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Prevalence of Autism Spectrum Disorders - AD, AS and PDD NOS ... Surveillance and Screening of Autism Spectrum Disorders - Early identification ...

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Presentation Transcript
autism spectrum disorders
Autism Spectrum Disorders

Richard G Jimenez MD

Regional Vice President

OptumHealth Behavioral Solutions

United Health Group

autism spectrum disorders clinical overview
Autism Spectrum DisordersClinical Overview
  • Prevalence
  • Etiology
  • Clinical Presentation
  • Screening and Surveillance
  • Management
  • Interventions
  • Passion

AAP: PEDIATRICS Volume 120, Number 5, November 2007; AACAP: Practice Parameters for Autism and other PDDs, 1999

prevalence of autism spectrum disorders ad as and pdd nos
Prevalence of Autism Spectrum Disorders - AD, AS and PDD NOS
  • 6.6 per 1000 – CDC Autism & DD Monitoring Network – 2007
  • Change in terminology
  • Broadened diagnostic criteria - AD
  • New diagnosis in DSM – PDD NOS, AS
  • Studies varied in case ascertainment strategies
  • More reliable screening tools
  • More proficient recognition and diagnosis
  • Diagnosis tied to funding – IDEA, ADA
  • Inclusion of other disorders

AAP: PEDIATRICS Volume 120, Number 5, November 2007; AACAP: Practice Parameters for Autism and other PDDs, 1999

etiology of autism spectrum disorders
Etiology of Autism Spectrum Disorders
  • Biologically based
  • Neuro-developmental
  • Heritable
  • Cause: Unknown due to genetic complexity and phenotypic variation – environmental factors (“second-hit” during development – prenatal, perinatal, postnatal)
  • ASD genes – X, 2, 3, 7, 15 and 22 – The International Molecular Genetic Study of Autism Consortium
  • Idiopathic vs. Secondary to disorder known to associate
  • Cerebellum; Forebrain Limbic System; Frontal & Temporal Lobes; Inferior Olive and Brainstem
  • Increased brain volume, regional grey/white matter volumetric differences, neurotrophin differences
  • Neuropathologic findings suggest pathology arises in utero

AAP: PEDIATRICS Volume 120, Number 5, November 2007; AACAP: Practice Parameters for Autism and other PDDs, 1999

clinical signs of autism spectrum disorders
Clinical Signs of Autism Spectrum Disorders
  • Social skill deficits
  • Restricted, repetitive, stereotypic – behavior, interests, activities
  • Significant language delays – AD and PDD-NOS
  • GDD/MR – splinter skills
  • Sensory Motor – hypo/hyper sensitivities
  • Heterogeneous phenotype with indistinct end points – especially at mild end of spectrum
  • Speech delays at 15-18 months prompt queries to PCP’s
  • Public awareness prompting earlier queries to PCP’s due to social skill deficits

AAP: PEDIATRICS Volume 120, Number 5, November 2007; AACAP: Practice Parameters for Autism and other PDDs, 1999

surveillance and screening of autism spectrum disorders early identification
Surveillance and Screening of Autism Spectrum Disorders - Early identification
  • ASD – specific surveillance and screening
  • Developmental surveillance at every preventive visit:
    • Parent concerns
    • Developmental history
    • Observations of Child
    • Risk and Protective Factors
    • Documenting findings
  • Use of standard screening tool at 9, 18, 24, 30 months
    • PCP/Parent - Not yet validated
  • Comprehensive Evaluation – Assessing Functioning; Categorical Diagnosis; Etiology (hx, exam, parent, lab)
  • Prognosis pressing parental concern – not curable/chronic illness (independent living, employment, relationships, mental health)

AAP: PEDIATRICS Volume 120, Number 5, November 2007; AACAP: Practice Parameters for Autism and other PDDs, 1999

management of autism spectrum disorders
Management of Autism Spectrum Disorders
  • Maximizing functional independence and quality of life
  • Facilitating development and learning
  • Promoting socialization
  • Reducing maladaptive behaviors
  • Educating and supporting families
  • Guiding toward empirically supported interventions
    • Medical Therapies
    • Educational Strategies – behavior strategies and habilitative therapies – adaptive skills
  • Management of coexisting medical conditions

