1. Autism Spectrum Disorders:
Making AAP Policy and the
Toolkit Work for You

2. Speakers
Scott M. Myers, MD, FAAP
Geisinger Medical Center, Danville, PA
Mark Rosenberg, MD, FAAP
Child Health Associates, Chicago, IL
The speakers have no relevant financial
relationships with the manufacturers
of any commercial products and/or
provider of commercial services
discussed in this CME activity.
They do not intend to discuss an
unapproved/investigative use of a
commercial product/device in their
presentation.

3. Objectives
Describe the recommendations put forth in the 2
AAP Autism Clinical Reports (Nov 2007)
Utilize the AAP Autism Screening Algorithm in
office practice
Identify strategies for implementing at least 2
tools from the AAP Autism Toolkit

4. Leo Kanner
Autistic Disturbances of Affective Contact
Nervous Child 1943;2:217-53
Lack of typical motivation for social
interaction and affective contactProfound
disturbances in communication
lack of speech, echolalia, literalness,
pronominal reversal
Unusual responses to the environment,
resistance to change

5. Autistic Disorder
DSM-IV (APA, 1994)
Qualitative impairment
in social interaction
Qualitative impairment
in communication
Restricted, repetitive and
stereotyped patterns of
behavior, interests, and
activities
Delay or abnormality in
social interaction,
language use for social
communication, or
symbolic or imaginative
play with onset before
age 3

6. Autism Spectrum Disorders
Autistic Disorder
Asperger Syndrome
Pervasive Developmental Disorder Not
Otherwise Specified (PDD NOS)
Behaviorally defined conditions
Caused by neurological dysfunction of
multiple etiologies
Spectrum of varying severity

7. Epidemiology
1 out of 6 children are diagnosed with a
developmental disorder/behavioral problem
Current detection rates are lower than
prevalence
Prevalence of ASDs is 1 in 150 children1
44% of PCPs report caring for at least 10
children with ASD; however, only 8%
routinely screen2
1 CDC. Prevalence of autism spectrum
disorders – ADDM network, 14 sites, US
2002. MMWR 2007;56(1):12-28.
2 Dosreis S, Weiner CL, Johnson L,
Newschaffer CJ. Autism spectrum disorder
screening and management practices
among general pediatric providers. J Dev
Behav Pediatr. 2006;27:S88–S94

8. Important Roles of Primary Care
Physicians
Early recognition
• Knowledge of signs and symptoms
• Developmental surveillance and screening
Guiding families to diagnostic
resources and intervention services
Conducting a medical evaluation
Providing ongoing health care
Supporting and educating families

9. AAP Clinical Reports:
Guidance for the Clinician in Rendering Pediatric Care
Autism Resource Toolkit
Pediatrics, November, 2007 AAP, 2007

10. Identification and Evaluation of
Children With ASDs
Diagnostic Surveillance and
criteria screening
Epidemiology Algorithm
Prevalence 1/150 Referral for
Etiology evaluation and
Neuropathology services
and Comprehensive
neuroimagingCli evaluationGenetic
nical signs counseling
Coexisting Prognosis
conditionsMyers Pediatrics 2007;120:1183-1215 with
Johnson CP,
Disabilities,
SM, and the Council on Children

11. Key Points
Conduct ASD surveillance at all
preventative well child visits and
whenever there is a concern
Screen all children at 18 and 24
months
Increased vigilance in younger
siblings with a 10x increased risk
Refer for hearing evaluation and early
intervention services as soon as an
ASD is seriously considered rather
than waiting for a definitive diagnosis
Early recognition  access to
intervention  improved outcomes
Johnson CP, Myers SM, and the Council on Children with
Disabilities, Pediatrics 2007;120:1183-1215

12. Management of Children With ASDs
Educational Interventions Medical
Preschool and School ManagementSeizures
Programs Gastrointestinal
Specific Strategies Problems
Applied Behavior Analysis Sleep Disturbance
Structured Teaching Challenging Behaviors
Developmental Models Psychopharmacology
Speech and Language
Complementary and
TherapySocial Skills
Instruction Alternative Medicine
Occupational Therapy Family Support
Sensory Integration Therapy Parents
Siblings
Myers SM, Johnson CP, and the Council on Children with Disabilities,
Pediatrics 2007;120:1162-1182

13. Key Points
Chronic management within a
medical home is required
Educational
interventions, including
behavioral strategies and
habilitative therapies, are the
cornerstones of treatment
Early, intensive intervention is
recommended
Pediatricians can support families
by providing information and
access to resources
Myers SM, Johnson CP, and the Council on Children with
Disabilities, Pediatrics 2007;120:1162-1182

