Autism Spectrum Disorders: Making AAP Policy and the Toolkit Work for You
32
Autism Spectrum Disorders: Making AAP Policy and the Toolkit Work for You
-
Upload
visualbeecom -
Category
Documents
-
view
423 -
download
0
Transcript of Autism Spectrum Disorders: Making AAP Policy and the Toolkit Work for You
Autism Spectrum Disorders: Making AAP Policy and the
Toolkit Work for You
SpeakersScott M. Myers, MD, FAAPGeisinger Medical Center, Danville, PAMark Rosenberg, MD, FAAPChild Health Associates, Chicago, IL
The speakers have no relevant financial relationships with the manufacturers of any commercial products and/or provider of commercial services discussed in this CME activity.
They do not intend to discuss an unapproved/investigative use of a commercial product/device in their presentation.
Objectives
Describe the recommendations put forth in the 2 AAP Autism Clinical Reports (Nov 2007)
Utilize the AAP Autism Screening Algorithm in office practice
Identify strategies for implementing at least 2 tools from the AAP Autism Toolkit
Lack of typical motivation for social interaction and affective contactProfound disturbances in communication
lack of speech, echolalia, literalness, pronominal reversal
Unusual responses to the environment, resistance to change
Leo Kanner Autistic Disturbances of Affective Contact
Nervous Child 1943;2:217-53
Autistic DisorderDSM-IV (APA, 1994)
Qualitative impairment in social interactionQualitative impairment in communicationRestricted, repetitive and stereotyped patterns of behavior, interests, and activitiesDelay or abnormality in social interaction, language use for social communication, or symbolic or imaginative play with onset before age 3
Autistic DisorderAsperger SyndromePervasive Developmental Disorder Not Otherwise Specified (PDD NOS)
Behaviorally defined conditionsCaused by neurological dysfunction of multiple etiologiesSpectrum of varying severity
Autism Spectrum Disorders
Epidemiology1 out of 6 children are diagnosed with a developmental disorder/behavioral problemCurrent detection rates are lower than prevalencePrevalence of ASDs is 1 in 150 children1
44% of PCPs report caring for at least 10 children with ASD; however, only 8% routinely screen2
1 CDC. Prevalence of autism spectrum disorders – ADDM network, 14 sites, US 2002. MMWR 2007;56(1):12-28.
2 Dosreis S, Weiner CL, Johnson L, Newschaffer CJ. Autism spectrum disorder screening and management practices among general pediatric providers. J Dev Behav Pediatr. 2006;27:S88–S94
Important Roles of Primary Care Physicians
Early recognition
• Knowledge of signs and symptoms• Developmental surveillance and screening
Guiding families to diagnostic resources and intervention services
Conducting a medical evaluation
Providing ongoing health care
Supporting and educating families
Pediatrics, November, 2007 AAP, 2007
Autism Resource Toolkit
AAP Clinical Reports:Guidance for the Clinician in Rendering Pediatric Care
Diagnostic criteriaEpidemiology
Prevalence 1/150
EtiologyNeuropathology and neuroimagingClinical signsCoexisting conditions
Surveillance and screening
AlgorithmReferral for evaluation and servicesComprehensive evaluationGenetic counselingPrognosisJohnson CP, Myers SM, and the Council on Children with Disabilities,
Pediatrics 2007;120:1183-1215
Identification and Evaluation of Children With ASDs
Key PointsConduct ASD surveillance at all preventative well child visits and whenever there is a concernScreen all children at 18 and 24 monthsIncreased vigilance in younger siblings with a 10x increased riskRefer for hearing evaluation and early intervention services as soon as an ASD is seriously considered rather than waiting for a definitive diagnosisEarly recognition access to intervention improved outcomes
Johnson CP, Myers SM, and the Council on Children with Disabilities, Pediatrics 2007;120:1183-1215
Educational Interventions
Preschool and School ProgramsSpecific Strategies
Applied Behavior AnalysisStructured TeachingDevelopmental ModelsSpeech and Language TherapySocial Skills InstructionOccupational TherapySensory Integration Therapy
Medical ManagementSeizures
Gastrointestinal ProblemsSleep DisturbanceChallenging BehaviorsPsychopharmacologyComplementary and Alternative Medicine
Family SupportParentsSiblings
Myers SM, Johnson CP, and the Council on Children with Disabilities, Pediatrics 2007;120:1162-1182
