Developmental Surveillance of Infants and Toddlers by Maternal and Child Health Nurses in an Australian Community-Based Setting: Promoting the Early Identification of Autism Spectrum Disorders1,2

Previous Verbal Presentations: SA2009 Growing Together: Australian Association of Maternal, Child & Family Health Nurses: Adelaide, South Australia. April 2 – 4, 2009. International Meeting for Autism Research (IMFAR): Chicago, Illinois. May 7 – 9 2009. Asia Pacific Autism Conference (APAC): Sydney, Australia. August 20 – 22, 2009
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Although signs of autism spectrum disorders (ASDs) are evident during the first year of life, few children are diagnosed prior to 3 years. The objective in this article is to highlight the role that primary health care professionals can play in the early identification of ASDs by briefly outlining the successful implementation of The Social Attention and Communication Study. Maternal and child health nurses were trained on the early signs of ASDs, which enabled them to identify these children prior to 2 years. The training procedure used will be outlined, and the early signs that were monitored will be explained in detail. It is recommended that routine monitoring for ASDs in infancy and toddlerhood become standard practice among all primary health care professionals.

Section snippets

Introduction to ASDs

Autism spectrum disorder is an umbrella term used to describe a group of pervasive developmental disorders characterized by a triad of impairments, including qualitative impairments in (a) social interaction, (b) verbal and nonverbal communication, and (c) a restricted repertoire of activities and interests combined with repetitive behaviors and stereotypies (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision [DSM-IV-TR]; American Psychiatric Association [APA],

Importance of Early Detection and Diagnosis

Early identification of ASDs is the first step to facilitating referral and diagnosis. Early diagnosis is crucial because it provides the best opportunity for specialized early intervention, which serves to maximize developmental outcomes for affected children and their families. The benefits of early intervention for children with an ASD are now unquestionable (see Dawson, 2008, Rogers and Vismara, 2008, for an overview) and, if instituted early enough, can serve to move the young child toward

Monitoring for ASDs in the Community

There is currently no universally recommended screening program for detecting ASDs, despite the American Academy of Pediatrics (American Academy of Pediatrics (AAP). Council on Children With Disabilities Section on Developmental Behavioral Pediatrics; Bright Futures Steering Committee; Medical Home Initiatives for Children With Special Needs Project Advisory Committee, 2007, Johnson and Myers, 2007) calling for routine screening for signs of ASDs in the second year of life. The American Academy

The MCH Service

In the State of Victoria, Australia, infant and child development is monitored through the universal MCH service, which is offered free of charge to all families with children less than 6 years of age (Department of Education and Early Childhood Development [DEECD], 2007a). The major provider of MCH services is local government, which is responsible for the provision of service to metropolitan, rural, and remote areas of the state (DEECD, 2007a). The MCH service program standards identify their

Implementation of Developmental Surveillance in a Community-Based Setting

Pinto-Martin et al. (2005a), in arguing for the importance of routine screening for ASDs in pediatric primary care, cited various barriers to standardized screening, including costs, large patient volumes, diminished reimbursements for staff, and failure to attend appointments by parents. Issues with screening tools themselves included length, variety, lack of uniformity in regards to their properties, and lack of formal training for practitioners in administration and scoring of the tools.

Training Procedure and Results of the SACS

A cohort of 22,168 children was monitored though 184 MCH centers in 17 local government areas (LGAs) in metropolitan Melbourne, over a 6-month period, between September 2006 and June 2007. The LGAs were chosen based on proximity to facilitate ease of referral, with most centers within a 20-km radius of a Melbourne University, where the study was conducted.

Each child was monitored by their MCH nurse from 8- to 24-months of age; however, children were only referred to the SACS team at the Child

Social Attention and Communication Behaviors

Delayed, absent or abnormal development in the behaviors listed below should be considered “red flags” for an ASD. It is important to note that the presence of any of these behaviors does not exclude the possibility of an ASD. Rather, it is paramount that the quality of these behaviors be monitored in addition to their presence or absence. Furthermore, the behaviors listed should not be used in isolation to identify whether a child is at risk for an ASD but should, instead, be considered in

Evaluation of the SACS Implementation by MCH Nurses

The MCH nurses who participated in the SACS were asked to evaluate its implementation at three time points: immediately after the initial training workshop (Time 1), 6 to 9 months after commencement of the study (Time 2), and immediately after completion of the study (Time 3). Nurses rated items on a 5-point Likert scale from strongly agree to strongly disagree. All nurses (241) completed the evaluation at Time 1, 83% of nurses completed the evaluation at Time 2, and 68% of nurses completed the

Implementation of Developmental Surveillance of Social Attention and Communication Behaviors

On the basis of the results from the SACS and the nurses' evaluations of its implementation, it is argued here that developmental surveillance of social attention and communication behaviors should be undertaken universally and preferably within children's regular health checks during their second year of life (Curry and Duby, 1994, Dworkin, 1989, Filipek et al., 2000, Pinto-Martin et al., 2005a). By training MCH nurses on the early signs of ASDs, it has been possible to prospectively identify

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  • Cited by (0)

    1

    Funded by: the Telstra Foundation Community Development Fund.

    2

    Previous Verbal Presentations: SA2009 Growing Together: Australian Association of Maternal, Child & Family Health Nurses: Adelaide, South Australia. April 2–4, 2009; International Meeting for Autism Research (IMFAR): Chicago, Illinois. May 7–9, 2009; Asia Pacifc Autism Conference (APAC): Sydney, Australia. August 20–22, 2009.

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