PEDIATRICIANS + TECHNOLOGY WILL IMPROVE FAMILY-CENTERED AUTISM CARE

BY COLLEEN KRAFT, MD, MBA

I have been a pediatrician for 31 years and know that all families want their children to grow and thrive and develop into caring and responsible people. Parents are usually the first to recognize when their child has a developmental concern.

However, the current pathway to diagnosis and treatment is variable and depends on local resources and systems of care. Yet, we realize that it is early identification and early intervention for these developmental concerns that can result in significant improvements in a child's language, communication, socialization skills and cognitive and behavioral development.

We also know that it is possible to identify and diagnose some conditions at an early age. Parents of children who are diagnosed with autism reported their first concerns on average as early as age 14 months.1 While research has demonstrated autism can be identified in children as young as 18 months,2 the average age of diagnosis has remained at over 4 years old for decades. Children of color, girls, and those from rural areas or disadvantaged socioeconomic backgrounds are also often diagnosed even later, and sometimes missed altogether.

The healthcare community attitudes and organizational culture are shifting to empower pediatricians in the early identification of autism. In 2020, the American Academy of Pediatrics (AAP) published an updated clinical report4 on autism spectrum disorder, Identification, Evaluation, and Management of Children with Autism Spectrum Disorder, which provides pediatricians with a framework for the identification and management of at-risk children based on the available evidence. The reality is that pediatrics can and should have an active role that extends beyond screening – that assesses risk of delays – and to the child's evaluation that leads to a diagnosis. Pediatricians are a trusted partner with the child's family, and an active partnership in evaluating the child's concerns while connecting them to services facilitates the best results for the child. And the good news is that innovative technology can further support the partnership between pediatricians and families.

UNIQUE POSITION OF PRIMARY CARE PHYSICIANS AND PEDIATRICIANS

Pediatricians have frequent access to children at a young age and greater context of a child and their family through well child visits. Pediatricians are indeed child health specialists. They are in a unique position to identify behavioral and developmental delays. Many are already managing behavioral health conditions such as ADHD, anxiety, and depression. The next step is to develop and support primary care physicians so that the pediatric medical home can serve as the center and locus of care for children living with autism and developmental disabilities.

THE ADVENT OF TECHNOLOGY-BASED SOLUTIONS

Pediatricians need the tools, training, and connections to broader support services to make informed diagnoses and next-step-in-care decisions. New technology can facilitate these processes.

IN CLOSE TOUCH: Pediatricians know their patients and families, and are committed to partnering for solutions that will allow every child to learn, grow, and fulfill their potential.

An important development has been the incorporation of Artificial Intelligence and Machine Learning (AI/ML) into both diagnostic and therapeutics tools. AI/ML are computer and biostatistics programs that use information from sources, such as parent questionnaires and videos of a child to identify some of the most con tionnaires and videos of a child to identify some of the most concerning features of developmental delay. A trained specialist can observe poor eye contact, repetitive movements, and abnormal patterns of speech; an AI/ML program can do so as well, often with greater speed and accuracy than a human observer. For pediatrics, these AI/ML tools can be incorporated into their practice, much like a lab test or X-ray. Clinicians and families can review the results together. The information that a trusted pediatrician already knows about the child, together with such tools, could lead to an earlier diagnosis of autism so that families receive the appropriate care they need sooner.

In contrast, a specialty evaluation often results in a much more detailed evaluation of a child's core deficits, with greater breadth and depth and insight into the child's concerns. But these evaluations, and subsequent diagnoses, often don't occur until 6-18 months after the child is referred. An earlier diagnosis means that families and clinicians can prioritize their child's concerns; start earlier evaluations in speech, behavior, and occupational therapy; follow the progress that the child is making; and brainstorm other concerns about the child such as sleeping or picky eating. Pediatric Specialists are very much needed when a diagnosis is challenging, or when a family needs more expertise in treating the child. As the pediatric medical home becomes the locus of care for families with developmental concerns, many children could receive optimal and autism-specific therapies while their individual diagnostic journey is established.

Improving care for children is at the heart of every pediatrician. I predict technology will become a cornerstone of family-centered care, and we will make strides toward realizing the goals of high quality, individualized, equitable care. Pediatricians know their patients and families, and are committed to partnering for solutions that will allow every child to learn, grow, and fulfill their potential.•

ABOUT THE AUTHOR

Colleen Kraft, MD, MBA, is a Senior Medical Director of Clinical Adoption, Cognoa, Professor of Pediatrics and 2018 Past President of the American Academy of Pediatrics.