Welcome to the training on Autism Spectrum Disorder: Screening, Diagnosis and Management provided by the Texas Health and Human Services Commission (HHSC) and the Texas Department of State Health Services (DSHS).
Goal
The goal of this module is to equip Texas Health Steps providers and others to recognize autism spectrum disorder (ASD) in children and adolescents and to provide guidelines for diagnosis, referral and continuity of care in a primary care setting.
Target Audience
Texas Health Steps providers and other interested health-care professionals.
Specific Learning Objectives
After completing the activities of this module, you will be able to:
- Assess common risk factors and clinical features of ASD.
- Specify how and when to conduct routine screenings for ASD and apply criteria for diagnosis.
- Summarize the importance of the medical home in caring for patients with ASD and how to respond to concerns expressed by parents and caregivers.
- Choose when to refer patients with ASD to a specialist or subspecialist.
Note: In this course, the term "autism" refers to autism spectrum disorder (ASD) as recognized by the American Psychiatric Association’s DSM-5. In addition, the term "parent" also refers to guardians and other caregivers.
Please note this module expires on 8/18/2023.
This module was released on 8/18/2020.
Accreditation Statement
Continuing Medical Education
The Texas Department of State Health Services, Continuing Education Service is accredited by the Texas Medical Association to provide continuing medical education for physicians.
The Texas Department of State Health Services, Continuing Education Service designates this enduring material for a maximum of 1.50 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Continuing Nursing Education
The Texas Department of State Health Services, Continuing Education Service is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation. The Texas Department of State Health Services, Continuing Education Service has awarded 1.50 contact hour(s) of Continuing Nursing Education.
Social Workers
The Texas Department of State Health Services, Continuing Education Service under sponsor number CS3065 has been approved by the Texas State Board of Social Worker Examiners to offer continuing education contact hours to social workers. The approved status of The Texas Department of State Health Services, Continuing Education Service expires annually on December 31. The Texas Department of State Health Services, Continuing Education Service has awarded 1.50 contact hour(s) of Continuing Social Work Education.
Certified Health Education Specialists
Sponsored by The Texas Department of State Health Services, Continuing Education Service, a designated provider of continuing education contact hours (CECH) in health education by the National Commission for Health Education Credentialing, Inc. This program is designated for Certified Health Education Specialists (CHES) and/or Master Certified Health Education Specialists (MCHES) to receive up to 1.50 total entry-level Category I contact education contact hours.
Certificate of Attendance
The Texas Department of State Health Services, Continuing Education Service has designated 1.50 hour(s) for attendance.
Disclosures
One of the requirements of continuing education is disclosure of the following information to the learner:
- Notice of requirements for successful completion of continuing education activity. To receive continuing education credit the learner must successfully complete the following activities:
- Create a Texas Health Steps account.
- Complete on-line registration process.
- Thoroughly read the content of the module.
- Complete the on-line examination.
- Complete the evaluation.
- Commercial Support.
The THSTEPS Web-based Continuing Education Series has received no commercial support. - Disclosure of Relevant Financial Relationships.
The THSTEPS Continuing Education Planning Committee has the following relevant financial relationships to disclose:- Anne Marie Hain - Physician - Spouse of employee (Paul Hain) of a commercial interest organization - Chief Medical Officer, Senior Vice President, Blue Cross Blue Shield Texas.
- Non-Endorsement Statement.
Accredited status does not imply endorsement of any commercial products or services by the Department of State Health Services, Continuing Education Service; Texas Medical Association; or American Nurse Credentialing Center. - Off-Label Use.
Using a disclosure review process, the THSTEPS Continuing Education Planning Committee has examined documents and has concluded that the authors of these modules have not included content that discusses off-label use (use of products for a purpose other than that for which they were approved by the Food and Drug Administration).
The following are policies and definitions of terms related to continuing education disclosure:
The intent of disclosure is to allow Department of State Health Services (DSHS) Continuing Education Service the opportunity to resolve any potential conflicts of interest to assure balance, independence, objectivity and scientific rigor in all of its Continuing Education activities.
All faculty, planners, speakers and authors of Department of State Health Services (DSHS) Continuing Education Service sponsored activities are expected to disclose to the Department of State Health Services (DSHS) Continuing Education Service any relevant financial, relationships with any commercial or personal interest that produces health care goods or services concerned with the content of an educational presentation. Faculty, planners, speakers and authors must also disclose where there are any other potentially biasing relationships of a professional or personal nature.
Glossary of Terms
Conflict of Interest: Circumstances create a conflict of interest when an individual has an opportunity to affect Continuing Education content about products or services of a commercial interest with which she/he has a financial relationship or where there are any other potentially biasing relationships of a professional or personal nature.
Commercial Interest: Any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients.
