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The New Autism Guidelines
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  1. The New Autism Guidelines Daniel L. Coury MD

  2. Faculty Disclosure Information In the past 12 months, I have had the following financial relationships with the manufacturer(s) of any commercial product(s) and/or provider(s) of commercial service(s) discussed in this CME activity: Novartis – Consultant, Speakers BureauLilly – Research Grant, ConsultantMcNeil - ConsultantShire - Research Grant It is my obligation to disclose to you that I am on the Speakers Bureau for Novartis. However, I acknowledge that today’s activity is certified for CME credit and thus cannot be promotional. I will give a balanced presentation using the best available evidence to support my conclusions and recommendations. I do not intend to discuss an unapproved/investigative use of a commercial product/device in my presentation

  3. Objectives • Review the new AAP Guidelines for Diagnosis and Management of Autism Spectrum Disorders and for Developmental Surveillance • Identify new resources for physicians and families regarding ASD • Discuss suggested management strategies

  4. In case you missed this Pediatrics 2006, 118: 405-420 July 2006

  5. Developmental Screening Algorithm

  6. Developmental Screening Algorithm

  7. Developmental Surveillance A flexible, longitudinal, continuous, cumulative process with 5 components: • Eliciting and attending to parents concerns • Documenting and maintaining developmental history • Making accurate observations • Identifying risk and protective factors • Maintaining an accurate record and documenting process and findings

  8. Developmental Screening Algorithm Refer, Don’t Defer

  9. Developmental Screening Algorithm If either parent or professional has concerns, there is risk and screening should be done

  10. Key Philosophy • Ongoing developmental surveillance at each health supervision visit • Periodic formal developmental screening at the 9, 18 and 30 month visits

  11. What Developmental Screening Tool Should I use? • AAP policy statement lists 20 different tools without endorsing any single one • Most listed take 10 to 20 minutes • Parent completed screens can be both time and cost effective, such as Ages and Stages Questionnaire (ASQ) Child Development Inventory (CDI) Parent’s Evaluation of Developmental Status (PEDS)

  12. What Developmental Screening Tool Should I use? • Parent completed questionnaires should be done by parents at home prior to office visit; results in waiting room less reliable • These can be billed using CPT 96110; require statement of interpretation in visit note, but no formal report

  13. Developmental Screening can be done online • PEDS – Parents Evaluation of Developmental Status http://www.pedstest.com/ • If parent completes online, and child is in 18 to 59 month age group, M-CHAT online is administered immediately afterwards • Both produce printout of results • Both can be billed for reimbursement using CPT code 96110, and are being reimbursed in Ohio

  14. Developmental Screening Algorithm

  15. Hope you didn’t miss this Pediatrics. 2007 Nov;120(5):1183-215

  16. Identification and Evaluation of Children with ASDs • Provides concise background information on definition, history, epidemiology, early signs, neuropathologic aspects and etiologic possibilities • Especially useful is an algorithm for early identification of children with ASDs

  17. Pediatrics. 2007 Nov;120(5):1183-215

  18. Surveillance and ScreeningAlgorithm for ASDs Pediatrics. 2007 Nov;120(5):1183-215

  19. Surveillance and ScreeningAlgorithm for ASDs Pediatrics. 2007 Nov;120(5):1183-215

  20. Surveillance and ScreeningAlgorithm for ASDs Pediatrics. 2007 Nov;120(5):1183-215

  21. Surveillance and ScreeningAlgorithm for ASDs Pediatrics. 2007 Nov;120(5):1183-215

  22. Surveillance and ScreeningAlgorithm for ASDs Pediatrics. 2007 Nov;120(5):1183-215

  23. OK, that makes sense, but • What autism screens should I use? • What am I really looking for? • Are there any really worrisome findings or red flags to watch for?

  24. Recommended ASD Screens • CHAT Parent completed or interview 18 – 24+ months; 5 minutes sensitivity low, specificity high www.autismresearchcentre.com/tests • M-CHAT Parent completed or interview 16-48 months, 5 -10 minutes sensitivity moderate, specificity high www.firstsigns.org/downloads/m-chat.pdf

  25. M-CHATSample questionsDoes your child… • take an interest in other children? • enjoy playing peek-a-boo or hide and seek? • ever use his index finger to indicate interest in, or ask for, something? • look you in the eye for more than a second or two? • look at things you are looking at? • understand what people say? • imitate you? http://www.firstsigns.org/downloads/m-chat.PDF

  26. Recommended ASD Screens • Pervasive Developmental Disorders Screening Test – II, Primary Care Screener (PDDST-II-PCS) Parent completed questionnaire; Spanish available 18 – 48 months; 10 – 15 minutes sensitivity moderate to high, specificity moderate to high Purchase: PsychCorp / Harcourt Assessment www.harcourtassessment.com

  27. Early Identification • National initiative of the CDC to promote screening for autism and developmental delays • http://www.cdc.gov/ncbddd/autism/ActEarly/default.htm

  28. http://www.cdc.gov/ncbddd/autism/ActEarly/default.htm

  29. http://www.cdc.gov/ncbddd/autism/ActEarly/default.htm

  30. http://www.cdc.gov/ncbddd/autism/ActEarly/default.htm

  31. http://www.cdc.gov/ncbddd/autism/ActEarly/default.htm

  32. ASD Video Glossary • First Signs has an online video glossary of examples of various aspects of autism spectrum disorders • http://www.firstsigns.org/asd_video_glossary/asdvg_about.htm • Intended for parents but also very useful for professionals

  33. ASD “Red Flags” • Failure to respond to name by 12 months of age Arch Pediatr Adolesc Med. 2007 Apr;161(4):378-83. • Failure of response to joint attention at age 14 months J Autism Dev Disord. 2007 Jan;37(1):37-48.

  34. ASD “Red Flags” • Child should follow adult point by 14 months • Child should point to request something by 12 months • Child should point to comment on something by 14 months

  35. Can you make the DSM-IV-TR criteria friendlier to primary care providers?

  36. Deficits in Reciprocal Social Interaction

  37. Caring for Children with ASD:A Resource Toolkit for Clinicians • Includes the 2 ASD Clinical Reports and the developmental screening policy statement • Sample screening tools • Medical Home sheets, ongoing management sheets, coding recommendations

  38. Caring for Children with ASD:A Resource Toolkit for Clinicians • Sample forms for communicating with early intervention programs • Guidelines for choosing medications for management of problematic behaviors (sleep, disruptive, inattentive)

  39. Thank You Questions?