Collaborative Approach Is the Best Way to Address Autism: University of Miami's Program Is a Model
McNamara, Damian, Clinical Psychiatry News
The best strategy to care for children with autism is to diagnose and treat symptoms early. And optimal success requires a collaborative effort between physicians, local public health officials, parents, and teachers, according to participants in a Webcast on autism sponsored by the University of North Carolina at Chapel Hill.
"Autism is on the rise among our children. Is that because of better diagnosis or some other underlying cause?" asked Dr. William L. Roper, dean of the university's School of Public Health.
The exact prevalence of autistic spectrum disorder (ASD) is unknown; diagnosis is subjective and based solely on behavior. Because ASD is a spectrum disorder, increases in reported cases may be a result of diagnosis of its milder forms. "It is estimated that 10-20 individuals per 10,000 have a more severe form of ASD. Prevalence of milder forms is two-to-three times more," said Craig J. Newschaffer, Ph.D., of Johns Hopkins Bloomberg School of Public Health, Baltimore.
"We need to behave as though it's an epidemic," Dr. Hugh Tilson of the University of North Carolina School of Public Health said during the conference, which was also sponsored by the Centers for Disease Control and Prevention.
Primary care providers are essential to recognition and intervention. "By and large, most health care professionals are not adequately trained to diagnose autism early," said Michael Alessandri, Ph.D., director of the University of Miami's Center for Autism and Related Disabilities (CARD).
"The presenting chief complaints can be very vague, very difficult for parents to describe. Unfortunately they can be missed very quickly, very easily in fast clinic visits," Dr. Edwin Trevathan said. "So the main thing clinicians need to know is that when there are issues in the areas of language and social function, they need to spend a significant amount of time--maybe blocked off as a separate visit--to address the issues of autism," said Dr. Trevathan of Washington University, St. Louis.
Dr. Newschaffer estimated that screening and diagnostic tools could take 90 minutes to 2 hours. Suggested screens such as the Modified Checklist for Autism in Toddlers (M-CHAT) or the Social Communication Questionnaire "are hard to infuse into clinical practice. Therefore they are mostly used in research."
Some specific behaviors suggest a child is at risk for ASD. For example, a child who has not babbled, pointed, or made meaningful gestures by age 1 year may be at risk. Other factors include not speaking a word by 16 months or a two-word phrase by 2 years. Poor eye contact, not knowing how to play with toys, and not smiling socially may also be significant, especially in combination.
"Research shows us that cognitive status is the strongest indicator of outcome in children with ASD," Dr. Newshchaffer said. Regardless of where the children fall on the autism spectrum, early intervention can improve communication and social skills, he added. …