Management of Children With ASDs
Key PointsChronic management within a medical home is requiredEducational interventions, including behavioral strategies and habilitative therapies, are the cornerstones of treatmentEarly, intensive intervention is recommendedPediatricians can support families by providing information and access to resources
Myers SM, Johnson CP, and the Council on Children with Disabilities, Pediatrics 2007;120:1162-1182
Key PointsEffective treatment of coexisting medical problems such as seizures, challenging behaviors, and sleep disorders may allow the child to benefit more fully from educational interventionsPediatricians can help families to understand how to evaluate the scientific merits of various therapies and guide them to scientifically validated treatmentsMyers SM, Johnson CP, and the Council on Children with
Disabilities, Pediatrics 2007;120:1162-1182
Developmental Screening/ASD Policy
Identifying Infants and Young Children with Developmental Disorders in the Medical Home: An Algorithm for Developmental Surveillance and Screening. July 2006
Routine developmental surveillance at each well-child visitDevelopmental screening at 9,18, and 30 months
Identification and Evaluation of Children With Autism Spectrum Disorders. Nov 2007
Autism-specific screening at 18, 24 months
Management of Children With Autism Spectrum Disorders. Nov 2007
ToolkitAUTISM: Caring for Children With Autism Spectrum Disorders: A Resource Toolkit for Clinicians was developed by the AAP Autism Subcommittee to support health care professionals in the identification and ongoing management of children with ASDs in the medical home
GoalsImprove early identification of children with autism spectrum disorders in primary care so they can receive treatment services as early as possibleEmpower pediatricians to take a strong role in the management of children with ASDs and their associated conditions in the medical home
The fully searchable CD-ROM has an extensive library of ASD-specific information and practice
tools:• Screening and surveillance algorithms• Examples of screening tools• Guideline summary charts• Management checklists• Developmental checklists• Developmental growth charts• Web links• Early intervention referral forms and tools
• Record-keeping tools• Emergency information forms• ASD coding tools• Reimbursement tips• Sample letters to insurance companies• ASD management fact sheets• Family education handouts
Toolkit Content
Toolkit Content
Hard copies of the following resources
are included:•CDC/Learn the Signs. Act Early. Developmental Growth Chart•“Understanding Autism Spectrum Disorders” Parent booklet•“Is Your One-Year-Old Communicating With You” Parent Brochure
Asperger syndromeBehavioral principlesCAM TreatmentsDietary txEating & nutritionGI problems
Treatment decisionPsychopharmacologySeizures & EpilepsySleep disordersToilet training
Fact sheets for primary care professionals (PDF files) Topics
Toolkit Content
Behavioral challengesDietEarly interventionGI problemsChildhood to adolescenceGuardianshipLab testsMedicationNutrition & eating problemsSchool based services
Seizures & epilepsySibling issuesSleep problemsSupport programs for familiesToilet trainingTransition to adulthoodVaccines Visiting the doctor
Fact sheets for primary care professionals to give families (PDF files) Topics
Toolkit Content
Screening for Autism Spectrum Disorder in Your Office
Rationale for screeningMeans to screenReimbursementResources
Screening for Autism Spectrum Disorder in Your Office
SCREENING CONFORMS TO BRIGHT FUTURES GUIDELINESSCREENING AS QUALITY IMPROVEMENT:AMERICAN BOARD OF PEDIATRICS PERFORMANCE CRITERIA
Screening for Autism Spectrum Disorder in Your Office
The need:Parents want to know how their child is doingParents want to know how they are doing
The means:Given limited time use of developmental screening tools promotes efficiency
Resources for Pediatricians
AAP Clinical ReportsAutism ToolkitWeb sites:
WWW.DBPEDS.ORGWWW.EDOPC.ORGWWW.MEDICALHOMEINFO.ORG
REIMBURSEMENTDEVELOPMENTAL SCREENING TOOLS
96110 ROUTINE SCREENING TOOL
MAY USE MORE THAN ONCE PER VISIT
96111 DETAILED DEVELOPMENTAL VISIT
RISK ASSESSMENT99420 POST PARTUM DEPRESSION
PROLONGED SERVICES CODES
99354-5 ADDITION TO PREVENTIVE VISIT
RESOURCES FROM TOOLKIT
Early Intervention Referral FormEmergency Care FormCommunity Resources