AAP: PEDIATRICS Volume 120, Number 5, November 2007; AACAP: Practice Parameters for Autism and other PDDs, 1999

interventions to autism spectrum disorders
Interventions to Autism Spectrum Disorders
  • Early Childhood Programs – behavioral, analytic, developmental and structured teaching
    • 25+ hours/week, 12 months/year
    • low student teacher ratio
    • parent training
    • measurement and documentation of target behaviors
    • highly structured/predictable
    • generalization of skills – functional, communication, social
    • reduction of maladaptive behavior
    • readiness/academic skills
  • Medical Management – Sz, GI, Sleep, Comorbid conditions
  • Family Support

AAP: PEDIATRICS Volume 120, Number 5, November 2007; AACAP: Practice Parameters for Autism and other PDDs, 1999

unproven therapies for autism spectrum disorders
Unproven Therapies for Autism Spectrum Disorders
  • Applied Behavioral Analysis
  • Sensory Integration Therapy
  • Touch Therapy
  • Music Therapy
  • Auditory Integration Therapy
  • Hormone Therapies
  • Immunologic Therapies
  • Anti-Yeast Therapies
  • Vitamin Therapies
  • Diet Therapies
  • Hippotherapy
  • Chelation Therapy

AAP: PEDIATRICS Volume 120, Number 5, November 2007; AACAP: Practice Parameters for Autism and other PDDs, 1999

passion in autism spectrum disorders
Passion in Autism Spectrum Disorders
  • Life long disability in a child
  • More common than Pediatric: Cancer, Diabetes and AIDS – combined
  • Indiscriminate of Race, Ethnicity, Social Group
  • Fastest growing DD in the USA
  • Est. costs $35 billion per year - growing
  • Receives less funding than less prevalent childhood illnesses
  • No cure
  • Public awareness
  • Advocacy

AAP: PEDIATRICS Volume 120, Number 5, November 2007; AACAP: Practice Parameters for Autism and other PDDs, 1999

appendix

Appendix

Subspecialty Society Guideline Recommendations

subspecialty society guideline recommendations scope of services 0 3 yo
Subspecialty Society Guideline Recommendations: Scope of Services 0 – 3 yo
  • Early and Periodic Screening, Diagnosis and Testing (EPSDT) exam
  • Comprehensive diagnostic evaluation
    • Audiological evaluation
    • Genetic assessment
    • Lead screening
    • Neurological assessment
    • Psychiatric assessment
    • Psychometric testing
  • Individualized Family Service Plan (IFSP) development
  • Home-based/child care-based services
    • Psychosocial skills training
    • Communication skills
    • Behavioral Modification
    • Audiological services
  • Routine, periodic physical examination
  • Specialist evaluation (as needed)
  • Care coordination and oversight by an experienced provider (physician)
  • Re-evaluation of progress in developmental capabilities and behavioral changes

AAP: PEDIATRICS Volume 120, Number 5, November 2007; AACAP: Practice Parameters for Autism and other PDDs, 1999

subspecialties society guideline recommendations scope of services 3 yo
Subspecialties Society Guideline Recommendations: Scope of Services 3+ yo
  • Individualized Education Program (IEP) Plan
  • School-based services
    • The Individuals with Disabilities Education Act (IDEA) guarantees the right of students with disabilities to a free and appropriate education in the “least restrictive” possible setting for persons from 3 to 21 years of age (Mandlawitz, 2005). Federal monies have been allocated to the states to build these services
      • Communication skills
      • Social Interactive skills
      • Activities of daily living skills
  • Medical-based services
    • Basic Behavioral Health Services
    • Pharmacotherapy
    • Audiological services
    • Occupational services
    • Behavioral modification
    • Social interactive skills
  • Routine, periodic physical examination
  • Specialist evaluation (as needed)
  • Care coordination and oversight by an experienced provider (physician)
  • Re-evaluation of progress in developmental capabilities and behavioral changes

AAP: PEDIATRICS Volume 120, Number 5, November 2007; AACAP: Practice Parameters for Autism and other PDDs, 1999

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