There is an unprecedented increase in the number of children diagnosed with autism. This has led those in the medical and scientific community to conduct studies not only to find out the cause and the cure for the disorder but also to detect this disorder at its earliest stage. The efforts of medical professionals in the past have led to the development of standardized screening techniques to detect early signs of autism.
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However despite the substantial development in the screening techniques, current screening practices reveal that we are far from achieving its maximum potential. A substantial number of children with signs of autism reach the age of three or four years old without being detected and screened. Research on the current literature reveals that the two primary reasons for the failure to conduct developmental screening are: lack of awareness of pediatricians and pediatric nurses of the early signs of autism; and lack of knowledge of the screening tools for autism. The solution to this problem is to adequately arm the pediatricians and pediatric nurses with sufficient knowledge so that they will become aware of the early signs of autism and recommend early intervention techniques to the parents.
Autism is a brain disorder that affects a child’s ability to develop normal communication skills and social responsiveness to other people.It is currently the most common condition in a group of developmental disorders known as the autism spectrum disorders (ASD). Current research shows that there has been an alarming increase in cases of autism among children. According to the Centers for Disease Control and Prevention, the disease now affects one in every 150 children born today in the U.S. (“One in every 150 U.S. children autistic”) In New Jersey, it is estimated that the rate of autism is 1 in 94. About ten years ago, it was 1 in every 500 cases. In view of this information, autism is now considered as the fastest growing developmental disability – worse than childhood cancer, juvenile diabetes or pediatric AIDS combined.
A child with autism is characterized by three distinctive behaviors otherwise known as the ‘triad of impairments.’ First impairment is that autistic children experience difficulties in interacting socially with fellow children. Autistic children are aloof and indifferent to people. They are unresponsive and unsociable and have problems fitting in a group. They are also unwilling to look people in the eye. Second impairment is that children with autism have difficulty with verbal and non-verbal communication. Usually, they will not respond even if called by their name. They are also incapable of interpreting what others are thinking and feeling. Third impairment is they have the tendency towards repetitive behavior and have narrowly limited interest. They would often engage in repetitive movements such as rocking and twirling or biting or head-banging.
Before a child can find treatment for autism disorder, it is essential for him to be diagnosed with autism. Detecting autism, however, is very difficult especially when parents who do not pay particular attention to their child’s development and may disregard early symptoms of autism. In some cases, parents will notice signs of autism before the child reaches the age of three while in some cases parents will fail to notice it until the child reaches the age of four. This can be attributed to the fact that a child with autism, at first, may not exhibit unusual behavior. He may develop normally at first and then shows autistic traits. However, in some cases, even if parents notice something unusual about their child’s behavior and relay their observation to their pediatricians and nurses, the latter may merely dismiss such fears and allay the parents fears to say that the child is just a late bloomer without conducting a more thorough screening or evaluation. (Mary Amoroso) Because of this neglected child with autism do not get the necessary medical intervention from experts until it is too late to do so.
In addition, autism is a complex disorder which requires a comprehensive evaluation and not just a specific test. To confirm whether a child has autism, a multidisciplinary team is needed which includes a psychologist, neurologist, psychiatrist, speech therapist and other professionals. A thorough neurological evaluation and cognitive and language testing must be conducted for the team to rule out other problems such as hearing impairment or delayed speech development.
In view of this inherent difficulty, the American Academy of Pediatrics has now taken a proactive role in helping parents detect early signs of autism among children. It now mandates as part of routine pediatric care the monitoring of children for developmental disability including ASD. Routine screening and monitoring of children for developmental disability is being done so that the condition of a child who has autism or other disorder may be detected in advance.
Developmental screening is defined as the “brief, formal evaluation of developmentalskills applied to a total population of children, which is intended to identify those children withsuspect problems who should be referred for a complete diagnostic assessment and the prospective identification of unrecognized disorders by the application of specific tests or examinations.” Developmental screening as a required practice in pediatric primary care was formulated in 1999 by a panel comprised of 13 organizations which include the Child Neurology Society, American Academy of Neurology and the National Institutes of Health. The panel formulated the parameter for the screening of and diagnosis of children with autism under a two-level approach. The first level comprises of the routine screening for abnormal development which will be followed by the ASD-specific screening for children who are found positive on the general developmental screening test. The second level screening follows if a child scores positive on the ASD-specific screen or if a child is found to have other abnormalities. The second level screening includes a more thorough screening of the child by determining the child’s developmental and health history and neurological assessment and a formal evaluation by a multidisciplinary team of clinicians.
Current Research, however, shows that while screening techniques have improved in the past years, the parameters established by the panel are not being observed by the pediatricians and pediatric nurses. According to a survey, only 50% of pediatricians and nurses conducted routine developmental screening during well-child visits. (Jennifer A. Pinto-Martin 165) In another survey in Australia, only 41% used standardized developmental screening measure and a lot of them used the screening incorrectly. In another study in Virginia, it was reported that 97% of the respondents conducted developmental screening but only 58% used standardized screening.
One of the primary reasons for the failure to observe the parameters as established by the panel is that pediatricians and pediatric nurses fail to recognize the early symptoms of ASD. (“Study: Pediatricians Overlook Early Signs of Autism Spectrum Disorder”) This was the result of the study conducted by Special Abilities, Inc which found that out of a total of 500 respondents, 42 of the pediatricians did not notice any developmental delay in those children who were eventually diagnosed with ASD. Pediatricians’ failure to recognize the early symptoms of autism can be attributed to the fact that they received minimal information about autism back in medical school.
Another reason why developmental screening is not being actively implemented is the lack of knowledge among some pediatricians and pediatric nurses of the use of screening tools. This is confirmed in a study conducted by Johns Hopkins Children’s Center and the Johns Hopkins Bloomberg School of Public Health. The results of the study show that of the 255 pediatricians 82% said they regularly conduct screening for general development delays but only 8% conducted screening for ASD. Almost 62% of the respondents admitted that they failed to do so because of lack of familiarity with the screening tools. (“Pediatricians Fail to Screen for Autism, Johns Hopkins Study Finds; Most Know Too Little About the Screening Tools”)
Considering the importance of pediatricians and pediatric nurses in the early detection of children with autism, it is suggested that the following actions be undertaken:
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