Early identi ﬁ cation and intervention for developmentaldisorders are critical to the well-being of children and are the responsibility of pediatric professionals as an integral function of the medical home. This report models a universal system of developmental surveillance and screening for the early identi ﬁ cation of conditions that affect children ’ s early and long-term development and achievement, followed by ongoing care. These conditions include autism, deafness/hard-of-hearing, intellectual and motor disabilities, behavioral conditions, and those seen in other medical conditions. Developmental surveillance is supported at every health supervision visit, as is as the administration of standardized screening tests at the 9-, 18-, and 30-month visits. Developmental concerns elicited on surveillance at any visit should be followed by standardized developmentalscreening testing or direct referral to intervention and specialty medical care. Special attention to surveillance is recommended at the 4- to 5-year well-child visit, prior to entry into elementary education, with screening completed if there are any concerns. Developmental surveillance includes bidirectional communication with early childhood professionals in child care, preschools, Head Start, and other programs, including home visitation and parenting, particularly around developmentalscreening. The identi ﬁ cation of problems should lead to developmental and medical evaluations, diagnosis, counseling, and treatment, in addition to earlydevelopmentalintervention. Children with diagnosed developmentaldisorders are identi ﬁ ed as having special health care needs, with initiation of chronic condition management in the pediatric medical home.
For young children at risk for ASD the full year between 12 and 24 months requires especially close surveillance as early behavioral markers of ASD emerge during this time period (Baranek, 1999; Colgan et al., 2006; Zwaigenbaum, 2005); however, there is only one scheduled well-child visit (18 months) during this critical period. If a child at-risk for ASD misses the 18-month visit, then the potential for intervention is delayed. In addition, redundancies across the three sets of screening guidelines for children with developmental and behavioral disorders (AAP, 2006; AAP, 2007; AAP, 2010) have been identified and an alignment of screening and surveillance algorithms has been suggested (Marks et al., 2011). Other future directions include (1) examining timing of well-child visits for children with developmental risk factors, and (2) examining the role of parents in the developmentalscreening process, especially if they have a concern about their child.
Early identification of developmentaldisorders is critical to the well-being of children and their families. It is an integral function of the primary care medical home and an appropriate responsibility of all pediatric health care professionals. This statement provides an algorithm as a strategy to support health care profes- sionals in developing a pattern and practice for addressing developmental concerns in children from birth through 3 years of age. The authors recommend that developmental surveillance be incorporated at every well-child preventive care visit. Any concerns raised during surveillance should be promptly addressed with standardized developmentalscreening tests. In addition, screening tests should be administered regularly at the 9-, 18-, and 30-month visits. (Because the 30-month visit is not yet a part of the preventive care system and is often not reimbursable by third-party payers at this time, developmentalscreening can be performed at 24 months of age. In addition, because the frequency of regular pediatric visits decreases after 24 months of age, a pediatrician who expects that his or her patients will have difficulty attending a 30-month visit should conduct screening during the 24-month visit.) The early identification of developmental problems should lead to further developmental and medical evaluation, diagnosis, and treatment, including earlydevelopmentalintervention. Children diagnosed with developmentaldisorders should be identified as children with special health care needs, and chronic-condition management should be initiated. Identification of a developmental disorder and its underlying etiology may also drive a range of treatment planning, from medical treatment of the child to family planning for his or her parents.
The real role in the identification of the disease is in the hand of pediatrician, as at the early age the children visit the primary pediatrician for health related concerns. Thus it becomes the most important responsibility of the pediatrician to learn the identification skills to judge this neurological developmental disorder which will be more effective intervention for children with autism in comparison to other disorders (Lipkin and Schertz, 1996). Generally, the role of pediatric clinicians is to ideally follows the guidelines for the diagnosis and management of ASD’s in children and recommend the effective treatment (Kanner, 1943; American Academy of Pediatrics, 2006; American Academy of Pediatrics, 2007).There are various levels of treatment approaches on the arrival of the children to clinic. A Level 2 approach is recommended for screening and diagnosing autism when a child fails normal developmentalscreening (Baron-Cohen et al., 1992; Baron-Cohen et al., 2000; Berument et al., 1999; Rutter et al., 2003). Child who fails autism screening, there is referral for evaluation recommended to experienced clinician for further observation. There is also referral recommended (Osterling and Dawson, 1994; Mars et al., 1998; Werner et al., 2000).
