Published online June 1, 2007
PEDIATRICS
Vol. 119
No. 6
June 2007, pp.
1253-1254
(doi:10.1542/peds.2007-0772)
Early Autism Identification: In Reply
Vidya B. Gupta, MD On behalf of the AAP Autism Expert Panel
Member, AAP Autism Expert Panel
Department of Pediatrics
New York Medical College
Valhalla, NY 10029
Paul H. Lipkin, MD On behalf of the AAP Policy Revision Committee on Developmental Surveillance and Screening
Chair, AAP Policy Revision Committee on Developmental Surveillance and Screening and AAP Council on Children With Disabilities
Division of Neurology and Developmental Medicine
Kennedy Krieger Institute
Baltimore, MD 21205
Department of Pediatrics,
Johns Hopkins University School of Medicine
Baltimore, MD 21287
All the issues raised by Dr Pivalizza are pertinent to developmental surveillance and screening for autism. We agree that access to health care is pivotal to any public health effort. The American Academy of Pediatrics (AAP) is committed to every child's access to a medical home, including children with autism and other developmental disorders.1 The medical home should be linked to an array of specialty services with which children who screen positive for autism can be evaluated to confirm the diagnosis. The child should also be referred to a local early intervention program, coincident with such evaluation.2,3 In the United States, early intervention is now universally available for children with autism through part C of the Individuals With Disabilities Act.3
We share Dr Pivalizza's concern that local factors may make these services difficult to access or that the provided services may be suboptimal for the child's particular condition. Work needs to be done to both improve subspecialty access for all medical homes and ensure the availability of good-quality evidence-based interventions for all children who are diagnosed with an autism spectrum disorder. Early intervention should be available through local government-funded services or through health insurance, but such coverage is sometimes less than optimal. The AAP has several resources to help pediatricians and families. The Department of Practice and Quality Improvement (www.aap.org/moc/reimburse/default.cfm) can assist pediatricians who are helping families obtain coverage for such services, including intensive behavioral services.
Provider education is a key to all of these efforts. Through its Expert Panel on Children With Autism, the AAP is developing a tool kit for primary care providers to assist them in the identification and care of children with autism. Developmental surveillance for this developmental disorder is a continuous process that should be performed at all visits. Although the Policy Revision Committee on Developmental Surveillance and Screening and the Expert Panel on Children With Autism have recommended autism-specific screening at 18 and 24 months, the pediatrician should perform it at any age if they have a high index of suspicion for this disorder on the basis of parental concerns or other forms of developmental surveillance.
The cost-effectiveness of autism-specific screening seems self-evident, because it can be performed at a minimal cost (relative value unit: 0.36).4 The benefits of early identification and early intervention of autism are also well established; there exists a substantial body of research that supports the effectiveness of early intensive behavioral interventions for children with autism.5,6 However, we agree with Dr Pivalizza that research needs to be done to determine the cost-effectiveness of developmental and autism-specific screening to "support and guide" our recommendations. Additional study that examines the cost-effectiveness of currently available intervention services or autism-specific services (such as the 25 hours/week recommended for children with autism spectrum disorders5,7) is also necessary for our profession to inform public policy initiatives and to more effectively advocate for the best use of available resources to serve children who are in need of developmental interventions. Although the framework for early intervention service exists, we agree that additional research would help optimize the ultimate impact of our developmental and autism-specific screening recommendations.
REFERENCES
- American Academy of Pediatrics, Medical Home Initiatives for Children With Special Healthcare Needs Project Advisory Committee. The medical home.
Pediatrics. 2002;110
:184
–186[Abstract/Free Full Text]
- American Academy of Pediatrics, Council on Children With Disabilities, Section on Developmental Behavioral Pediatrics, Bright Futures Steering Committee, Medical Home Initiatives for Children With Special Needs Project Advisory Committee. Identifying infants and young children with developmental disorders: an algorithm for developmental surveillance and screening [published correction appears in Pediatrics. 2006;118:1808–1809].
Pediatrics. 2006;118
:405
–420[Abstract/Free Full Text]
- American Academy of Pediatrics, Committee on Children With Disabilities. Role of the pediatrician in family-centered early intervention services.
Pediatrics. 2001;107
:1155
–1157[Abstract/Free Full Text]
- American Academy of Pediatrics, Section on Developmental and Behavioral Pediatrics Committee on Coding and Nomenclature. Guidance on reporting developmental screening, testing.
AAP News. 2005;26
:34[Free Full Text]
- National Research Council, Committee on Educational Interventions for Children With Autism, Division of Behavioral and Social Sciences and Education.
Educating Children With Autism. Lord C, McGee JP, eds. Washington, DC: National Academy Press; 2001
- Olley JG. Curriculum and classroom structure. In: Volkmar FR, Paul R, Klin A, Cohen D, eds.
Handbook of Autism and Pervasive Developmental Disorders, 3rd ed, Vol 2. Hoboken, NJ: John Wiley & Sons; 2005:863–881
- Jacobson JW, Mulick JA, Green G. Cost-benefit estimates for early intensive behavioral intervention for young children with autism: general model and single state case.
Behav Intervent. 1998;13
:201
–226[CrossRef]
PEDIATRICS (ISSN 1098-4275). ©2007 by the American Academy of Pediatrics
