HJAR Mar/Apr 2025

AUTISM CARE 10 MAR / APR 2025 I  HEALTHCARE JOURNAL OF ARKANSAS not show core features of autism, such as social reciprocity and difficulties with social relationships. This is likely also contribut- ing to the increase of referrals for autism evaluations in our state and around the country. Regardless of the reason, there is an increase in families and medical provid- ers requesting autism evaluations. Another question that we get asked fre- quently is, “Why does it take so long to get into a center to receive an evaluation?” Autism spectrum disorder is a behavioral diagnosis, and best practice entails a com- prehensive evaluation, which includes detailed history taking, ruling in and ruling out other developmental confounds, and using autism-specific measures to assess for social concerns. In our current climate, this time-consuming, multi-disciplinary evaluation is very difficult or impossible to conduct in a busy primary care setting. In addition, there are financial concerns for administrators, which also play into the consideration of allowing medical provid- ers to conduct these longer evaluations. We, the authors of this series, speak to many physicians in our state who express their desire to help patients with autism concerns but have the challenges mentioned above that makes this difficult. The literature also describes other variables that may make it difficult for PCPs to dis- cuss developmental and autism concerns. Studies have shown that PCPs have a low comfort level and perceive low self-com- petence in providing assessment and ongo- ing care for patients withASD. 8 Williams, et al., found that less doctors rated themselves as good or excellent in the ability to handle early concerns of developmental issues, and their knowledge of ASD resources was rated as fair or poor by 63% of them. 9 PCPs also share they have difficulties with conveying initial concerns of ASD to families when such concerns may not yet be accepted by the family. 10 These studies highlight that it is important to not only create more services for autistic individuals, but to also provide education and mentorship for the provid- ers in our state who want to do this work. Goals for This Special Series Our goals for this special series are to review best practice for screening, diagno- sis, and treatment of autism, as well as pro- vide information on medical, genetic, and behavioral comorbid conditions that can occur in ASD. This series will also provide information on the transition into adult services. Our series will highlight some of the innovative programs we have created to provide services for screenings and edu- cation for providers in our state. Lastly, an opinion piece is also included to help high- light the continued needs in our state and suggestions on how to continue to forge a more comprehensive support system in our state for mentoring, diagnostic work, and interventions. The goal of this piece is to help us all “dream big.” As a pediatric psychologist (Bellando) and a developmental-behavioral pedia- trician (Flor) who work with autistic indi- viduals and their families, we could not be prouder of the dedication and the hearts of the professionals in our state. We are also always in awe of the families who work tire- lessly each day to provide and advocate for their children. Our wish is that this special issue helps give information to assist pro- fessionals in finding ways to expand our existing systems to provide best practice to autistic individuals and resources for our families who work tirelessly to help their children have a bright future. n Early Detection of Autism: Screening, Diagnosis, and Barriers to Care By Jaimie Flor, MD and Jayne Bellando PhD Guidelines on Autism Screening In 2020, the American Academy of Pedi- atrics (AAP) released guidelines on patient care for children with autism spectrum dis- order (ASD), entitled “Identification, Eval- uation and Management of Children with Autism Spectrum Disorder.” 1 The AAP rec- ommends a general screen for develop- mental delays at 9, 18, and 30 months of age during health supervision visits, and an autism-specific screen to identify children at risk for ASD at age 18 and 24 months. 2,3 How is ASD Screening Done? There are several screening tools avail- able to screen for autism. The Modified Checklist for Autism in Toddlers (M-CHAT), a caregiver-completed questionnaire, is one broadly utilized and validated screen- ing tool for autism in children ages 16 to 30 months. 1,4 For the M-CHAT Revised with Follow-Up questions (M-CHAT R/F) ver- sion, children with a positive screen are found to be at high risk for autism, and therefore warrant prompt referrals for diag- nostic evaluation and therapy services. 1,4 This screening tool is free and can be found at https://www.mchatscreen.com/. Why Screen Early? The ultimate goal of early detection is timely treatment, as studies show early intervention for children 36 months and younger subsequently lead to a positive payoff in developmental outcomes. 5,6 How- ever, it is important to note that a formal diagnosis of autism is not required in order to initiate services that would benefit a child with known developmental delays. 1 If you see a child in your practice with develop- mental delays, referral to Early Intervention, Early Childhood Services, preschools, or developmental preschools can occur imme- diately, even without an autism diagnosis. What Are the Next Steps If a Child Is Detected to Be at Risk for Autism? Children with suspected ASD should be referred by their PCPs for therapy services (i.e. speech, occupational, and physical ther- apies), audiologic evaluation, and an autism