Dianne McBrien, MD Refresher Course for the Family Physician April 6, 2018

Transcription

1 Dianne McBrien, MD Refresher Course for the Family Physician April 6, 2018

2 Why screen your preschool age patients?

3 All kinds of questions Time Who administers the screen? How do I bill for it? Which screening tools should I use? What do I do with the information? Don t my clinical skills make screening unnecessary?

4 You are extremely important In Iowa and other rural states, FPs as or more likely to provide medical home for children as peds The addition of screening into patient visits has been shown to help substantially with case finding

5 Common and comorbid problems An estimated 17% of US children have behavioral or developmental problems (e.g. motor, language, pre academic or academic skills, behavioral, social emotional, mental health or autism spectrum disorders). 20 to 25% have psychosocial risks (parental mental illness, low literacy, poverty, homelessness, or failure to encourage their child's language or academic skills) (Glascoe 2014).

6 Screening and surveillance: Playing a long game Children who have falsepositive screens (screening test positive/concerning but subsequently ineligible for early intervention) are a high-risk group Likelihood of a failed screen increases as child ages

7 AAP recommendations for children under 3 9 month visit 18 month visit 30 month visit Screen for autism at 18 and 24 months

8 Ages and Stages Questionnaire (ASQ-3) Valid from 1 to 66 months Available in English, Spanish, Vietnamese, and Arabic Completed by a parent in 10 to 15 minutes 1 to 2 minutes for staff to score Screens multiple domains including communication, fine motor, gross motor, problem solving, and adaptive skills Considered to perform well in children with biological risk factors

9 PEDS Parental Evaluation of Developmental Status Exam From early infancy to 8 years 9 questions with multiple choice answers Yes, No, or A little 5 minutes to administer Does not require any other supplies or the family to do specific activities Scored in 1 to 2 minutes

10 Which should I use? The ASQ-3 is somewhat more sensitive and specific, especially when it comes to communication skills Specificity of PEDS is poor in families with concerns in one developmental domain One approach use PEDS, then administer ASQ-3 if positive screen on PEDS Time and feasibility most important considerations

11 Screening for autism M-CHAT-R/F Validated on children 16 to 30 months of age Free Available in Spanish

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15 Autism screening in older children Social Communication Questionnaire (SCQ) Validated in children >4 years of age Must have developmental age of 2 years minutes to administer 40 yes/no questions Lifetime version, vs last 3 months version

16 Other autism screens for older children Social Responsiveness Scale (SRS) 4 to 18 years 10 to 15 minutes to administer 65 item Likert scale

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18 Screening for ADHD Only the Conners Comprehensive Behavior Rating Scales and the ADHD Rating Scale IV have been validated in preschool-aged children (4 and 5 years of age) The NICHQ Vanderbilt scales were normed on children 6 years and older, but can be used on most preschoolers Must have information from two environments

19 What do I do with this information? Behavior vs attention Mix of the two Parent training (Parent-Child Interaction Therapy, TIES program) Some children benefit from both

20 Parent-Child Interaction Therapy Ages 2 to 7 Option for children with disabilities Requires commitment of several months Covered by Title XIX to find providers near your patient Good evidence in terms of treating preschoolers with attention AND disruptive behavior

21 Don t wait for a diagnosis before you refer to early intervention A diagnosis is not needed for referral Only a percentage of delay (1.5 SD below mean or 40 per cent below chronological age in one developmental domain) is needed to establish eligibility for services

22 Early intervention can take many forms Head Start or Early Head Start Parenting interventions (Parents as Teachers, BHIS) Psychosocial interventions (parental mental health referral, domestic violence contact, WIC or food bank referral)

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