Pediatricians Fail to Screen for Autism

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mom_of_an_autie
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Pediatricians Fail to Screen for Autism

Postby mom_of_an_autie » Wed May 31, 2006 12:57 pm

Pediatricians Fail To Screen For Autism, Hopkins Study Finds
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Main Category: Autism News
Article Date: 13 May 2006 - 15:00pm (PDT)

Few Maryland and Delaware primary care pediatricians screen patients regularly for autism and autism-spectrum disorders (ASD) as part of their overall look at possible developmental delays, according to results of a joint study from Johns Hopkins Children's Center and the Johns Hopkins Bloomberg School of Public Health.

Of the 255 pediatricians who participated in the study, 209 (82 percent) said they regularly screen their patients for general developmental delays, but only 20 of the 255 (8 percent) said they do so for ASD. Of those who do not screen routinely for ASD, almost two-thirds (62 percent) said they failed to do so because they weren't familiar with the screening tools.

"Lack of familiarity with ASD screening tools appears to be the single greatest barrier to routine screening," said Susan dosReis, Ph.D., of the Children's Center Division of Child and Adolescent Psychiatry and lead author of the paper, which appears in a May 11 supplement of the April issue of the Journal of Developmental and Behavioral Pediatrics.

The findings suggest that screening for ASD remains largely opportunistic rather than systematic, researchers say.

Screening is essential, as delay in diagnosis and treatment generally leads to poorer outcomes in children with developmental disorders.

"This study suggests that current national efforts may not be sufficient to actively promote the use of ASD screening tools in the general pediatric practice," dosReis added. "So it is important to learn what some obstacles might be and what needs to be done to overcome those barriers."

Previous research suggests that another factor might be that many pediatricians do not feel well-trained in general developmental and behavioral issues, researchers say.

Enhancement of residency training, complemented by introduction and training in ASD screening tools, might boost ASD screening in the general pediatric practice, dosReis added.

Almost half (47 percent) of the physicians who did not screen routinely said they preferred to send the child to a clinical specialist, whereas nearly one-third (32 percent) cited lack of time as a major reason for not screening. Of those who reported screening regularly for ASD, 90 percent said they were usually prompted to do so by parental concern and/or suspicion of ASD during routine examination.

Of the 18 percent who reported not screening routinely for any developmental delays, 73 percent cited lack of time as their top reason.

The prevalence of autism, estimated to be between 12 and 40 cases per 10,000 children, has grown over the last decade. The reasons behind the higher prevalence have flamed an ongoing debate. Some researchers attribute the increase to an actual jump in the incidence of the disorder, while others claim it is because of more aggressive screening and new diagnostic criteria, which leads to a higher number of new diagnoses.

In the Hopkins study, 99 percent of the pediatricians who believed there is an increase in ASD prevalence attributed it, at least in part, to new diagnostic criteria. At the same time, 38 percent said that underlying risk factors, other than new diagnostic guidelines, have played a role. Of these, one-third believed that environmental factors played a role, while only 7 percent attributed the increase to genetic factors, and 1 percent attributed it to vaccinations.

Researchers caution that the findings cannot be generalized beyond Maryland and Delaware because screening practices might vary by geographic area.

###

Co-investigators included Craig Newschaffer, Ph.D., and Lakeisha Johnson of the Center for Autism and Developmental Disabilities Epidemiology at the Johns Hopkins Bloomberg School of Public Health; and Courtney Weiner, B.S., of the Children Center's Division of Child and Adolescent Psychiatry.

The study was funded in part by the National Centers on Birth Defects and Developmental Disabilities at the Centers for Disease Control and Prevention.