14. Key Points
Effective treatment of
coexisting medical problems
such as seizures, challenging
behaviors, and sleep disorders
may allow the child to benefit
more fully from educational
interventions
Pediatricians can help families
to understand how to evaluate
the scientific merits of various
therapies and guide them to
scientifically validated
treatments
Myers SM, Johnson CP, and the Council on Children with
Disabilities, Pediatrics 2007;120:1162-1182

15. Developmental Screening/ASD Policy
Identifying Infants and Young Children
with Developmental Disorders in the
Medical Home: An Algorithm for
Developmental Surveillance and
Screening. July 2006
Routine developmental surveillance at each
well-child visit
Developmental screening at 9,18, and 30
months
Identification and Evaluation of Children
With Autism Spectrum Disorders. Nov
2007
Autism-specific screening at 18, 24 months
Management of Children With Autism
Spectrum Disorders. Nov 2007

17. Toolkit
AUTISM: Caring for
Children With Autism
Spectrum Disorders: A
Resource Toolkit for
Clinicians was developed
by the AAP Autism
Subcommittee to support
health care professionals
in the identification and
ongoing management of
children with ASDs in the
medical home

18. Goals
Improve early identification
of children with autism
spectrum disorders in
primary care so they can
receive treatment services
as early as possible
Empower pediatricians to
take a strong role in the
management of children
with ASDs and their
associated conditions in the
medical home

19. Toolkit Content
The fully searchable CD-ROM has an extensive library of
ASD-specific information and practice tools:
• Screening and surveillance algorithms • Record-keeping tools
• Examples of screening tools • Emergency information forms
• Guideline summary charts • ASD coding tools
• Management checklists • Reimbursement tips
• Developmental checklists • Sample letters to insurance companies
• Developmental growth charts • ASD management fact sheets
• Web links • Family education handouts
• Early intervention referral forms and tools

20. Toolkit Content
Hard copies of the
following resources are
included:
• CDC/Learn the Signs. Act
Early. Developmental
Growth Chart
• “Understanding Autism
Spectrum Disorders”
Parent booklet
• “Is Your One-Year-Old
Communicating With
You” Parent Brochure

21. Toolkit Content
Fact sheets for primary care professionals
(PDF files) Topics
Asperger syndrome Treatment decision
Behavioral Psychopharmacolog
principles y
CAM Treatments Seizures & Epilepsy
Dietary tx Sleep disorders
Eating & nutrition Toilet training
GI problems

22. Toolkit Content
Fact sheets for primary care professionals to
give families (PDF files) Topics
Behavioral challenges
Seizures & epilepsy
Diet
Sibling issues
Early intervention
Sleep problems
GI problems
Support programs for
Childhood to adolescence families
Guardianship Toilet training
Lab tests Transition to adulthood
Medication Vaccines
Nutrition & eating problems Visiting the doctor
School based services

23. Screening for Autism Spectrum
Disorder in Your Office
Rationale for
screening
Means to
screen
Reimbursemen
t
Resources

24. Screening for Autism Spectrum
Disorder in Your Office
SCREENING
CONFORMS TO
BRIGHT FUTURES
GUIDELINES
SCREENING AS
QUALITY
IMPROVEMENT:
AMERICAN
BOARD OF
PEDIATRICS
PERFORMANCE
CRITERIA

25. Screening for Autism Spectrum
Disorder in Your Office
The need:
Parents want to know
how their child is doing
Parents want to know
how they are doing
The means:
Given limited time
use of developmental
screening tools
promotes efficiency

26. Resources for Pediatricians
AAP Clinical Reports
Autism Toolkit
Web sites:
WWW.DBPEDS.ORG
WWW.EDOPC.ORG
WWW.MEDICALHOMEINFO.ORG

27. REIMBURSEMENT
DEVELOPMENTAL
SCREENING TOOLS
96110 ROUTINE
SCREENING TOOL
MAY USE MORE THAN
ONCE PER VISIT
96111 DETAILED
DEVELOPMENTAL
VISIT
RISK ASSESSMENT
99420 POST PARTUM
DEPRESSION
PROLONGED SERVICES
CODES
99354-5 ADDITION TO
PREVENTIVE VISIT

28. RESOURCES FROM TOOLKIT
Early Intervention
Referral Form
Emergency Care
Form
Community
Resources

29. EI Referral Form

30. EMS Form

31. Community Resources

32. Questions?