The Journal of the Arkansas Medical Society Med Journal Aug 2019 Final 2 | Page 12

EDITORIAL PANEL: Chad T. Rodgers, MD, FAAP | Elena M. Davis, MD, MPH | Shannon Edwards, MD | William L. Mason, MD | Michael Moody, MD | J. Gary Wheeler, MD, MPS
Following Children with Developmental
Disorders in Primary Care
ANGELA SCOTT, MD, PHD, FAAP; MAYA LOPEZ, MD, FAAP; JILL FUSSELL, MD, FAAP; and JAIMIE FLOR, MD, FAAP
GD, a 37-month-old boy with
Autism Spectrum Disorder returns
for his three-year well-child check.
Last year you referred him to the
Arkansas Autism Partnership (AAP)
Waiver program for evidence-based
behavioral interventions, and to First
Connections for speech-language
and occupational therapy at his Head
Start. His parents say “everything
is going well” but can’t give details
about progress or goals. Annual
occupational and speech therapy
assessments indicate slow progress.
Your clinical observations indicate very
limited social engagement.
T
he importance of early access
to developmental therapies in
children with developmental
delays is well established. 1
How does a primary care physician
(PCP) assess the quality of a child’s
developmental services? Progress
may be difficult to appreciate during
a PCP visit. Updated therapy goals
or annual testing results may not be
readily available.
While detailed assessment of
progress and outcome may not
be possible in a brief visit, it is
incumbent upon the child’s PCP to
follow up with families to ensure
that developmental services are
optimizing outcomes. These key
questions help assess quality of
services during follow-up visits.
What progress has he
made? Parents of children with
developmental delays watch
their child’s progress closely. It is
important to give them a chance to
celebrate hard-won improvements.
Start with general questions and
then ask detailed ones, such as What
has improved since I last saw you?
What has not? Where had you hoped
to see more progress? Parents may
have unrealistic expectations for
progress and/or may not recognize
clinically specific gains. This provides
an opportunity for counseling and
education.
What therapies is he getting? Is
he receiving services and therapies
appropriate for his developmental
needs? Therapies often take place
within complex systems that are
difficult to navigate. Provider avail-
ability, transportation and compet-
ing priorities can get in the way. The
National Autism Center maintains
a reliable list of clinically appropri-
ate, evidence-based interventions,
ranked according to strength of
evidence. The National Standards
36 • THE JOURNAL OF THE ARKANSAS MEDICAL SOCIETY
Project is available online at www.
nationalautismcenter.org.
What are his therapy goals? Do
his current goals match the family’s
most pressing concerns? Are the
goals clinically appropriate to his
diagnosis? A child with autism
should have at least some goals that
target foundational communication
skills. In GD’s case, his progress in
all other areas will be slow until his
social engagement skills improve.
His treatment plan should include
evidence-based strategies, such
as applied behavioral analysis
(ABA) to target the core social-
communication deficits associated
with autism. The AAP’s MCD Waiver
program provides these and other
autism-specific interventions.
Additional information at https://
uofapartners.uark.edu/projects/
autism-partnership/.
Who is on his team? Effective
developmental services must hap-
pen within a coherent team of adults
caring for the child. The team should
include parents and family caregiv-
ers, therapists, teachers, clinicians
and everyone who interacts with
the child. Framing the relationship
between caregivers and profession-
als in this way highlights the impor-
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