Founded in 1912 as the children's hospital of the Johns Hopkins Medical Institutions, Johns Hopkins Children's Center offers one of the most comprehensive pediatric medical programs in the country, from performing emergency trauma surgery, to finding causes and treatments for childhood cancers, to delivering a child's good bill of health. The Johns Hopkins Children's Center's pediatric trauma service is Maryland's only state-designated trauma center for children. With recognized Centers of Excellence in 20 pediatric subspecialties including cardiology, transplant, psychiatric illnesses and genetic disorders, Children's Center physicians, nurses and staff provide compassionate care to more than 90,000 children each year. For more information, please visit: http://www.hopkinschildrens.org

littlebopeep
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Postby littlebopeep » Wed May 31, 2006 2:06 pm

Our ped. was miserable at detecting autism. She asked about Alex's words and brushed off my concerns - no further questions. I learned about autism signs from people on the Internet.
Fred, 7, NT
Barney, 5, autism

Gabesmom
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Postby Gabesmom » Wed May 31, 2006 3:53 pm

Likewise, I told my son's pediatrician that I suspected autism, but she noticed that he makes eye contact and will play peek-a-boo, so she really didn't think he was autistic. Still, she did give me a referral to the children's hospital where he was later diagnosed. In her case, and maybe this is true of most pediatricians, I think that they still have the image of the "classically" autistic child where the traits are very obvious. If your child has more subtle symptoms, it could easily be missed by a person not trained to diagnose autism. I think that's why anytime a parent has a concern about their child's development they should be immediately referred to a specialist. Pediatricians have a lot on their plate, so I think they primarily need to be trained to listen to parents and admit when they don't know something. I respect doctors who do that.
Jennifer, Mother to Anna, 5 (NT), Gabriel, 4, Autistic

livsparents
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Postby livsparents » Wed May 31, 2006 4:45 pm

It is unconscionable that a disorder that has a 1 in 162 ratio does not have 'standard' practices across all doctors offices. Forgive me if i rant yet again, but THIS IS A REAL CONCRETE ISSUE that the CDC has utterly failed on. No knocking on the mercury issue but they can always hide behind the studies. The fact that they don't have standard practices for diagnosing and have not properly trained doctors is one of the things i'd like to hold them to the fire on. I can only be cynical and assume that the only reason they are not pushing doctors to do it is there is no money to be made with lab tests or vaccines or time spent that is not 'billable'
Bill

dgdavis64
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Postby dgdavis64 » Wed May 31, 2006 5:07 pm

My ped. kept telling me Luke's problem was because he was a twin. And twins talk later than singletons. I guess it didn't help that they always had their appts together. Maybe I should've insisted they go on different days and let the Dr do the well check ups individually. You know what they say about hindsight........

Beware of the pharma trollbot shills posting from anonymous proxy servers

Winnie
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Postby Winnie » Wed May 31, 2006 5:28 pm

It is unconscionable that a disorder that has a 1 in 162 ratio does not have 'standard' practices across all doctors offices. Forgive me if i rant yet again, but THIS IS A REAL CONCRETE ISSUE that the CDC has utterly failed on.


My pediatrician was not "in the know" about autism either -- though in contrast to 7 + years ago, I do notice MANY more children receiving diagnoses before the age of three...

What follows is just a snippet from the American Academy of Pediatrician's website -- one of their autism pages:

April is Autism Awareness Month
Autism Speaks, in partnership with the AAP and others, is releasing a series of public service announcements about autism, including information about how common autism is as well as the importance of early detection. These ads will bring an increased focus on autism and may increase the number of parents asking questions about child development. >>>More Resources and Information on ASDs

Learn The Signs. Act Early.
Early Identification of Children with Autism or other Developmental Disorders Awareness Campaign.

The Centers for Disease Control and Prevention (CDC), in partnership with the many organizations, including the AAP, has launched an awareness campaign to educate parents about childhood development, including early warning signs of autism and other developmental disorders. The earlier a child with a developmental delay receives appropriate assessment and intervention, the better the developmental outcome can be.

To help prepare the health care community for the anticipated increase in questions and requests for information from parents, CDC has developed a Provider Resource Kit. This kit contains materials designed to help health care professionals communicate with parents about childhood development, what parents should be concerned about, and the warning signs of autism and other delays. Materials are available at the CDC autism awareness campaign Web site or order materials to be mailed to your office at no charge to you.


