Caroline Helwick

October 26, 2012

NEW ORLEANS — A new "autism toolkit" designed to help clinicians diagnose and manage autism spectrum disorders (ASD) and provide resources for the families of these children has been launched by the American Academy of Pediatrics (AAP).

Released here at the AAP 2012 National Conference and Exhibition, the second edition of the autism toolkit is entitled Autism: Caring for Children With Autism Spectrum Disorders: A Resource Toolkit for Clinicians and includes the latest AAP guidelines on autism screening, surveillance, diagnosis, treatment, and referral.

According to the toolkit coeditor Susan E. Levy, MD, University of Pennsylvania School of Medicine, Philadelphia, it provides doctors with tools to help them "be more comfortable in their understanding of the policies put forward by the AAP for evaluating and managing ASD."

"We modelled it after the toolkit for attention-deficit/hyperactivity disorder, which has had very good uptake by pediatricians. We were inspired by how effective that was, and we think the new toolkit is equally great," said Dr. Levy, who is board certified in pediatrics and neurodevelopmental disabilities

According to Susan L. Hyman, chair of the autism subcommittee of the AAP Council on Children With Disabilities, this second edition, the first since 2007, was revised on the basis of feedback from primary care providers for ease of use and includes additional and updated topic areas related to medical, behavioral, and educational care.

Dr. Levy emphasized that the toolkit was developed with abundant input.

"We were part of the group that wrote the first version, and we were tasked with the revision. It went out for review to members of the Council, and even more importantly, to families with different-aged children with ASD. The information was vetted through families," she said.

The toolkit includes more than 70 tools for healthcare providers, including developmental screening questionnaires and screening tools, diagnostic criteria, treatment algorithms, family handouts in English and Spanish, record-keeping tools, and clinician fact sheets on specific health concerns.

Its main components include the following:

  • Practice-focused guidelines and recommendations: New and recently reaffirmed AAP clinical reports and policy statements on ASD identification, evaluation, and management.

  • Developmental screening and surveillance tools: Algorithms, questionnaires, growth charts, diagnostic criteria, Centers for Disease Control and Prevention developmental milestones, and record-keeping tools.

  • Visit preparation and tracking aids: Detailed guidance for facilitating ASD office visits; tools to track key steps in identification, diagnosis, intervention, and management.

  • Clinician fact sheets: Expert insights and advice on Asperger syndrome, sleep disorders, toilet training, nutrition, gastrointestinal disorders, seizures and epilepsy, psychopharmacology, complementary and alternative therapies, transition to adult care, and more.

  • Referral tools and time-savers: Ready-to-use early-intervention referral and follow-up forms.

  • Coding and billing guidance: Techniques to help ensure prompt, proper payment for ASD-related services.

  • Family education handouts in English and Spanish: Handouts for quick duplication and distribution; topics include behavioral challenges, early-intervention services, school-based services, medications, vaccines, toilet training, sleep problems, sibling issues, eating problems, transition to adulthood, and more.

Dr. Levy added that one of the most valuable additions is guidance for the medical workup of children with autism.

"We worked with a geneticist, for example. The information is up-to-date," she said.

David Matthews, MD, of Jonesboro, Arkansas, who is president of the state AAP chapter, attended a presentation by Dr. Levy and commented on the toolkit's value.

"I think it will be a very good resource for dealing with patients. In my practice, only 2 of us are trained for upper-level autism screening, and this toolkit will be especially helpful to physicians with less frequent contact with these patients," he said.

Early Recognition Critical

Commenting on the findings for Medscape Medical News, Laura Politte, MD, a child and adolescent psychiatrist and clinical instructor at Harvard Medical School in Boston, Massachusetts, noted that the prevalence of ASD is growing, and so it is more critical than ever that clinicians become more familiar with how to recognize the early signs of the disorder and make appropriate specialist referrals.

"Early recognition by pediatricians is particularly imperative, as outcomes for children with ASD can improve substantially with intensive educational and behavioral therapies instituted early in the course of development," said Dr. Politte, who is also an assistant in psychiatry and pediatrics at Massachusetts General Hospital.

She noted that the toolkit "has the potential to improve early detection of ASD and the quality of care throughout childhood for those affected."

Dr. Levy, Dr. Hyman, Dr. Matthews, and Dr. Politte have disclosed no relevant financial relationships.

American Academy of Pediatrics (AAP) 2012 National Conference and Exhibition. Presented October 20, 2012.

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