Health care provider responses to initial parental reports of autism spectrum disorder symptoms: results from a nationally representative sample.

BACKGROUND: Health care provider (HCP) responses to initial parental report of autism spectrum disorder (ASD) symptoms were examined in relation to latency to diagnosis and child chronological age at diagnosis. METHOD: Secondary data analyses were conducted for a sample of 1384 parents of children with ASD utilizing data from the National Survey of Children with Special Health Care Needs (NS-CSHCN, 2009-2010 National Survey of Children with Special Health Care Needs, 2009) and the Centers for Disease Control and Prevention Pathways to Diagnosis and Services (CDC PDS, Survey of pathways to diagnosis and services, 2011). RESULTS: Approximately 44% of the sample experienced predominantly delayed HCP responses, 38% experienced predominantly proactive responses, while the remaining 18% experienced a relatively even mix of delayed and proactive responses across HCPs. With regard to outcomes correlated with the type of HCP response, individuals exposed to proactive HCPs were diagnosed with ASD almost a year earlier for child chronological age than individuals exposed to mixed HCPs. This difference increased beyond a year between individuals receiving proactive HCPs versus individuals experiencing delayed HCPs. Finally, after controlling for socioeconomic status, parent-reported severity of ASD symptoms, and age at time of referral, proactive HCP was correlated with decreased time to diagnosis from parental first report of ASD symptoms. CONCLUSIONS: Results are discussed with regard to increasing proactive HCP responses to parental first concerns of ASD symptomology versus a mix or delayed responses.

Preliminary Evidence for the Integrated Systems Using Telemedicine.

BACKGROUND: Autism affects as many as 1 in 68 children in the United States. Early identification and access to intervention services promote improved outcomes for children with autism and other developmental delays. Children living in rural and underserved areas have limited access to such services and are diagnosed later than those living more suburban and urban areas. Our Integrated Systems Using Telemedicine (ISUT) Model uses a cost-effective method for families to access diagnostic and other specialty care through telemedicine. This model links families, trained early intervention providers and educators, and university-based medical professionals. MATERIALS AND METHODS: We trained autism diagnostic teams throughout the state who completed diagnostic measures and connected to university medical center teams for final diagnosis of autism and coexisting conditions. We gathered preliminary data to measure the impact of the ISUT model on access to services, potential cost savings for families, and parent satisfaction with the model. RESULTS: Preliminary data indicate that our ISUT model provided families in rural and underserved areas improved access to diagnostic services as well as cost savings for travel. Our satisfaction data indicate that parents are equally satisfied with services received through the ISUT and through the University-Based Medical Center Team Model. CONCLUSIONS: The ISUT model provides a unique collaboration among the family, educational system, autism experts in the community, and the university medical center autism team while providing a cost-effective means for families to access specialty care while promoting coordination of care within the community.

Care of children with autism spectrum disorder.

Autism spectrum disorder (ASD) is both common and complicated. Many children with ASD are not identified until school age. The primary care physician (PCP) plays a vital role in recognizing the symptoms of ASD and in making referrals for definitive diagnosis. Most children with ASD also have co-occurring learning, medical, and/or mental health problems that require collaboration across the educational, medical, and mental health systems. This article reviews the symptoms of ASD, screening tools for school-aged children suspected of having ASD, and the PCP's role in identifying ASD and managing co-occurring conditions in the primary care medical home.

Barriers to autism screening in family medicine practice: a qualitative study.

AIM: We explored potential barriers to adoption of recommended screening for autism by family physicians at 18- and 24-month well-child visits. BACKGROUND: The American Academy of Pediatrics recommends early detection and intervention of autism through the use of a standardized autism-specific screening tool on all children at the 18- and 24-month well-child visits. However, not all family physicians screen for autism. METHODS: Three focus groups and six semi-structured interviews were conducted with 15 family physicians in the Kansas City metropolitan area. Verbatim transcripts were inductively coded; data were analyzed using standard text analysis. FINDINGS: Participants had differing views on the increased incidence of autism. Most participants attributed the increase to changes in diagnostic criteria. There was no consensus on the benefit of implementing universal screening for autism during the 18- or 24-month visit. Many preferred to identify potential problems through general developmental assessments and observations. No participants used specific screening tools for autism, and only one participant was aware of such a tool (M-CHAT). Lack of adequate training on child development and screening methods as well as limited availability of community-based resources to manage children with autism was seen as major barriers to routine screening. Suggested solutions included working toward a stronger evidence base, improving physician training and continuing education, and making systemic changes in healthcare. In conclusion, universal screening for autism at the 18- and 24-month visits is not widely accepted, nor is it implemented by family physicians.

Evidence for alterations in stimulatory G proteins and oxytocin levels in children with autism.

The neurotransmitter oxytocin plays an important role in social affiliation. Low oxytocin levels and defects in the oxytocin receptor have been reported in childhood autism. However, little is known about oxytocin's post-receptor signaling pathways in autism. Oxytocin signals via stimulatory and inhibitory G proteins. c-fos mRNA expression has been used as a marker of OT signaling as well as of G protein signaling. Herein, we hypothesized that oxytocin and its signaling pathways would be altered in children with autism. We measured plasma oxytocin levels by ELISA, G-protein and c-fos mRNA by PCR, and G proteins by immunoblot in cultured peripheral blood mononuclear cells (PBMCs) in children with autism and in age-matched controls. Males with autism displayed elevated oxytocin levels compared to controls (p<0.05). Children with autism displayed significantly higher mRNA for stimulatory G proteins compared to controls (p<0.05). Oxytocin levels correlated strongly positively with c-fos mRNA levels, but only in control participants (p<0.01). Oxytocin, G-protein, and c-fos mRNA levels correlated inversely with measures of social and emotional behaviors, but only in control participants. These data suggest that children with autism may exhibit a dysregulation in oxytocin and/or its signaling pathways.