designed for health professionals, and specific to children who may have Autism. However, educators are often more available to administer this assessment, and although they may not be as informed, which can cause a difference in results, they are still considered qualified. They promote public education about red flags for various developmentaldisorders, seeing that the earlier the identification and intervention, the better the developmental outcome will be. In Canada, a similar trend has been happening. Across Ontario Early Years Centres, and throughout a few other childcare providers, ECEs are administering screening tools to ensure that all children are developmentally on track. They are doing this for infants, toddlers, and preschool aged children. This is what was recommended by the ELECT framework, but many private childcare sites do not follow suit. According to Feeney-Kettler et al. (2010), the primary step should be to establish preventative measures including screening tools. In their study they mention mental health screening to combat against social- emotional disturbances that could result later in life. They also declare that more than one measure can be synthesised to provide a more accurate approximation of the child’s socio-emotional development. The Best Start Expert Panel on Early Learning (2007) recommends that children should be screened by age three, before entering school. Its authors suggest that researchers should advocate for early identification, which will point out early signs of delay. Registered early childhood educators are required to screen for behavioural, social, emotional, or cognitive concerns, and monitor the development of their enrolled children; however there is concern over what is being done to follow up. Although the Day Nurseries Act (1990) is a set of guidelines that all licensed childcare must follow, they do not include any standardized screening tools, or any specific
the clinicians, across settings and departments/disciplines, reported little if any use of standardized instruments for assessing substance use problems. They often relied on home- grown tools and questions they have come to feel comfortable with, or instruments developed for adult and inappropriate for use with teens, which they learned in medical school (e.g., the CAGE). In some cases these were combined with tools their clinic had in place, usually embedded in larger screening instruments. While a few pediatricians who had become familiar with the CRAFFT tool through the training they received in the parent RCT discussed its ease of use, most clinicians did not use brief evidence-based tools, even when they were easily available to them in the EHR, along with clinical tools such as the ability to track patients’ substance use over time. It is well established that clinical impressions of substance use are frequently inaccurate, and that structured, evidence-based screening instruments offer a quick, easy and far more accurate way to identify adolescent substance use problems. 252 Any attempt to implement more effective substance use prevention and earlyintervention must focus on training providers on the value, effectiveness and use of evidence-based, EHR-embedded screening and assessment instruments and clinical decision- support tools, such as brief intervention and referral algorithms and scripts.
A third limitation is that many states allow eligibility determination based on qualitative assessment practices. Children may become eligible through these pathways who demonstrate atypical behavior without a corresponding delay on standardized assessment instruments (Shakelford, 2006). In addition, eligibility determination is required to include clinical opinion for Part C services (see 34 CFR 303.322(c)(2)) (Shakelford, 2006). For the current study, states that reported only clinical opinion were grouped with states using a somewhat more lenient cutoff for eligibility (1.5 SD below the mean in at least one area). In practice, it is likely that there is variability of implementation of a qualitative standard such as “informed clinical opinion” based on local program factors and the expertise and professional background of the eligibility team. It is also possible that this qualitative component of eligibility determination sometimes results in determining a child is eligible, and in other cases contributes to a determination the child is not eligible for Part C services. Therefore, it is difficult to precisely identify eligible children from these states, and aspects of clinical judgment may alter the representation of other children’s eligibility as well. Eligibility determination done by local earlyintervention professionals and teams may also differ in other qualitative ways from the approach used in the current study in that local teams should use multiple sources of information beyond
Early identiﬁcation and intervention can be important in determining adult adjustment to LDs, and pediatricians are often on the front lines of identiﬁ- cation. Clinicians are encouraged to review school performance with fami- lies by examining report cards and test scores and by speaking with parents about academics to screen for LDs. In addition, pediatricians should be fa- miliar with the ADAAA and education laws that relate to LDs, including the Individuals With Disabilities Education Act. 70 When considering outcomes for
Two hundred and fifty-four patients met the study inclu- sion criteria and accepted the invitation to participate. Of this number, and after an AUDIT screening conducted by a physician or a nurse, 112 patients were subsequently randomly assigned to intervention or control groups in a 1:1 ratio. The randomization scheme was drawn by a sta- tistician, who used the Web site [http://www.randomizer. org/]. A random permuted block method was used, with blocks of 4 patients. The sequence was concealed from all investigators with numbered opaque sealed envelopes pre- pared by the statistician and handed over to the physician in charge of the study.
