Autism Spectrum Disorders:Making AAP Policy and the   Toolkit Work for You
Speakers  Scott M. Myers, MD, FAAP  Geisinger Medical Center, Danville, PA  Mark Rosenberg, MD, FAAP  Child Health Associa...
Objectives       Describe the recommendations put forth in the 2       AAP Autism Clinical Reports (Nov 2007)       Utiliz...
Leo KannerAutistic Disturbances of Affective Contact        Nervous Child 1943;2:217-53Lack of typical motivation for soci...
Autistic DisorderDSM-IV (APA, 1994) Qualitative impairment in social interaction Qualitative impairment in communication R...
Autism Spectrum DisordersAutistic DisorderAsperger SyndromePervasive Developmental Disorder NotOtherwise Specified (PDD NO...
Epidemiology    1 out of 6 children are diagnosed with a    developmental disorder/behavioral problem    Current detection...
Important Roles of Primary CarePhysiciansEarly recognition• Knowledge of signs and symptoms• Developmental surveillance an...
AAP Clinical Reports:   Guidance for the Clinician in Rendering Pediatric Care                                   Autism Re...
Identification and Evaluation of Children With ASDsDiagnostic                       Surveillance andcriteria              ...
Key Points Conduct ASD surveillance at all preventative well child visits and whenever there is a concern Screen all child...
Management of Children With ASDsEducational Interventions                 Medical   Preschool and School                  ...
Key Points Chronic management within a medical home is required Educational interventions, including behavioral strategies...
Key Points Effective treatment of coexisting medical problems such as seizures, challenging behaviors, and sleep disorders...
Developmental Screening/ASD Policy Identifying Infants and Young Children with Developmental Disorders in the Medical Home...
Toolkit AUTISM: Caring for Children With Autism Spectrum Disorders: A Resource Toolkit for Clinicians was developed by the...
Goals Improve early identification of children with autism spectrum disorders in primary care so they can receive treatmen...
Toolkit Content    The fully searchable CD-ROM has an extensive library of            ASD-specific information and practic...
Toolkit Content     Hard copies of the  following resources are          included:• CDC/Learn the Signs. Act  Early. Devel...
Toolkit ContentFact sheets for primary care professionals  (PDF files) Topics   Asperger syndrome    Treatment decision   ...
Toolkit ContentFact sheets for primary care professionals to         give families (PDF files) Topics Behavioral challenge...
Screening for Autism SpectrumDisorder in Your Office Rationale for screening Means to screen Reimbursemen t Resources
Screening for Autism SpectrumDisorder in Your Office                      SCREENING                      CONFORMS TO      ...
Screening for Autism SpectrumDisorder in Your Office The need:    Parents want to know    how their child is doing    Pare...
Resources for Pediatricians AAP Clinical Reports Autism Toolkit Web sites:   WWW.DBPEDS.ORG   WWW.EDOPC.ORG   WWW.MEDICALH...
REIMBURSEMENT DEVELOPMENTAL SCREENING TOOLS   96110 ROUTINE   SCREENING TOOL      MAY USE MORE THAN      ONCE PER VISIT   ...
RESOURCES FROM TOOLKIT Early Intervention Referral Form Emergency Care Form Community Resources
EI Referral Form
EMS Form
Community Resources
Questions?
Autism Spectrum Disorders: Making AAP Policy and the Toolkit Work for You
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Autism Spectrum Disorders: Making AAP Policy and the Toolkit Work for You

  1. 1. Autism Spectrum Disorders:Making AAP Policy and the Toolkit Work for You
  2. 2. Speakers Scott M. Myers, MD, FAAP Geisinger Medical Center, Danville, PA Mark Rosenberg, MD, FAAP Child Health Associates, Chicago, ILThe 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.