There is much more on this AAP site -- lots of links, including screening and diagnostic practices, and even a 51-page parent book that is downloadable. Here is the link, and you can check out the information yourself:

http://www.aap.org/healthtopics/autism.cfm

Certainly not all pediatricians are "on board" with all the info, but the situation is far improved from years past.

I thought it was interesting that Autism Speaks was partnered with the AAP for those public service announcements -- sometimes unexpected facts emerge when one actually checks the sources.
Winnie
"Make it a powerful memory, the happiest you can remember."

srinath
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Mine suggested

Postby srinath » Wed May 31, 2006 5:32 pm

Mine suggested autism ... when we said he's losing language ...
After that we saw nothing but gloom and doom, hand wringing, completely un founded generalisations and predictions, and lots and lots of brochures that pretty much said "there is no evidence of that" ... in fact he said it over and over 100's of times.
We pretty much think he knew it because deep down he knows what caused it ... he's denying it because that's the CDC motto ...
Cool.
Srinath.

livsparents
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Postby livsparents » Wed May 31, 2006 5:52 pm

One of my pediatricians said "Lets wait a few months" the other said "OH MY GOD! We can only PRAY it's not." Stick the latter one into the 'acceptance' folder, stick BOTH in the woeful ignorance category...
Bill

mom_of_an_autie
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Postby mom_of_an_autie » Wed May 31, 2006 6:05 pm

:D

Mary
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Postby Mary » Wed May 31, 2006 6:15 pm

We got an early diagnosis, maybe because of the severity and pervasiveness of the symptoms (couldn't walk, sit up, talk, self-feed). It makes you wonder about the notion that doctors are overdiagnosing autism. How can that be if many pediatricians don't screen for it? God bless the ones who do! Things are getting better. Hopkins has said autism can be diagnosed as early as 12 months, if the person is properly trained.[/u]

littlebopeep
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Postby littlebopeep » Wed May 31, 2006 6:20 pm

livsparents wrote: the other said "OH MY GOD! We can only PRAY it's not." Stick the latter one into the 'acceptance' folder, stick BOTH in the woeful ignorance category...
Bill


Sounds to me like this doc, similarly to ours, doesn't even have enough education on autism to be in the "acceptance" camp. We use our ped. for physically related needs only, not for autism consultation. I get far more info from parent message boards than I could ever hope to get from a general pediatrician.

I agree with Gabesmom that peds have a lot on their plates, but to not keep up with basic signs of autism is inexcusable - and lazy.
Fred, 7, NT

Barney, 5, autism

livsparents
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Re: Mine suggested

Postby livsparents » Wed May 31, 2006 6:39 pm

srinath wrote:After that we saw nothing but gloom and doom, hand wringing, completely un founded generalisations and predictions, and lots and lots of brochures that pretty much said "there is no evidence of that" ... in fact he said it over and over 100's of times.
We pretty much think he knew it because deep down he knows what caused it ... he's denying it because that's the CDC motto ...
Cool.
Srinath.


I know we need to fight the CDC as to the cause eventually, but we also have to hit them on what they are failing on that they cannot hide behind statistics. They can't hand me that they don't have enough time. Bull dink! Things that don't generate money for the MEDICAL community get relegated to the back burner. Meanwhile, 92% of those kids in DE and MD are NOT getting properly screened! THAT is a CRIME!
Bill

mom_of_an_autie
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Postby mom_of_an_autie » Wed May 31, 2006 9:13 pm

Maybe those slots of time they give to the drug company sales reps could be put to better use......

BTDT
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Postby BTDT » Wed May 31, 2006 11:32 pm

This is what First Signs is all about. It is an organization started in 1998 by an autism Mom, Nancy Wiseman, dedicated to early identification of developmental delays. Last summer I attended a First Signs conference whose targent audience was: pediatricians, family physicians, pediatric nurse practitioners, pediatric specialists (i.e. developmenal pediatricians, psychologists, psychiatrists, neurologists), public health physicians and nurses, clinicians, and early childhood educators and providers.

