5-Minute Screening Identifies Subtle Signs Of Autism In 1-Year Olds

A five-minute checklist that parents can fill out in pediatrician waiting rooms may someday help in the early diagnosis of autism spectrum disorder (ASD), according to a study funded by the National Institutes of Health. Published today in the Journal of Pediatrics, the study’s design also provides a model for developing a network of pediatricians to adopt such a change to their practice.

“Beyond this exciting proof of concept, such a screening program would answer parents’ concerns about their child’s possible ASD symptoms earlier and with more confidence than has ever been done before,” noted Thomas R. Insel, M.D., director of the National Institute of Mental Health (NIMH), part of NIH.

Identifying autism at an early age allows children to start treatment sooner, which can greatly improve their later development and learning. However, many studies show a significant delay between the time parents first report concerns about their child’s behavior and the eventual ASD diagnosis, with some children not receiving a diagnosis until well after they’ve started school.

Recognizing the need to improve early ASD screening, Karen Pierce, Ph.D., of the University of California, San Diego, and colleagues established a network of 137 pediatricians across San Diego County. Following an hour-long educational seminar, the pediatricians screened all infants at their 1-year, well-baby check-up using the Communication and Symbolic Behavior Scales Developmental Profile Infant-Toddler Checklist, a brief questionnaire that detects ASD, language delay, and developmental delay. The questionnaire asks caregivers about a child’s use of eye gaze, sounds, words, gestures, objects and other forms of age-appropriate communication. Any child who failed the screen was referred for further testing and was re-evaluated every six months until age 3.

Out of 10,479 infants screened, 32 were identified as having ASD. After excluding for late onset and regression cases, this is consistent with current rates that would be expected at 12 months, according to the researchers. When including those identified as having language delay, developmental delay, or some other form of delay, the brief screen provided an accurate diagnosis 75 percent of the time.

Following the screen, all toddlers diagnosed with ASD or developmental delay and 89 percent of those with language delay were referred for behavioral therapy. On average, these children were referred for treatment around age 17 months. For comparison, a 2009 study using data from the Centers for Disease Control and Prevention found that, on average, children currently receive an ASD diagnosis around 5.7 years (68.4 months) of age, with treatment beginning sometime later.

In addition to tracking infant outcomes, the researchers also surveyed the participating pediatricians. Prior to the study, few of the doctors had been screening infants systematically for ASD. After the study, 96 percent of the pediatricians rated the program positively, and 100 percent of the practices have continued using the screening tool.

“In the context of a virtual lack of universal screening at 12 months, this program is one that could be adopted by any pediatric office, at virtually no cost, and can aid in the identification of children with true developmental delays,” said Dr. Pierce.

The researchers note that future studies should seek to further validate and refine this screening tool, track children until a much older age, and assess barriers to treatment follow up.

This study was also supported by an NIMH Autism Center of Excellence grant as well as Autism Speaks and the Organization for Autism Research.

The mission of the NIMH is to transform the understanding and treatment of mental illnesses through basic and clinical research, paving the way for prevention, recovery and cure. For more information, visit <http://www.nimh.nih.gov>.

REFERENCE:
Pierce K, Carter C, Weinfeld M, Desmond J, Hazin R, Bjork R, Gallagher N. Catching, Studying, and Treating Autism Early: The 1-Yr Well-Baby Check-Up Approach. J Pediatr. 2011 Apr. [Epub ahead of print]

Source: NIH News Release

Practice-Based Research: Parents’ Perspectives On Their Children’s Health Insurance

Wright State researchers with SOARnet, the Southwestern Ohio Ambulatory Research Network, report that children covered by private health insurance were twice as likely to be underinsured than children with public health insurance. Their study, presented at the annual meeting of the American Academy of Pediatrics in San Francisco, is titled “Parents’ Perspectives On Their Children’s Health Insurance: Plight of the Uninsured.”

According to a news story in today’s Los Angeles Times:

Researchers from the Wright State University Boonshoft School of Medicine in Ohio surveyed 1,978 parents to see if health insurance — or the lack of it — was a factor in following doctors’ orders. About 13% of parents said they couldn’t fulfill at least one of their child’s doctor’s recommendations in the last year because they couldn’t afford it. This constituted being underinsured by the researchers.

There was a divide among insured and underinsured children. The study authors found that children with private insurance were about two times as likely as children with public insurance to be underinsured, after they adjusted for annual family income and health status. And after controlling for various demographic factors, the authors discovered that having an annual family income between $15,000 and $34,999 was the best forecaster of a child’s health taking a hit because the family couldn’t pay.

Those with the lowest and highest incomes were less inclined to have a tough time getting needed healthcare for their kids, since those with the lowest incomes probably had public insurance, and those with the highest incomes likely had better private insurance than those with middle incomes.

Authors of the study were John M. Pascoe, M.D., M.P.H.; William Spears, Ph.D.; and Caroline McNicholas.

SOARnet investigators will discuss the practice-based research network at the 2010 Central Research Forum on Tuesday, Oct. 26.

FDA Workshop on Cell and Gene Therapy Clinical Trials Scheduled Nov. 2

The U.S. Food and Drug Administration (FDA) will hold a one-day Public Workshop on “Cell and Gene Therapy Clinical Trials in Pediatric Populations” on November 2, 2010, in Bethesda, MD.  The purpose of the workshop is to gather information from Institutional Review Boards (IRBs), gene and cellular therapy clinical researchers, and other stakeholders regarding best practices related to cell and gene therapy clinical trials in pediatric populations, as well as challenges and considerations in the review of these clinical trials. Read more.

Faculty Development Workshop Explores Clinical and Translational Research Opportunities

SOARnet will host a faculty development workshop on “Clinical and Translational Science Awards”  on Friday, November 20, 2009, 1:30-4:00 p.m., at the Children’s Medical Center of Dayton (Private Dining Room A). The workshop presenter is Ron Ackermann, M.D., M.P.H., assistant professor of medicine at Indiana University School of Medicine.

If you plan to attend, please RSVP to Susan Howard (susan.howard@wright.edu) or Caroline McNicholas (caroline.mcnicholas@wright.edu).

The Southwestern Ohio Area Research Network (SOARnet) is a new and growing group of pediatricians and family medicine physicians associated with Wright State University and the Children’s Medical Center in Dayton, Ohio. Its mission is to support its members to design and carry out office-based clinical research of importance and interest to its members, to other primary care providers, and to those involved in formulating health policy. The research network facilitates the formulation of clinical questions and provides support in study design and statistical analysis of data.

Pediatric Research Opportunities for Medical Students

The American Pediatrics Society and Society for Pediatric Research offer a medical student research training program to encourage gifted medical students to consider careers in research related to pediatrics. This program is specifically designed for students seeking a research opportunity at an institution other than their own medical school. Students selected to the program are able to choose or are assigned to leading research laboratories. Currently, the APS-SPR directory lists research opportunities at more than 300 laboratories in the United States and Canada. Each research experience allows the student to spend eight to ten weeks at 40 hours per week in a research environment. The program provides students with a stipend of up to $4,270. The application deadline is January 23, 2009. See the APS-SPR web site for application details. Further information can be obtained from the student research program coordinator at student-research@aps-spr.org.