  3. 3. 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
  4. 4. Leo KannerAutistic Disturbances of Affective Contact Nervous Child 1943;2:217-53Lack of typical motivation for socialinteraction and affective contactProfounddisturbances in communication lack of speech, echolalia, literalness, pronominal reversalUnusual responses to the environment,resistance to change
  5. 5. Autistic DisorderDSM-IV (APA, 1994) Qualitative impairment in social interaction Qualitative impairment in communication Restricted, repetitive and stereotyped patterns of behavior, interests, and activities Delay or abnormality in social interaction, language use for social communication, or symbolic or imaginative play with onset before age 3
  6. 6. Autism Spectrum DisordersAutistic DisorderAsperger SyndromePervasive Developmental Disorder NotOtherwise Specified (PDD NOS)Behaviorally defined conditionsCaused by neurological dysfunction ofmultiple etiologiesSpectrum of varying severity
  7. 7. Epidemiology 1 out of 6 children are diagnosed with a developmental disorder/behavioral problem Current detection rates are lower than prevalence Prevalence of ASDs is 1 in 150 children1 44% of PCPs report caring for at least 10 children with ASD; however, only 8% routinely screen21 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
  8. 8. Important Roles of Primary CarePhysiciansEarly recognition• Knowledge of signs and symptoms• Developmental surveillance and screeningGuiding families to diagnosticresources and intervention servicesConducting a medical evaluationProviding ongoing health careSupporting and educating families
  9. 9. AAP Clinical Reports: Guidance for the Clinician in Rendering Pediatric Care Autism Resource ToolkitPediatrics, November, 2007 AAP, 2007
  10. 10. Identification and Evaluation of Children With ASDsDiagnostic Surveillance andcriteria screeningEpidemiology Algorithm Prevalence 1/150 Referral forEtiology evaluation andNeuropathology servicesand ComprehensiveneuroimagingCli evaluationGeneticnical signs counselingCoexisting PrognosisconditionsMyers Pediatrics 2007;120:1183-1215 with Johnson CP, Disabilities, SM, and the Council on Children
  11. 11. Key Points Conduct ASD surveillance at all preventative well child visits and whenever there is a concern Screen all children at 18 and 24 months Increased vigilance in younger siblings with a 10x increased risk Refer for hearing evaluation and early intervention services as soon as an ASD is seriously considered rather than waiting for a definitive diagnosis Early recognition  access to intervention  improved outcomes Johnson CP, Myers SM, and the Council on Children with Disabilities, Pediatrics 2007;120:1183-1215
  12. 12. Management of Children With ASDsEducational Interventions Medical Preschool and School ManagementSeizures Programs Gastrointestinal Specific Strategies Problems Applied Behavior Analysis Sleep Disturbance Structured Teaching Challenging Behaviors Developmental Models Psychopharmacology Speech and Language Complementary and TherapySocial Skills Instruction Alternative Medicine Occupational Therapy Family Support Sensory Integration Therapy Parents Siblings Myers SM, Johnson CP, and the Council on Children with Disabilities, Pediatrics 2007;120:1162-1182
  13. 13. Key Points Chronic management within a medical home is required Educational interventions, including behavioral strategies and habilitative therapies, are the cornerstones of treatment Early, intensive intervention is recommended 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
  14. 14. Key Points 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 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
  15. 15. 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 visit Developmental 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
  16. 16. Toolkit 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
  17. 17. Goals Improve early identification of children with autism spectrum disorders in primary care so they can receive treatment services as early as possible Empower pediatricians to take a strong role in the management of children with ASDs and their associated conditions in the medical home
  18. 18. Toolkit Content The fully searchable CD-ROM has an extensive library of ASD-specific information and practice tools:• Screening and surveillance algorithms • Record-keeping tools• Examples of screening tools • Emergency information forms• Guideline summary charts • ASD coding tools• Management checklists • Reimbursement tips• Developmental checklists • Sample letters to insurance companies• Developmental growth charts • ASD management fact sheets• Web links • Family education handouts• Early intervention referral forms and tools
  19. 19. 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
  20. 20. Toolkit ContentFact sheets for primary care professionals (PDF files) Topics Asperger syndrome Treatment decision Behavioral Psychopharmacolog principles y CAM Treatments Seizures & Epilepsy Dietary tx Sleep disorders Eating & nutrition Toilet training GI problems
  21. 21. Toolkit ContentFact sheets for primary care professionals to give families (PDF files) Topics Behavioral challenges Seizures & epilepsy Diet Sibling issues Early intervention Sleep problems GI problems Support programs for Childhood to adolescence families Guardianship Toilet training Lab tests Transition to adulthood Medication Vaccines Nutrition & eating problems Visiting the doctor School based services
  22. 22. Screening for Autism SpectrumDisorder in Your Office Rationale for screening Means to screen Reimbursemen t Resources
  23. 23. Screening for Autism SpectrumDisorder in Your Office SCREENING CONFORMS TO BRIGHT FUTURES GUIDELINES SCREENING AS QUALITY IMPROVEMENT: AMERICAN BOARD OF PEDIATRICS PERFORMANCE CRITERIA
  24. 24. Screening for Autism SpectrumDisorder in Your Office The need: Parents want to know how their child is doing Parents want to know how they are doing The means: Given limited time use of developmental screening tools promotes efficiency
  25. 25. Resources for Pediatricians AAP Clinical Reports Autism Toolkit Web sites: WWW.DBPEDS.ORG WWW.EDOPC.ORG WWW.MEDICALHOMEINFO.ORG
  26. 26. REIMBURSEMENT DEVELOPMENTAL SCREENING TOOLS 96110 ROUTINE SCREENING TOOL MAY USE MORE THAN ONCE PER VISIT 96111 DETAILED DEVELOPMENTAL VISIT RISK ASSESSMENT 99420 POST PARTUM DEPRESSION PROLONGED SERVICES CODES 99354-5 ADDITION TO PREVENTIVE VISIT
  27. 27. RESOURCES FROM TOOLKIT Early Intervention Referral Form Emergency Care Form Community Resources
  28. 28. EI Referral Form
  29. 29. EMS Form
  30. 30. Community Resources
  31. 31. Questions?

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