Technology is helping paediatricians do a better job screening for autism by identifying at-risk children at the 24-month visit.
In today’s medical climate, paediatricians often do not have the time to perform a detailed screen in the short time allotted for preventive care.
The new software, the Child Health Improvement through Computer Automation system (CHICA), personalizes and automates the patient screening process then alerts the physician to the results.
CHICA also prompts the paediatricians to follow up in needed areas. Open-source CHICA can potentially interface with any electronic medical record system.
CHICA has supported the care of more than 36,000 patients since its 2004 implementation for paediatric preventive care and disease management at community clinics. Half of the families served by CHICA are black, and a third are Hispanic. More than two-thirds of the families have Medicaid.
At each visit, CHICA produces a 20-question prescreening form (in English or Spanish) personalized to the patient, linked to the child’s electronic medical record and completed by parents in the waiting room.
At the 24-month visit, CHICA produces a standard autism screening instrument that is automatically scored. If concerns are raised, the physician receives an alert to verify and make a referral for further work-up and/or early intervention.
If the electronic medical record indicates higher risk for autism (for example, an autistic sibling), CHICA bypasses formal screening and alerts the physician to refer the child for further evaluation.
Approximately 1 in 88 children has been identified with an autism spectrum disorder, according to estimates from the CDC’s Autism and Developmental Disabilities Monitoring Network. Nationwide, children typically are not diagnosed with autism until age 4-½ or 5 years.
Once an autism diagnosis is made, it is easier for a family to obtain needed services, including early intervention to gain developmental skills.
“It is natural to worry about your child’s development. Parents bring concerns to the pediatrician, and while paediatricians know how children should be developing, visits are brief — and there is a tremendous amount to cover and juggle during that visit,” said Nerissa Bauer, M.D.
“Autism isn’t like strep throat where you can do a quick throat swab and then have a diagnosis. Autism is a behavioral diagnosis and can look very different depending on the child.
“Some behaviors are subtle, especially early on. CHICA prompts parents to think about whether they have concerns about certain health risks, such as autism, which makes it easier for the doctor to focus on key issues during a hectic visit.”
National guidelines call for pediatricians to screen children for autism at 18 and at 24 months, but many physicians find it difficult to fit this into a busy appointment that also calls for vaccinations and other screenings.
Screening allows paediatricians to then refer the child for further evaluation to clarify the diagnosis and to community providers who can work with the child and family when a child has delays in development.
“What’s important here is that CHICA will help pediatricians identify autism earlier when treatment is more likely to be effective,” said Stephen M. Downs, M.D., M.S.
“Because physicians are busy juggling guidelines for preventive care and need to address concerns brought up by parents during the child’s visit — concerns which can supplant routine care — CHICA helps them also address important screening and prevention.
“Even with CHICA, we find physicians sometimes miss opportunities to screen. So we hope CHICA can go beyond alerting the physician to positive responses to autism prescreening and create alerts directed to a nurse or developmental specialist for support and follow-up.”
The new study is published in the journal Infants & Young Children.
This article first appeared on Psych Central on 18 November 2013.