Be prepared to screen for autism spectrum disorder

Autism spectrum disorder (ASD) is being diagnosed more broadly than in the past”, and “all primary care providers can expect to have children and youth with ASD as patients in their practices.

American Academy of Pediatrics clinical report (2020)

ASD Fast Facts:

• 1 in 54 U.S. children have ASD, or 1.8 percent
• 4 times more common among boys than girls
• Occurs in all racial, ethnic and socioeconomic groups
• Can be diagnosed as early as 18 months of age
• Affects more than 5 million Americans
• Costs $1.4 to $2.4 million over a lifetime for education, health care and other services

Sources: American Academy of Pediatrics (AAP) and Centers for Disease Control and Prevention (CDC), 2020.

Primary care providers may be the only medical professionals who routinely see children in their first months and years of life. Texas Health Steps providers must be able to identify early symptoms of ASD, diagnose and make referrals for intervention, support the family with shared decision-making and manage a patient’s ongoing medical conditions.

Case Study

Kirby missed his 24-month Texas Health Steps preventive medical checkup because his family spent the summer with out-of-state relatives. Kirby’s mother brings him to your office because he appears to have a painful earache. “But I thought something was wrong even before he developed this earache,” she says. “He wasn’t interested in playing with his cousins like he used to be. He just seems to be in his own little world. It’s hard to get his attention. I’m wondering if something is wrong with his hearing?”

Read on for actions to help you address Kirby’s immediate problem and determine whether he has an underlying condition.

Check Kirby for an ear infection and provide treatment and instructions based on the results of your findings.

Based on Kirby’s behavior and his mother’s report, tell the mother you want to conduct some additional tests today. Assure Kirby’s mother you will return to speak with her after the screenings are completed.

Engage clinical staff members in conducting audiometric hearing and developmental screenings while you continue seeing patients.

Test Kirby’s hearing using approved audiometric equipment.

Conduct developmental and ASD screening using Texas Health Steps approved developmental and ASD screening tools. The standardized, validated M-CHAT or M-CHAT R/F tool should be used to detect potential ASD.

Upon receiving results of Kirby’s hearing test and developmental and ASD screening evaluations, return to discuss the results with Kirby’s mother and determine whether referral or additional follow up is indicated.

Be Prepared

Busy primary care providers should expect the unexpected. Providers can train staff to have screening tools ready at a moment’s notice and to be able to explain them to parents. Planning ahead allows you to be ready to smoothly integrate unexpected developmental screenings into the daily schedule. Your staff also should have referral resources, helpful literature and information about community resources for families available for immediate use.

If a parent or caregiver raises a concern about a child’s developmental progress it is not appropriate to wait and see. Screen immediately as studies show that parents who voice developmental concerns are usually correct.

Related Course

References

American Academy of Pediatrics. (2020). Clinical Report: Promoting Optimal Development: Identifying Infants and Young Children With Developmental Disorders Through Developmental Surveillance and Screening.

Centers for Disease Control and Prevention. (2020). Data & Statistics on Autism Spectrum Disorder.

Texas Health Steps Periodicity Schedule.