Screening for Autism
Autistic spectrum disorders (autism, pervasive developmental disorder, not otherwise specified (PDD-NOS) and Asperger disorder) are much more common than previously thought. Latest statistics show that autism spectrum disorders affect as many as six out of one thousand children (http://aapnews.aappublications.org/).
It is important for pediatricians to screen for this disorder because early intervention (EI) can maximize potential outcome. The AAP has published an excellent position paper on developmental screening and surveillance (http://pediatrics.aappublications.org/cgi/content/full/118/1/405#F1). The AAP statement recommends screening for Autism Spectrum Disorders at 18 months and then again at 24 months. We suggest that these screenings should be done with either the CHAT (chat.pdf) or M-CHAT (m-chat.pdf).
The CHAT is a simple screening tool that combines parental report
and observations of the child. It aims to
identify children who are at risk for social-communication disorders.
A few toys are necessary for administration and it can be easily
adapted to the individual practitioner’s style.
The M-CHAT is a parent questionnaire that is reviewed by the
practitioner or office staff. Scoring
for both tools is simple and straightforward (CHAT
scoring.pdf and MCHAT scoring.pdf).
The key items look at behaviors which, if absent
at 18 months, put a child at risk for a social-communication disorder.
These behaviors are joint attention, including pointing to show and
gaze monitoring (e.g. looking to where a parent is pointing), and pretend
play (e.g. pretending to pour tea from a toy teapot).
If autism spectrum disorder is suspected, the child should be referred to EI and for further neuro-developmental evaluation. Consider a Developmental-Behavioral Pediatric or additional medical evaluation. It should be noted that mild cases of ASD might be missed by these tools.
For additional information on tests to identify autism please see:
Please refer to the following link for research on the CHAT:
on Children with Disabilities, New York Chapter 2
(Download Word file)
Every pediatric practice is a medical home to
CSHCN. We provide expert medical care to the child and family –
caring for medical illnesses, providing immunizations and referring to
subspecialists as needed. Our goal is to become a better medical
home. The AAP website: National Center of Medical Home
is an excellent resource.
10 Steps to Becoming a Better Medical Home for CSHCN
Jack Levine, MD
(Download as Word
Much has been written about what goes into a proper transition to adulthood for children with special health care needs. The goal of transition is to ensure maximal independence within one’s developmental capabilities. Goals should be set for education, training, and integration into the adult community. Planning with the individual with a disability and family should include ownership and understanding of the medical process and of the medical history.
Planning for Transition to adult medical care should start some time during the middle school years, ages 11-131. It should not happen when a patient is leaving the pediatric practice.
In a 2002 consensus statement the AAP recommends six steps for transition to adult medical care2. The following Six Steps are adapted from those guidelines.
Using these six steps as guidelines and the tools provided the pediatrician can provide a smooth transition to the patient with CSHCN.
1. Identify a primary care provider:
2. Identify the "core knowledge and skills": The Pediatrician has to determine realistic and attainable goals and skills for the adolescent/adult with CSHN. To do so the following check lists are helpful:
3. Create a portable medical summary: The pediatrician should start a medical summary early and update it on a regular basis. An alternative is an Emergency Information form. The following are examples.
4. Create a transition plan: A basic transition plan should include: who provides the needed services and who pays for those services. The following tools and guideline are excellent resources.
5. Continue to Provide Preventive Health Care: Children with Special Health Care needs should have the same preventive medical care as all adolescents and young adults. There are many guidelines available.1 Pediatrician should not to forget counseling and evaluation of nutrition issues, exercise, assessing for high risk behaviors, and mental health.1 Sexuality should be discussed in a developmentally appropriate manner as well.
6. Insure Continuing Affordable Health Care Coverage: Ongoing insurance coverage into adulthood is essential for all young adults as well as those with ongoing special health care needs. The following websites have information about various options:
7. Legal Aspects: Another important consideration is the legal aspects of the transition process, including guardianship, assent, consent, conservationship, health surrogate, advanced directive and DNR.
Additional information and tools were taken from the AAP medical home website www.medicalhomeinfo.org, Healthy and Ready to Work (HRTW) National Resource Center www.hrtw.org, as well as On the Threshold to the Adult Medical Home: Care Coordination in Transition, (Patience H. White M.D. and Patti Hackett MEd September 2009, Pediatric Annals 38:9 pp513-520) (www.PediatricSuperSite.com).
Lynn Davidson, MD
Home Care and the Pediatric Medical Home