Financial Relationships: Those relationships in which the individual benefits by receiving a salary, royalty, intellectual property rights, consulting fee, honoraria, ownership interest (e.g., stocks, stock options or other ownership interest, excluding diversified mutual funds), or other financial benefit. Financial benefits are usually associated with roles such as employment, management position, independent contractor (including contracted research), consulting, teaching, membership on advisory committees or review panels, board membership, and other activities for which remuneration is received or expected. Relevant financial relationships would include those within the past 12 months of the person involved in the activity and a spouse or partner. Relevant financial relationships of your spouse or partner are those of which you are aware at the time of this disclosure.
Off Label: Using products for a purpose other that that for which it was approved by the Food and Drug Administration (FDA).
Browser Requirements
Texas Health Steps courses are best viewed using a current browser. If you are using an out-of-date browser or a version of Internet Explorer less than 11, lesson progress and interactive features may not function properly.
American Academy of Pediatrics. AAP Bright Futures: Guidelines for the Health Supervision of Infants, Children, and Adolescents
American Academy of Pediatrics clinical report Promoting Optimal Development: Identifying Infants and Young Children With Developmental Disorders Through Developmental Surveillance and Screening (2020).
American Academy of Pediatrics Autism Toolkit.
American Academy of Pediatrics Surveillance and Screening Algorithm: Autism Spectrum Disorders.
Early Childhood Intervention ECI Referral web page.
U.S. Department of Health and Human Services (HHS). (2014). Additional guidance for developmental and behavioral screening can be found in Birth to 5: Watch Me Thrive!, which contains helpful information for the primary care provider about how to present the results of developmental screening.
The following resources can support the primary care provider in caring for children diagnosed with ASD and their families. The websites offer scientifically sound and evidence-based information, and several represent state and federal government agencies.
Ages and Stages Questionnaires.
Association for Science in Autism Treatment: For Medical Professionals.
Autism Speaks. (2020). ATN/AIR-P Toilet Training Guide.
Immunization Action Coalition. (2016). Clear Answers and Smart Advice About Your Baby’s Shots. Excerpt from Brown, A., Baby 411.
Parent to Parent of New York State. (n.d.). Tip Sheets for Caregivers of Individuals with Special Health Care Needs.
Autism: Caring for Children With Autism Spectrum Disorders: A Resource Toolkit for Clinicians, 3rd Edition, for sale from the American Academy of Pediatrics (AAP).
Birth to 5: Watch Me Thrive!, offered by the U. S. Department of Health and Human Services, helps families and providers identify concerns and developmental delays early and promotes universal screening.
Centers for Disease Control and Prevention. (2020). Learn the Signs. Act Early. Developmental Milestones.
Diagnostic and Statistical Manual of Mental Disorders, 5th Edition. (2013). American Psychiatric Association: Washington, DC.
Johnson, C. P., Myers, S.M.; American Academy of Pediatrics Council on Children With Disabilities. (2007). Identification and evaluation of children with autism spectrum disorders. Pediatrics, 120(5):1183-1215.
Maenner MJ, Shaw KA, Baio J, et al. Prevalence of Autism Spectrum Disorder Among Children Aged 8 Years — Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2016.
Maternal and Child Health Bureau
Modified Checklist for Autism in Toddlers, Revised with Follow-Up (M-CHAT-R/F).
National Autism Association. (2020). Big Red Safety Box.
National Center for Complementary and Integrative Health. (2016). What the Science Says: Autism Spectrum Disorder and Complementary Health Approaches.
Parents’ Evaluation of Developmental Status (PEDS).
Texas Education Agency. (2019). Child Find, Evaluation & ARD Supports Network.
Texas Education Agency. (2020). Early Childhood Education in Texas.
Texas Education Agency. (2019). Technical Assistance: Child Find & Evaluation.
Texas Health and Human Services. Home and Community-based Services (HCS).
- Association for Science in Autism Treatment: For Parents and Educators.
- Autism Society. (2020). Environmental Modifications for Children with Autism: How to Shape the Environment to Boost Success.
- Autism Speaks. (2020). Applied Behavior Analysis (ABA).
- Autism Speaks. (2020). ATN/AIR-P Toilet Training Guide.
- Autism Speaks. (2016). Melatonin and Sleep Problems in ASD: A Guide for Parents.
- Autism Speaks. (2020). A Sibling’s Guide to Autism
- Autism Speaks: Toolkits for Families.
- Autism Speaks: Websites for Families is a listing of helpful websites about topics such as parenting, learning disabilities, traveling with children diagnosed with ASD and clinical research.
- Autism Spectrum Disorder: Information for Families, from the Centers for Disease Control and Prevention. Includes a Resource Kit for Parents, Positive Parenting Tips, and many other resources.
- Centers for Disease Control and Prevention. (n.d.). Science Summary: CDC Studies on Thimerosal in Vaccines. Fact Sheet.
- Early Childhood Intervention, free publications for distribution to families who are being referred for ECI services.
- Immunization Action Coalition. (2016). Clear Answers and Smart Advice About Your Baby’s Shots. Excerpt from Brown, A., Baby 411.
- Indiana University’s Indiana Resource Center for Autism. (n.d.). After the Diagnosis of an Autism Spectrum Disorder: A Resource for Families Whose Child is Newly Diagnosed.