impairments are typically not restricted to a single cognitive domain. The second group are disorders defined on the basis of behavioural deficits, such as dyslexia, Specific Language Impairment and autism. In these disorders, behavioural genetics indicates sometimes substantial heritability, but the causal genes are not yet known and may well not be mutations (that is, they may be spectrum disorders corresponding to an unlucky accumulation of normal genetic variations that each add a small risk for the target disorder). In these disorders, it is sometimes argued that the deficits are restricted to single cognitive domains (e.g., reading in dyslexia, language in Specific Language Impairment) but there remain doubts as to whether these disorders are indeed homogeneous rather than behavioural clusters with milder associated deficits and heterogeneous causes. The third group correspond to disorders where there is learning disability but its cause is unknown. The final group correspond to disorders caused by environmental factors, such as acquired brain damage, viral infections or an impoverished environment, be it cognitive (such as neglect) or biological (such as in Foetal Alcohol syndrome). The first and last of these four groups index the primary locus of causality – the first group nature, the last group nurture – while the middle two reflect our current lack of knowledge about the cause of some disorders. A given behavioural impairment may be generated in more than one way. For example, poor reading may be the consequence of either dyslexia or limited opportunities to learn to read. Our discussion will predominantly focus on the first two of these four groups – neurogenetic and behavioural disorders (see, e.g., Goldin-Meadow, 2005, for
There is an urgent need for effective prevention and earlyintervention for anxiety disorders in children, adolescents, and young adults to prevent the widespread debilitating effects of such mental health problems and progression to more serious illness. A great deal of further research is needed, however, and attention needs to focus on reasons for the lack of rigor- ous research in the field and high attrition rates in the few research studies. Foremost, the many self-help interventions that are already available to the public need to be the subject of good quality outcome-based research. Furthermore, self-help interventions that are developed through university research trials need to be able to be publicly available if they are shown to be efficacious. The role of support in the use of self-help interventions also needs to be examined. Using self-help as an adjunct to therapy, or in a guided manner with the sup- port of skilled or semi-skilled mental health professionals, is beginning to receive research attention. The role of parents in self-help for young people also needs to be investigated, however, particularly for children and younger adolescents, but also in relation to encouraging older adolescents to effec- tively use self-help interventions. Receiving appropriate and effective treatment as early as possible in the development of anxiety disorders is essential to improving the mental health and well-being of young people as they grow into adulthood. Ways to encourage research attention to this important area of earlyintervention need to be found.
In our study 12 individuals that is 30% of follow up patients have OGTT after 1 hour was more than160mg/dl and OGTT after 2 hours was more than140mg/dl after Life Style Intervention, this could be due to these individuals are nit stringent and compliant to the diet and exercise advised to these individuals as a part of life style modifications, may be because they do not have control over their hunger and not so much of dedication to continue the diet and exercise advised as a part of life style intervention.