The purpose of this educational activity is to: (1) educate medical practitioners and other professionals about the importance of early identification and intervention of young children at risk for autism and other developmental disorders; (2) improve upon the pediatric practice of screening and referral; and (3) lower the age at which young children are diagnosed.


http://www.firstsigns.org/index.html
Health care providers are the only professionals who have routine contact with all children prior to school entrance. Although most medical providers recognize the value of early intervention, they have significant difficulty identifying children with developmental delays and disorders. An important reason is the increasing time pressure placed on them to improve productivity. Often, providers will not use developmental assessments because they require more time for observation than allowed; others use them, but choose measures that are not sensitive enough. Study after study show that 70% to 80% of children in need of services are not identified by their primary care provider. Consequently, children often miss all opportunities for assistance during the most critical time of brain development.

Key policy statements have been issued by the American Academy of Neurology, American Academy of Pediatrics, and National Research Council to define guidelines for screening and diagnosis of autism spectrum disorders.

First Signs is creating a national model for disseminating key information about early warning signs, the need for routine screening, and the treatment options available to parents of children diagnosed. The First Signs program provides practitioners with tools and training, and parents with education and support, to help young children stay on a healthy developmental path.


Bringing First Signs to Your State http://www.firstsigns.org/programs/your_state.htm

littlebopeep
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Re: Mine suggested

Postby littlebopeep » Thu Jun 01, 2006 8:13 am

livsparents wrote:Meanwhile, 92% of those kids in DE and MD are NOT getting properly screened! THAT is a CRIME!
Bill


This is tangential, but young children are getting much more thorough screening in general than ever before. However it happens, via the child's ped, schools, First Signs and such PR campaigns, or the internet, awareness among parents is definitely growing. Personally, I believe that the internet and its instant information is the cause of the autism "epidemic."

Again, tangential - carry on.
Fred, 7, NT

Barney, 5, autism

Gabesmom
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Postby Gabesmom » Thu Jun 01, 2006 6:19 pm

Personally, I believe that the internet and its instant information is the cause of the autism "epidemic



Littlebopeep, I think you might be right about that, as least as it pertains to children whose symptoms are not as obvious. If not for the internet, I think I would still be looking at my son's behavior as a little on the quirky side, and if his language had developed enough by the time he entered school, he might have even been placed in the gifted program because of his hyperlexia. This did happen to another child I cared for who started reading at the age of three. He also had some "quirky" behaviors which turned out to be SI issues, but his mother and I were clueless because this was almost ten years ago, and the information about autism was not nearly as prevalent. Actually, this child was diagnosed with Asperger's/hyperlexia when he was ten years old. Had he been born today, he might very well have been diagnosed at 2 or 3 years old. I'm sure there are many more stories like this one.
Jennifer, Mother to Anna, 5 (NT), Gabriel, 4, Autistic

BTDT
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Postby BTDT » Fri Jun 02, 2006 9:27 am

Personally, I believe that the internet and its instant information is the cause of the autism "epidemic."


I think the internet has made a contribution to the increase as well. I diagnosed my son from information I found on the internet before his pediatrician was even willing to agree there was a problem.

livsparents
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Postby livsparents » Fri Jun 02, 2006 10:14 am

I think the internet has clarified autism. Think about it, 30 years ago, you could not compare information with others in similar situations, save those rare encounters with people under similar circumstances and the rare 'convention' if you could find out about it. Information from literally millions of resources is now at your fingertips! Those two things have made people aware that these 'quirky' behaviors are common across many kids. I HOPE people are not blaming the internet for misdiagnosis, I think it has helped immeasurably. If it were not for us searching 'Speech Regression' on the internet, we may STILL not have figured out what was going on...
Bill


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