08.03.2011 advocacy autism

8/6/2019 08.03.2011 Advocacy Autism

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Advocacy Morning Report: EarlyInterventionRebecca Percy

August 3, 2011


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Case Presentation

ID: 24 mo Burmese girl here for wcc.

HPI: 24 mo old girl has been doing well per MOC.MOC states that the girl has yet to begin talking,

but the mother does appear concerned by this.Patient can feed herself but does not follow themothers directions at home. The girl is able todress herself, go up and down stairs with minimalhelp, and does not yet hold a pencil. MOC does

not know how she interacts with other children asthere are none at home and the girl does notattend daycare.


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Case Presentation

PMH: none

FH: no history of autism, developmental

disorder, congenital disordersSH: Family from Burma, parents of child came 3

years ago, Patient was born here in SLC

MOC

is currently 6 months pregnant, no otherchildren at home

MED/ALL: none


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ROS/PE

ROS: Patient can be fussy and unable to besoothed. MOC does not know if it is related tohunger or tiredness throughout the day.

No repetitive behaviors per MOC.PE:

Vitals: WNL, Growth ~5-10%iles

Gen: NAD, well appearing, sitting at MOCs feet

Psych: upset with transitions/exam, does notsoothe, limited eye contact, non-verbal

Remaining Exam WNL


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Autism Spectrum Disorders

An autism screening tool must meet all three primary areas defined by the DSM-IV description for autistic disorder (#'s 1-3under A below) to qualify for a positive rating from First Signs:

A. A total of six (or more) items from (1), (2), and (3), with at least two from (1), and one each from (2) and (3):

(1) qualitative impairment in social interaction, as manifested by at least two of the following:

(a) marked impairment in the use of multiple nonverbal behaviors, such as eye-to-eye gaze, facial expression, body postures,and gestures to regulate social interaction

(b) failure to develop peer relationships appropriate to developmental level

(c) a lack of spontaneous seeking to share enjoyment, interests, or achievements with other people (e.g., by a lack of showing,bringing, or pointing out objects of interest)

(d) lack of social or emotional reciprocity (2) qualitative impairments in communication, as manifested by at least one of the following:

(a) delay in, or total lack of, the development of spoken language (not accompanied by an attempt to compensate throughalternative modes of communication such as gesture or mime)

(b) in individuals with adequate speech, marked impairment in the ability to initiate or sustain a conversation with others

(c) stereotyped and repetitive use of language or idiosyncratic language

(d) lack of varied, spontaneous make-believe play or social imitative play appropriate to developmental level

(3) restricted, repetitive, and stereotyped patterns of behavior, interests, and activities as manifested by at least one of thefollowing:

(a) encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either inintensity or focus

(b) apparently inflexible adherence to specific, nonfunctional routines or rituals

(c) stereotyped and repetitive motor mannerisms (e.g., hand or finger flapping or twisting or complex whole-body movements)

(d) persistent precoccupation with parts of objects

B. Delays or abnormal functioning in at least one of the following areas, with onset prior to age 3 years: (1) social interaction,(2) language as used in social communication, or (3) symbolic or imaginative play.

C. The disturbance is not better accounted for by Rett's disorder or childhood disintegrative disorder.


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Differential Diagnosis

Autism or pervasive developmental delay

Specific language disorder

Mental retardation/intellectual disability (MR/ID) without autism

Deafness

Selective Mutism Childhood disintegrative disorder

Neglect / Reactive Attachment Disorder

Personality disorder: schizophrenia, schizoid, schizotypal, avoidant

OCD or Stereotypy habit disorder with MR/ID

Genetic syndrome eg Rett syndrome Landau-Kleffner syndrome

Anger management issues/behavioral NOS

Normal (worried well)


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Rationale for Screening

17% of children have a developmental and/orbehavioral disorder, but only 30% of those areidentified prior to school entrance

Multiple studies have shown that earlyintervention does have long term effects onlanguage performance, overall educational andsocial outcomes, and decreased need for special

education services Early intervention saves society $30,000-

$100,000 per participant


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Screening Methods

www.developmentalscreening.org

http://www.cdc.gov/ncbddd/actearly/hcp/index.html

Current AAP Recommendations: All infants and young children be screened for

developmental delay

Surveillance and/or screening at wcc (9,18,24, and 30

months) Primary care provider is the one with the most

ongoing contact


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The Early Child Study

OBJ: To investigate the feasibility and outcome ofsystematic autism screening at 14-30 months in acommunity-based pediatrics practice.

Used M-CHAT and Infant Toddler Checklist

4 Questions: How many children with early ASD could be identified

through screening

Examine the extent screening could catch children prior toonset of concerning behavior

How screening worked in the context of diversebackgrounds

How much screening outside the wcc is feasible/necessary


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The Early Child Study

990 toddlers, all born in 2006, 14-24 mo at the

beginning of the 6 month period

80% completed a screening questionnaire Two steps: first, parents offered screening

packet (English/Spanish) at office visit, families

were then contacted by phone if their child

was at risk on either M-CHAT or ITC


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Early Intervention

Children 0-36 months have a free referral to

Early Intervention that, if services are needed

is either free (medicaid) or paid for on a

sliding scale UT is DDI

(www.ddivantage.com)

Ages 3-5 years also have state run services

(www.schools.utah.gov/SARS/)


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Resources

www.firstsigns.org

http://www.medicalhomeinfo.org/

http://www.medicalhomeportal.org/

http://www.autismawarenessonline.com/resources/States/utah.htm

http://www.utahfeat.org/site/category/show?cat

egory_id=14 http://nichcy.org/state-organization-search-by-

state


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Advocacy

Advocate at legislature for funding for early

intervention: www.healthpolicyproject.org andwww.utahchildren.org


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References

Developmental-behavioral surveillance and screening in primary care. Uptodate. Online. May 2011.

The development of cognitive and academic abilities: growth curves from an early childhood educational experience.

Developmental Psychology. 2001; 37(2): 231

The Early Child Study: Systematic Screening for Autism Spectrum Disorders in a Pediatric Setting. Pediatrics. 2011;

127(5):865.

Early intervention for disabled infants and their families: a quantitative analysis. Pediatrics. 1987; 80(5): 650

Identifying infants and young children with developmental disorders in the medical home: an algorithm for developmental

surveillance and screening. Council on Children With Disabilities, Section on Developmental Behavioral Pediatrics, BrightFutures Steering Committee, Medical Home Initiatives for Children With Special Needs Project Advisory

CommitteePediatrics. 2006;118(1):405

Longterm effects of an early childhod intervention on educational achievement and juvenile arrest: A 15-year follow-up of

low-income children in public schools.

JAMA. 2001; 285(18): 2339

www. Schools.utah.gov

www.ddivantage.com

08.03.2011 advocacy autism

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