Thursday, November 01, 2007

American Pediatricians Make Big Push for Autism Diagnosis, Awareness; Kits for Doctors, Checklists for Parents

The American Academy of Pediatrics, the national group for 60,000 primary care children's doctors, this week issued a major announcement to educate its members about the early diagnostic signs for autism spectrum disorders, and urge them to look for those signs during baby checkup visits.

This announcement, made at the Academy's annual national conference on Oct. 29, is important because it sets some baseline expectations for what pediatricians around the country should understand about autism, including the essential importance of early intervention services. The documents make clear to doctors (and parents, grandparents and caregivers) the importance of milestones for early childhood development and communications skills. The Academy advises doctors to look for these signs at every well-child visit, or baby checkups. For parents and advocates of young children with autism, the documents also could help set the stage for minimum expectations for early intervention services.

Read the announcement by clicking here. It is impressive in its scope. It includes links to two research studies published in the November 2007 issue of the journal Pediatrics: "Identification and Evaluation of Children with Autism Spectrum Disorders," explains the history of autism, summarizes research so far into possible causes for it, lays out specific criteria for doctors to diagnose autism and explains how to help parents look for developmental delays. The second report, "Management of Children with Autism Spectrum Disorders," establishes the importance of behavioral and educational interventions, including structured teaching methods such as Applied Behavior Analysis (ABA) and Treatment and Education of Autistic and Related Communication Handicapped Children (TEACHH) delivered in low student-teacher ratios "to allow sufficient amounts of 1-on-1 time" for "at least 25 hours per week, 12 months per year."

The Academy said it published both documents as an update and replacement for materials published in 2001.

Diagnostic Signs for Autism Before 18 Months of Age

"Language delays usually prompt parents to raise concerns to their child's pediatrician—usually around 18 months of age," the Academy notes. "However, there are earlier subtle signs that if detected could lead to earlier diagnosis." The signs include:

* not turning when the parent says the baby's name
* not turning to look when the parent points says, "Look at..." and not pointing themselves to show parents an interesting object or event;
* lack of back and forth babbling;
* smiling late; and
* failure to make eye contact with people.

The doctors' group notes:

"Red Flags" that are absolute indications for immediate evaluation include: no babbling or pointing or other gesture by 12 months; no single words by 16 months; no two-word spontaneous phrases by 24 months; and loss of language or social skills at any age. Early intervention can make a huge difference in the child's prognosis. "Autism doesn't go away, but therapy can help the child cope in regular environments," said Dr. Chris Plauche Johnson, a co-author of the reports. "It helps the children want to learn and communicate."

A Heads Up to Doctors About Parents' Use of Alternative Medical Therapies

In addition to developmental checklists, specific guidelines for doctors and explanations of the medical literature about autism and therapies for it, there's an interesting secondary theme the Academy of Pediatrics is working to convey to its members about parents' interest in alternative medical therapies. The message to doctors goes something like this: There's a great deal of media coverage and growing awareness out there about autism spectrum disorders and lots of information on the Internet. Engage parents in discussions, listen to their concerns. Don't dismiss their interest in alternative therapies, even as you share knowledge about evaluating whether a treatment option has evidence to show it is valuable.

Here's a passage from the Academy's announcement:

Pediatricians who treat children with ASDs should recognize that many of their patients will use nonstandard therapies. The report says it’s important for pediatricians to become knowledgeable about complementary and alternative medicine (CAM) therapies, ask families about current and past CAM use, and provide balanced information and advice about treatment options, including identifying risks or potential harmful effects. They should avoid becoming defensive or dismissing CAM in ways that convey a lack of sensitivity or concern, but they should also help families to understand how to evaluate scientific evidence and recognize unsubstantiated treatments.

“Many parents are interested in CAM treatments such as various vitamin and mineral supplements, chelation therapy, and diet restrictions. It’s important for pediatricians to maintain open communication and continue to work with these families even if there is disagreement about treatment choices, ” said co-author of the reports Scott M. Myers, MD, FAAP. “At the same time, it’s also important to critically evaluate the scientific evidence of effectiveness and risk of harm and convey this information to the families, just as one should for treatment with medication and for non-medical interventions.”

Although use of the gluten-free/casein-free diet for children with ASDs is popular, there is little evidence to support or refute this intervention. More studies are in progress, and it is anticipated that these studies will provide substantially more useful information regarding the efficacy of the gluten-free/casein-free diet.

All of this information is available for sale ($70 for members, $80 otherwise) in a package for pediatricians called "Autism: Caring for Children with Autism Spectrum Disorders: A Resource Toolkit for Clinicians," including "screening and surveillance tools, guideline summary charts, management checklists, developmental checklists, developmental growth charts, early intervention referral forms and tools, sample letters to insurance companies and family handouts."

No comments: