DOD - Technewszone

Story by Lt. Jennifer Cragg Subscriptions Icon Subscribe To This Journalist

WASHINGTON – A Uniformed Services University of the Health Sciences faculty member discussed Autism Awareness Month and the importance of early, proper diagnosis and treatment of children.

“Parents should feel confidence in raising questions about whether their child has autism,” Dr. Janice Hanson told “Dot Mil Docs” listeners during an, April 9, webcast on Pentagon Web Radio. “They are often the first ones to raise concerns and to raise them in a way that a pediatrician can sort out whether to be concerned, how concerned to be, and what to do about it next.”

According to Autism Speaks, a science and advocacy organization dedicated to funding research into the causes, prevention, treatments and a cure for autism, early intervention is critical to gain maximum benefit from existing therapies. While there are no effective means to prevent autism, no fully effective treatments, and no cure, current research suggests that early educational intervention for at least two years during the preschool years can result in significant improvements for many children with autism-spectrum disorders.

Hanson said children can be diagnosed with autism by age 3, but parents might notice changes in a child as young as 6 months. Three categories of characteristics describe a child with autism, she said.

“Before complete diagnosis of autism, a child would show some symptoms in … [each of] three areas: communication, social interaction, and stereotypical behavior,” Hanson explained. The three categories that go along with a diagnosis of autism include delayed speech or language; differences in social interaction, such as avoiding eye contact or misunderstanding social cues; and stereotypical behaviors such as playing with toys with a ritual behavior or rocking over and over again.

“Autism is a disorder of communication and social interaction,” the doctor said. “There is a range of disorders actually that fall within a spectrum that we call pervasive developmental disorders. The range goes from classic autism, with a fairly significant difference in communication and social interaction, to Asperger’s Syndrome, which is more mild and sometimes more difficult to diagnose.

“Also included in the spectrum is a group of children that don’t exactly fit the criteria, but have many of the characteristics,” she continued, “and they are called children with pervasive developmental disorder not otherwise specified.”

Hanson said the number of children diagnosed is hard to pin down with current data.

“That is actually a subject of debate and research as we speak,” she said. “I just read a study that summarized 43 studies in the literature from the last several decades, trying to pin down what that number might be, so what we have is a range of numbers. The greatest number would be about one child out of 150, and this would be the most broad use of the diagnostic categories, which would include children with autistic diagnoses all along that spectrum from the most severe to the most mild.”

Hanson said whether the number of diagnoses is increasing is another controversial subject.

“There has been a lot of controversy for the past 10 to 15 years about whether the incidence of autism is increasing, and if so why,” she said. “Some people think yes, it is definitely increasing. Others think we have improved our ability to identify these children and we’ve changed our criteria to include broader numbers.”

The Uniformed Services University of the Health Sciences is working toward educating and training physicians and nurses to accurately diagnosis autism early.

“We have a medical school and a graduate school of nursing that educates and trains physicians and nurse practitioners to work in the military health system, and that is where I am on the faculty,” Hanson said. “We do an intense, focused job of providing education for these students, not only about autism, how to diagnosis, and what to watch for, but also about the military environment and the special challenges for military families.

“We are trying very hard to send new doctors into our military health system with a strong awareness of when to refer, where to refer and how to get a child accurate diagnosis and effective interaction,” she added.

FORT HOOD, Texas –The likelihood of a school-aged American child receiving a diagnosis of autism, Asperger syndrome or a related developmental disorder is on the rise.

In 2006, the Center for Disease Control estimated one in every 110 children was diagnosed with autism spectrum disorders. That number has risen to 1 in 50, according to an analysis of a phone survey of parents released in March 2013 by the Centers for Disease Control and Prevention.

Locally, the Fort Hood Exceptional Family Member Program is tracking 404 active duty family members (or 4.8 percent of the total identified cases Army-wide) Autism Spectrum Disorders, and ASDs are estimated to affect nearly 8,500 children of active duty service members throughout the U.S. Army, Maj. (Dr.) Ryan Moore, Carl R. Darnall Army Medical Center chief of pediatrics, said.

