early Intervention3 years or above – refer to School DistrictFor diagnostic confirmation consider:
Developmental & behavioral pediatricianChild psychologistPediatric neurologistChild psychiatrist
0 – 3: Early Intervention
Different in each stateBabies Can’t Wait ProgramsAutism Centers of ExcellenceUniversity Based Developmental DisordersCheck with State Office
Call 1-800-323-GROW for nearest CFC
Special Education
Mandated by federal IDEA legislationPrograms managed and vary by school districtMake referrals in writing!Individualized Education Plan (IEP) for each childServices for children with autism may include:
Speech therapyOccupational therapyCommunication assistance (PECS)Teacher education on classroom management
Treatment Options
Issues to consider when choosing a treatment plan:
Evidence-basedCostTimeFamily involvement
Insurance Issues
Autism assessment with observation and parental discussion falls under the general well child visit codeImplement standardized developmental screening to increase reimbursement
Encouraging Next Steps
Acknowledge parent’s fear and griefProvide information on how to tell othersProvide parent with information on the referral sourcesEncourage communicationSet a follow-up appointment
Part 4 SummaryReferral
Physician plays the role of gatekeeperDiagnosis requires a TEAM evaluationEarly intervention makes a difference!Advances in effective treatments