Autism Spectrum Disorders: Making AAP Policy and the Toolkit Work for You Speakers вЂў Scott M. Myers, MD, FAAP Geisinger Medical Center, Danville, PA вЂў Mark Rosenberg, MD, FAAP Child 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 вЂў Describe the recommendations put forth in the 2 AAP Autism Clinical Reports (Nov 2007) вЂў Utilize the AAP Autism Screening Algorithm in office practice вЂў Identify strategies for implementing at least 2 tools from the AAP Autism Toolkit Leo Kanner Autistic Disturbances of Affective Contact Nervous Child 1943;2:217-53 вЂў Lack of typical motivation for social interaction and affective contact вЂў Profound disturbances in communication вЂ“ lack of speech, echolalia, literalness, pronominal reversal вЂў Unusual responses to the environment, resistance to change Autistic Disorder DSM-IV (APA, 1994) вЂў Qualitative impairment in social interaction вЂў Qualitative impairment in communication вЂў Restricted, repetitive and stereotyped patterns of behavior, interests, and activities вЂў Delay or abnormality in social interaction, language use for social communication, or symbolic or imaginative play with onset before age 3 Autism Spectrum Disorders вЂў Autistic Disorder вЂў Asperger Syndrome вЂў Pervasive Developmental Disorder Not Otherwise Specified (PDD NOS) вЂў Behaviorally defined conditions вЂў Caused by neurological dysfunction of multiple etiologies вЂў Spectrum of varying severity Epidemiology вЂў 1 out of 6 children are diagnosed with a developmental disorder/behavioral problem вЂў Current detection rates are lower than prevalence вЂў Prevalence of ASDs is 1 in 150 children1 вЂў 44% of PCPs report caring for at least 10 children with ASD; however, only 8% routinely screen2 CDC. Prevalence of autism spectrum disorders вЂ“ 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:S88вЂ“S94 1 Important Roles of Primary Care Physicians вЂў Early recognition вЂ“ Knowledge of signs and symptoms вЂ“ Developmental surveillance and screening вЂў Guiding families to diagnostic resources and intervention services вЂў Conducting a medical evaluation вЂў Providing ongoing health care вЂў Supporting and educating families AAP Clinical Reports: Guidance for the Clinician in Rendering Pediatric Care Autism Resource Toolkit Pediatrics, November, 2007 AAP, 2007 Identification and Evaluation of Children With ASDs вЂў Diagnostic criteria вЂў Epidemiology вЂ“ Prevalence 1/150 вЂў Etiology вЂў Neuropathology and neuroimaging вЂў Clinical signs вЂў Coexisting conditions вЂў Surveillance and screening вЂ“ Algorithm вЂў Referral for evaluation and services вЂў Comprehensive evaluation вЂў Genetic counseling вЂў Prognosis Johnson CP, Myers SM, and the Council on Children with Disabilities, Pediatrics 2007;120:1183-1215 Key Points вЂў Conduct ASD surveillance at all preventative well child visits and whenever there is a concern вЂў Screen all children at 18 and 24 months вЂў Increased vigilance in younger siblings with a 10x increased risk вЂў Refer for hearing evaluation and early intervention services as soon as an ASD is seriously considered rather than waiting for a definitive diagnosis вЂў Early recognition пѓЁ access to intervention пѓЁ improved outcomes Johnson CP, Myers SM, and the Council on Children with Disabilities, Pediatrics 2007;120:1183-1215 Management of Children With ASDs вЂў Educational Interventions вЂ“ Preschool and School Programs вЂ“ Specific Strategies вЂў вЂў вЂў вЂў Applied Behavior Analysis Structured Teaching Developmental Models Speech and Language Therapy вЂў Social Skills Instruction вЂў Occupational Therapy вЂў Sensory Integration Therapy вЂў Medical Management вЂ“ Seizures вЂ“ Gastrointestinal Problems вЂ“ Sleep Disturbance вЂ“ Challenging Behaviors вЂ“ Psychopharmacology вЂ“ Complementary and Alternative Medicine вЂў Family Support вЂ“ Parents вЂ“ Siblings Myers SM, Johnson CP, and the Council on Children with Disabilities, Pediatrics 2007;120:1162-1182 Key Points вЂў Chronic management within a medical home is required вЂў Educational interventions, including behavioral strategies and habilitative therapies, are the cornerstones of treatment вЂў Early, intensive intervention is recommended вЂў