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
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
References (52)
- et al.
A screening instrument for autism at 18-months of age: A six-year follow-up study
Journal of the American Academy of Child and Adolescent Psychiatry
(2000) - et al.
Prevalence of disorders of the autism spectrum in a population cohort of children in South Thames: The Special Needs and Autism Project (SNAP)
The Lancet
(2006) - et al.
The role of nurses in screening for autistic spectrum disorder in pediatric primary care
Journal of Pediatric Nursing
(2005) Identifying infants and young children with developmental disorders in the medical home: An algorithm for developmental surveillance and screening
Pediatrics
(2007)Diagnostic and statistical manual of mental disorders—fourth edition—text revision (DSM-IV-TR)
(2000)Standards of professional practice for maternal and child health nurses
(1999)- et al.
Autism as a strongly genetic disorder: Evidence from a British twin study
Psychological Medicine
(1995) - et al.
Autism spectrum disorders in infancy and toddlerhood: A review of the evidence on early signs, early identification tools, and early diagnosis
Journal of Developmental and Behavioral Pediatrics
(2009) - et al.
Prospective identification of autism spectrum disorders in infancy and toddlerhood using developmental surveillance: The Social Attention and Communication Study (SACS)
Journal of Developmental and Behavioral Pediatrics
(2010) - et al.
Can autism be detected at 18-months? The needle, the haystack, and the CHAT
British Journal of Psychiatry
(1992)
The disclosure of a diagnosis of an autistic spectrum disorder. Determinants of satisfaction in a sample of Scottish parents
Autism
Pervasive developmental disorder in preschool children
Journal of the American Medical Association
Developmental surveillance by pediatric nurses
Pediatric nursing
Developmental regression in autism: Maternal perception
Journal of Autism and Developmental Disorders
Early behavioral intervention, brain plasticity, and the prevention of autism spectrum disorder
Development and Psychopathology
Maternal and child health overview
Maternal and child health services annual report 2004–2005 statewide
Maternal and child health service program standards
Age at first measles–mumps–rubella vaccination in children with autism and school-matched control subjects: A population-based study in metropolitan Atlanta
Pediatrics
Screening for autistic spectrum disorder in children aged 14 to 15 Months: Population screening with the Early Screening of Autistic Traits. Design and general findings
Journal of Autism and Developmental Disorders
British and American recommendations for developmental monitoring: The role of surveillance
Pediatrics
Practice parameter: Screening and diagnosis of autism—Report of the Quality Standards Subcommittee of the American Academy of Neurology and the Child Neurology Society
Neurology
Epidemiology of autistic disorder and other pervasive developmental disorders
The Journal of Clinical Psychiatry
Pervasive developmental disorders in Montreal, Quebec, Canada: Prevalence and links with immunization
Pediatrics
Three reasons not to believe in an autism epidemic
Current Directions in Psychological Science
Collaborating with parents: Using parents' evaluation of developmental status to detect and address developmental and behavioral problems
Cited by (0)
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Funded by: the Telstra Foundation Community Development Fund.
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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.