- Texas Statewide Leadership for Autism Training (TSLAT) website, which lists resources for treatment that Texas schools are asked to provide.
- American Academy of Pediatrics. (2006, reaffirmed 2014). Identifying Infants and Young Children With Developmental Disorders in the Medical Home: An Algorithm for Developmental Surveillance and Screening. Pediatrics, 118(1).
- American Academy of Pediatrics. (2002, reaffirmed 2008). Policy Statement: The Medical Home. Pediatrics, 110:184–186.
- Autism Speaks. (2020). Applied Behavior Analysis (ABA).
- Autism Speaks. (2020). ATN/AIR-P Toilet Training Guide.
- Bai, D., Yip, B. H. K., Windham, G.C., et al. (2019). Association of Genetic and Environmental Factors with Autism in a 5-Country Cohort. JAMA Psychiatry. 2019 Jul 17.
- Baio, J., Wiggins, L., Christensen, D. L., et al. (2018). Prevalence of Autism Spectrum Disorder among Children Aged 8 Years - Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2014. MMWR Surveillance Summary. 67(6):1–23.
- Bauman, M. L. (2010). Medical comorbidities in autism: challenges to diagnosis and treatment. Neurotherapeutics. 7(3):320–327
- Centers for Disease Control and Prevention. (2020). Learn the Signs. Act Early. Developmental Milestones.
- Centers for Disease Control and Prevention. (2020). What Is Autism Spectrum Disorder?
- Centers for Disease Control and Prevention. (2019). Autism Spectrum Disorder: Signs and Symptoms.
- Centers for Disease Control and Prevention. (n.d.). Science Summary: CDC Studies on Thimerosal in Vaccines. Fact Sheet.
- Diagnostic and Statistical Manual of Mental Disorders, 5th Edition. (2013). American Psychiatric Association: Washington, DC.
- Glascoe, F. P., & Marks, K. P. (2011). Detecting children with developmental-behavioral problems: The value of collaborating with parents. Psychological Test and Assessment Modeling, 53(2), 258-279.
- Gordon-Lipkin, E., Marvin, A. R., Kiely Law, J., & Lipkin, P. H. (2018). Anxiety and Mood Disorder in Children With Autism Spectrum Disorder and ADHD. Pediatrics 141 (4) e20171377.
- Hazlett, H. C., Gu, H., Munsell, B. C., Kim, S. H., Styner, M., Wolff, J. J. . . . Piven, J. (2017). Early brain development in infants at high risk for autism spectrum disorder. Nature, 542(7641): 348-351.
- Hyman, S. L., Levy, S. E., Myers, S.M., AAP Council on Children with Disabilities, Sectin on Developmental and Behavioral Pediatrics. (2020). Identification, Evaluation, and Management of Children with Autism Spectrum Disorder. Pediatrics. 145(1):e20193447
- McGuire, K., Fung, L. K., Hagopian, L., et al. (2016). Irritability and Problem Behavior in Autism Spectrum Disorder: A Practice Pathway for Pediatric Primary Care. Pediatrics. 137(S2):e20152851L
- Myers, S. M., Johnson, C. P., & the American Academy of Pediatrics Council on Children With Disabilities. (2007). Management of Children With Autism Spectrum Disorders. Pediatrics, 120, 1162.
- Texas Department of State Health Services. (2020). Children with Special Health Care Needs (CSHCN) Services Program.
- U.S. Food and Drug Administration. (2019). Autism: Beware of Potentially Dangerous Therapies and Products.
- White, P.H., Cooley, W.C.; Transitions Clinical Report Authoring Group; American Academy of Pediatrics; American Academy of Family Physicians; American College of Physicians. (2018). Supporting the health care transition from adolescence to adulthood in the medical home [published correction appears in Pediatrics. 2019;143(2):e20183610]. Pediatrics, 142(5):e20182587
- Wong, C., Odom, S. L., Hume, K. A., et al. (2015). Evidence-based practices for children, youth, and young adults with autism spectrum disorder: a comprehensive review. Journal of Autism and Developmental Disorders, 45(7):1951–1966
- Zuckerman, K., Lindly, O. J., & Sinche, B. K. (2015). Parental Concerns, Provider Response, and Timeliness of Autism Spectrum Disorder Diagnosis. The Journal of Pediatrics, 166: 1431-1439.
The medical definitions in this module were obtained or adapted from the American Speech-Language-Hearing Association (ASHA), the Centers for Disease Control and Prevention, the Centers for Medicare & Medicaid, Fragilex.org, Jamanetwork.com, the Mayo Clinic, Medical News Today, Nationaleatingdisorders.org, the National Institute of Neurological Disorders and Stroke, the National Poison Control Center, Research Autism, Rettsyndrome.org, Rettsyndromenews.com, Texas Children’s Hospital, Verdugo Hills Autism Project (VHAP), the U.S. National Library of Medicine, the University of North Carolina Autism Research Center and the University of Queensland.
-
Related courses
Related courses