Pediatricians 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 Points вЂў Effective treatment of coexisting medical problems such as seizures, challenging behaviors, and sleep disorders may allow the child to benefit more fully from educational interventions вЂў Pediatricians can help families to understand how to evaluate the scientific merits of various therapies and guide them to scientifically validated treatments Myers SM, Johnson CP, and the Council on Children with Disabilities, Pediatrics 2007;120:1162-1182 Developmental Screening/ASD Policy вЂў Identifying Infants and Young Children with Developmental Disorders in the Medical Home: An Algorithm for Developmental Surveillance and Screening. July 2006 вЂ“ Routine developmental surveillance at each well-child visit вЂ“ Developmental screening at 9,18, and 30 months вЂў Identification and Evaluation of Children With Autism Spectrum Disorders. Nov 2007 вЂ“ Autism-specific screening at 18, 24 months вЂў Management of Children With Autism Spectrum Disorders. Nov 2007 Toolkit вЂў AUTISM: 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 Goals вЂў Improve early identification of children with autism spectrum disorders in primary care so they can receive treatment services as early as possible вЂў Empower pediatricians to take a strong role in the management of children with ASDs and their associated conditions in the medical home Toolkit Content The fully searchable CD-ROM has an extensive library of ASD-specific information and practice tools: вЂў Screening and surveillance algorithms вЂў Examples of screening tools вЂў Guideline summary charts вЂў Management checklists вЂў Developmental checklists вЂў Developmental growth charts вЂў Web links вЂў Early intervention referral forms and tools вЂў Record-keeping tools вЂў Emergency information forms вЂў ASD coding tools вЂў Reimbursement tips вЂў Sample letters to insurance companies вЂў ASD management fact sheets вЂў Family education handouts Toolkit Content Hard copies of the following resources are included: вЂў CDC/Learn the Signs. Act Early. Developmental Growth Chart вЂў вЂњUnderstanding Autism Spectrum DisordersвЂќ Parent booklet вЂў вЂњIs Your One-Year-Old Communicating With YouвЂќ Parent Brochure Toolkit Content Fact sheets for primary care professionals (PDF files) Topics вЂў Asperger syndrome вЂў Behavioral principles вЂў CAM Treatments вЂў Dietary tx вЂў Eating & nutrition вЂў GI problems вЂў вЂў вЂў вЂў вЂў Treatment decision Psychopharmacology Seizures & Epilepsy Sleep disorders Toilet training Toolkit Content Fact sheets for primary care professionals to give families (PDF files) Topics вЂў вЂў вЂў вЂў вЂў вЂў вЂў вЂў вЂў вЂў Behavioral challenges Diet Early intervention GI problems Childhood to adolescence Guardianship Lab tests Medication Nutrition & eating problems School based services вЂў вЂў вЂў вЂў вЂў вЂў вЂў вЂў Seizures & epilepsy Sibling issues Sleep problems Support programs for families Toilet training Transition to adulthood Vaccines Visiting the doctor Screening for Autism Spectrum Disorder in Your Office вЂў вЂў вЂў вЂў Rationale for screening Means to screen Reimbursement Resources Screening for Autism Spectrum Disorder in Your Office вЂў SCREENING CONFORMS TO BRIGHT FUTURES GUIDELINES вЂў SCREENING AS QUALITY IMPROVEMENT: AMERICAN BOARD OF PEDIATRICS PERFORMANCE CRITERIA Screening for Autism Spectrum Disorder in Your Office вЂў The need: вЂ“ Parents want to know how their child is doing вЂ“ Parents want to know how they are doing вЂў The means: вЂ“ Given limited time use of developmental screening tools promotes efficiency Resources for Pediatricians вЂў AAP Clinical Reports вЂў Autism Toolkit вЂў Web sites: вЂ“ WWW.DBPEDS.ORG вЂ“ WWW.EDOPC.ORG вЂ“ WWW.MEDICALHOMEINFO.ORG REIMBURSEMENT вЂў DEVELOPMENTAL SCREENING TOOLS вЂ“ 96110 ROUTINE SCREENING TOOL вЂў MAY USE MORE THAN ONCE PER VISIT вЂ“ 96111 DETAILED DEVELOPMENTAL VISIT вЂў RISK ASSESSMENT вЂ“ 99420 POST PARTUM DEPRESSION вЂў PROLONGED SERVICES CODES вЂ“ 99354-5 ADDITION TO PREVENTIVE VISIT RESOURCES FROM TOOLKIT вЂў Early Intervention Referral Form вЂў Emergency Care Form вЂў Community Resources EI Referral Form EMS Form Community Resources Questions?