November 13, 2009

Program aims to reduce waits for identifying autism disorders

Program aims to reduce waits for identifying autism disorders

A Vanderbilt Kennedy Center (VKC) study aimed at training community pediatricians to quickly identify autism spectrum disorders within their own practices demonstrated agreement between pediatrician judgments and independent diagnostic evaluations in a large majority of cases.

The study by Zachary Warren, Ph.D., Wendy Stone, Ph.D., and Quentin Humberd, M.D., appears in the Journal of Developmental & Behavioral Pediatrics.

Early diagnosis of autism spectrum disorders (ASD) represents a “critical public health and clinical practice issue,” the authors said, but lengthy wait times for diagnostic services and a lack of doctors trained to handle ASD patients hinder the benefits of early intervention.

“It is not uncommon for parents to have to wait a year or more from the time of initial concerns until receiving an appropriate diagnosis,” said Warren, director of Psychological Services at the VKC Treatment and Research Institute for Autism Spectrum Disorders (TRIAD).

“While the American Academy of Pediatrics (AAP) recently mandated screening for ASD in the second year of life, screening necessitates that something happens next,” added Warren. “Unfortunately, right now, what often happens next is an extremely long wait.”

“Early intervention services are crucial for optimizing functional developmental outcomes for children and their families,” added Stone, director of TRIAD.

Humberd, co-author, developmental pediatrician, and past chapter president for TNAAP, was frequently hearing frustrations from his colleagues around the state about these new recommendations. "One of my most experienced colleagues called me one weekend and expressed his frustration over being told to increase his efforts to screen for autism. He wanted something done now to help his patients get in to appropriate treatment."

In response to this service gap, the authors developed and studied a training program for community pediatricians in underserved geographic areas of Tennessee who were taught to identify autism via a standardized assessment process.

The training included use of the STAT (Screening Tool for Autism in Toddlers & Young Children), an interactive screening measure developed by Stone at Vanderbilt over a decade ago.

“Utilizing the STAT provided a simple and robust way that our pediatricians could identify autism within the real-world time limits of a busy pediatric practice,” she said.

“It takes less than 20 minutes to administer and provides a robust score that helps identify autism risk.”

The study demonstrated substantial agreement between children identified with autism (74 percent), although pediatricians tended to over-identify autism in children with other developmental disorders.

The Vanderbilt team is currently working to expand this training model, with anticipated trainings throughout Tennessee this year in order to develop a statewide network of pediatricians capable of identifying autism concerns and initiating appropriate early intervention services without prolonged waits.

“Even a small number of pediatricians in Tennessee performing similar diagnostic consultations on a small scale could dramatically shift lag times between identification of ASD risk and initiation of appropriate intervention services at a population level,” Warren said.

He estimates that a group of 20 trained pediatricians in Tennessee performing about one evaluation per week would be able to perform more than 1,000 consultations a year for children between the ages of 2 and 3, which exceeds the state's need when considering prevalence rates for ASD (1/150) and approximately 85,000 births in 2007.