“The spike is being attributed to various causes, including increased awareness of autism spectrum disorders among clinicians and parents and more diagnoses of milder autism disorders,” Moore said.

According to the CDC, autism spectrum disorders are a group of developmental disabilities characterized by atypical development in socialization, communication, and behavior.

“The symptoms of ASDs typically are present before age 3 years and often are accompanied by abnormalities in cognitive functioning, learning, attention, and sensory processing,” the CDC website states.

Symptoms of autism can be minimal or severe, and they can vary dramatically from one child to another.

Autistic children may struggle to maintain or completely avoid eye contact, prefer to play alone, avoid cuddling or touching, have poor speech or communication abilities or not develop speech at all. They may rub surfaces repeatedly, have a heightened or lowered response to pain or display intense tantrums.

Other symptoms of autism may appear to indicate other disorders like Attention Deficit Hyperactivity Disorder, Tourettes, Obsessive Compulsive Disorder or Oppositional Defiant Disorder, which can make an accurate diagnosis difficult.

This recent study released by the CDC also points out a potential concern that many children are not being diagnosed before age seven.

Autism can be reliably diagnosed by age three and potential interventions exist that can have a significant impact on their growth and development.

The emphasis on early detection and intervention has grown significantly over the past decade. At Carl R. Darnall Army Medical Center, providers who see pediatric patients have adopted a standardized approach to well-child visits, Moore said.

“Adopting the guidelines set forth by the American Academy of Pediatrics, clinics across the installation have instituted routine screening for autism spectrum disorders at 18-month and 24-month well-child visit,” he said. “The screening occurs at these visits because this is the age range where they symptoms of autism emerge.”

According to Moore, if the results of screening indicate a concern for autism, the primary care provider will typically refer the family to a specialist (developmental pediatrician, child psychiatrist or psychologist) who can provide more detailed evaluation and potentially definitive diagnosis.

Although a diagnosis of autism is difficult to hear, the prognosis today is much better than even a decade ago.

Early and effective intervention has changed the landscape of treatment for autism. A wide range of evidence-based treatment options exist to help parents and their affected children improve their overall outcomes.

Assistance through Tricare exists for children diagnosed with autism.

The road to accessing these available options starts with enrollment in the Exceptional Family Member Program. Once successfully enrolled in EFMP, the child can then be registered in the Extended Care Health Option. This program provides additional financial assistance for those families seeking treatments not covered under basic Tricare services.

While understanding has improved as experience with autism grows, a lot of confusion still exists over how to successfully navigate treatment options. Unfortunately, as national recognition of the disorder has grown, a wide range of treatment options have developed, many of which are not studied or validated.

Parents of a child diagnosed with autism will need to be their child’s strongest advocate and work closely with their child’s provider to find the right treatment course, Moore said.

Case management resources are also available through Tricare to assist with these processes.

“Facing an autism diagnosis can be scary, but CRDAMC doctors and support services are here to support and guide families through the process,” Moore said.

If you think your child may have autism or is showing signs of developmental delays talk to your primary care provider or contact Tricare appointment services at 254-288-8888 and request a well baby check-up.

Active duty family members who have severe physical or moderate-to-severe mental disabilities can receive specialized services through the Tricare Extended Care Health Option program. AD beneficiaries within the Southern Regional Medical Command must enroll in the ECHO program via the application process identified at: http://www.humana-military.com/library/pdf/echo-application.pdf .

Retiree beneficiaries are not eligible for enrollment into the Tricare ECHO program; a U.S. District Court order mandated that Tricare will provide ABA therapy as a medical benefit for retiree family members. Retiree beneficiaries with ASD or any other severe physical or moderate-to-severe mental disabilities can receive ABA therapy through a referral from their Tricare primary care manager.

Tricare does not cover expenses for respite care, equipment, or case managers for retiree beneficiaries.

Beneficiaries can obtain additional information regarding services for children with ASD at Humana-Military.com or by calling Customer Service at 1-866-323-7155. A resource for military families that have children with autism can find additional information at www.operationautismonline.org.