of ASD, determine whether there are comorbid dis- orders, and rule out disorders included in the differ- ential diagnosis. Some measure of the child’s overall level of cognitive functioning and adaptive skills is necessary, especially if there is a concern about co- morbid mental retardation. An audiologic evaluation and a comprehensive speech and language evalua- tion should be done in any child who has language delays whether or not autistic features are present. Other tests to consider include a lead screening, amino acid screening to detect phenylketonuria, DNA analysis to detect fragile X syndrome, high- resolution chromosome analysis, and prolonged sleep-deprived electroencephalography (in children who have symptoms of developmental regression or clinical seizures or when there is a high suspicion of subclinical seizures). 3,4 Computed tomography or
In general, however, there have been too few studies of either approach to assert that observed estimates of ef- fect for either approach are unlikely to change with future research. With a relatively larger (albeit still inade- quate) body of literature, UCLA/ Lovaas– based intervention and EIBI variant studies have revealed positive shifts in language, adaptive, cognitive, and educational outcomes, but our conﬁdence (strength of evidence) in that effect is low because of the need for additional, conﬁrmatory research, a lack of high-quality RCTs, and no studies that have directly compared ef- fects of promising manualized treat- ment approaches. The evidence base for interventions for very young chil- dren, including the ESDM, is insufﬁ- cient; there has been only 1 RCT, al- though results of this study were positive and the study warrants repli- cation. On balance, however, the com- bined research on UCLA/Lovaas– based interventions and the ESDM suggests a beneﬁt of early intensive approaches for some children that should continue to be studied. Less-intensive interventions that pro- vide parent training also may be useful for younger children with ASDs, partic- ularly for improving social communi- cation, language use, and, potentially, symptom severity and family function- ing, but the current evidence base for such treatment remains insufﬁ- cient. 17,18,27 Although parent-training
CTSS- The Children’s Therapeutic Services and Supports is one of the rehabilitative mental health packages covered by Minnesota Health Care Plans (MHCP). CTSS establishes policies and practices for certification and coverage of mental health services for children who require varying therapeutic and rehabilitative levels of intervention. Services available under CTSS allow providers to address the conditions of emotional disturbance that impair and interfere with children’s abilities to function. These rehabilitative services offer a broad range of medical and remedial services and skills to restore a child’s functional abilities as much as possible. DDST II – This is one of the oldest and most widely used screening tests. It relies on direct elicitation to rate development over four domains including: Personal-Social, Fine Motor - Adaptive, Language, and Gross Motor
offers a series of evidence-informed hypotheses for why families sort into those who engage with developmental services and those who do not. Understanding this “sorting” phenomenon is important for at least 2 reasons: first, the majority of young children in the United States identified with developmental delay
This study is one of the most rigorous studies to date on the effectiveness of EIBI in a community setting. Taking advantage of existing data collected through South Carolina’s Department of Disabilities and Special Needs Pervasive Development Disorders Program, this study assessed overall effectiveness, determined predictors of positive outcomes and examined the impact of data management and data availability on the validity of findings with a sample of more than 600 children with ASDs who received EIBI services. This study corroborates and advances findings regarding age at which EIBI treatment should begin and the impact of treatment duration on treatment outcomes. It provides important new results on baseline child characteristics that predict positive outcomes. It replicates other published findings that fewer than 50% of children experience desired outcomes. Finally, it provides results of the only known analysis of data availability and its potential impact on study validity in a large-scale, multi-year EIBI treatment program. Together, these findings have important
Neuroanatomic studies of WMS suffer from some methodologic limitations typical of complex behavioral phenotypes. Specifically, the broad array of neuroanatomic differences seen in WMS makes interpretation of relationships to genetics and behavior difficult. Fortunately, there is a limited number of genes in the critical WMS deletion region (approximately 20, compared with over 200 in Down syndrome), although several of these have prominent roles in brain development. Additionally, as with other developmentaldisorders of known genetic origin, WMS is a rare condition, which can lead to difficulties in gathering a statistically powerful sample, particularly for studies requiring tissue samples. Finally, as with other mental retardation syndromes and developmentaldisorders affecting emotional behavior, the noisy and relatively stressful environment of the MRI lab can be a barrier to research.