Champlain Valley AHEC is continually seeking ways to improve our services and programs. CVAHEC Executive Director Fran Joseph is eager to hear your complaints, concerns, suggestions, and compliments. You can email Fran directly at fjoseph@cvahec.org and she will personally see that your concern is addressed promptly.
Alexa Craig
Freeman Scholar Program
Autism is a disorder of childhood that affects approximately 1 in 500 children. One of the unique aspects of autism is the fact that it is diagnosed not by laboratory testing, but by observations of behaviors that demonstrate deficits in the areas of socialization, imagination and communication.
Early diagnosis of autism is of critical importance and has been shown to lead to improved outcomes for children. It is becoming clear that physicians need to have an increased awareness of developmental milestones and behaviors that might cause suspicion of developmental delay, in order to diagnose children early and initiate early intervention.
The research goal was to assess pediatricians’ and family practitioners’ awareness of behaviors that might suggest the presence of autism in young children and to assess which if any screening tools are routinely used in their practices.
In order to assess these variables, a nine-part questionnaire was designed with the input of Stephen Contompasis, MD. The questionnaire asked the physicians to check their specialty and then respond to a five-part question that asked at what ages they would refer children exhibiting various behaviors or loss of skills for developmental evaluations. This question was based on the Report of the Quality Standards Subcommittee of the American Academy of Neurology and the Child Neurology Society entitled “Practice parameter: Screening and diagnosis of autism”.
This report makes the following recommendations:
- Referral for developmental assessment by 12 months if the child does not point or gesture to indicate interest in something or does not babble
- Referral for developmental assessment by 16 months if the child does not have single words
- Referral for developmental assessment by 24 months if the child does not have two-word phrases
- Referral for developmental assessment if at any age, there is any loss of language or social skills
The other questions asked physicians to rate their own skills in detecting autism, to list other behaviors that would cause them to suspect autism, to list where they typically refer children they suspect and to list what other diagnostic tests they perform. The final questions asked if they were familiar with the autism screening tool known as the CHAT (Checklist for Autism in Toddlers) and whether they were familiar with the Report of the Quality Standards Subcommittee of the American Academy of Neurology and the Child Neurology Society entitled “Practice parameter: Screening and diagnosis of autism”.
The questionnaire and explanatory cover letter were mailed to 155 pediatricians and 242 family physicians in the state of Vermont. One hundred and nine replies were received by the deadline of August 22, 2003. Fifty-five were from Family Practitioners, 53 from Pediatricians and one person who did not check his or her specialty.
A preliminary assessment of the data has been performed. Family Practitioners seem to refer children at earlier ages than pediatricians. Most of the referrals are sent to Child Development Clinic (CDC) and to Family, Infant and Toddler Project (FITP). Many physicians order hearing evaluations and lead screening as other diagnostic tests.
Surprisingly few family practitioners are aware of the CHAT screening tool and neither family physicians nor pediatricians for the most part are aware of the Practice Parameters. There is a wide range of reported screening tools being used in primary care practices.
The final component of this research project is to mail an educational packet to the original mailing list (not just the respondents). This packet will include a summary of the results of my research, a summary of the practice parameters, the CHAT and an explanation of how to score the CHAT.
A formal statistical analysis is being performed. The results will be available in October. I will meet with my mentor, Dr. Contompasis following the statistical analysis to determine if the results warrant writing a paper and trying to get it published.
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The views expressed in the Student Project Reports are those of the authors and do not necessarily reflect the views of Champlain Valley Area Health Education Center.
