Future health professionals at Western University of Health Sciences learned important lessons about diagnosing and treating children with autism at the 2nd Dr. Robert L. Austin Endowed Lectureship in Pediatric Medicine and Pediatric Health Care Policy.
The lectureship, held April 5, 2011, featured pediatric and autism specialist Dr. Robert W. Sears, who talked about “”Autism: Early Detection, Effective Multidisciplinary Treatment, and Possible Preventative Measures.””
A lot has changed in autism diagnosis and treatment in the past two decades. Autism diagnoses jumped from 1 in 2,000 children in the late 1980s to 1 in 150 for children born in 1994 and 1 in 110 for children born in 1998, Sears said.
Treating autism has also changed dramatically. Doctors used to tell parents, “”There’s nothing you can really do for autism. We can do some behavioral therapy. You might see little improvements along the way, but get ready for your child to be in a special needs school and then probably an institution, because there’s not much we can do,”” Sears said.
About 15 years ago, doctors decided they weren’t going to stand for that, and started looking into what could be done besides developmental behavioral therapy.
“”What can we do medically? What can we do as practicing physicians that makes a difference for these kids?”” Sears said. “”Now we tell these parents there’s good news, there’s hope, there’s a lot we can do.””
Autism is a severe developmental disorder that begins at birth or within the first two-and-a-half years of life, according to the Autism Research Institute. Most autistic children are perfectly normal in appearance, but spend their time engaged in puzzling and disturbing behaviors that are markedly different from those of typical children. Less severe cases may be diagnosed with Pervasive Developmental Disorder (PDD) or with Asperger’s Syndrome (these children typically have normal speech, but they have many “”autistic”” social and behavioral problems).
Pediatricians should perform objective screening tests for autism at two critical ages – 18 months and 2 years old. Dr. Sears uses the Checklist for Autism in Toddlers (CHAT-23), in which he asks the parents 23 questions about their child’s development. He combines these answers with his own observations of whether the child is making eye contact, whether they will look at something he is pointing to in the room, and other tests.
“”If you see a child that might have autism, how do you broach that to the parents?”” Sears said. “”If you have an objective screening test, you can tell a parent, ‘I noticed you answered five of these 23 questions that indicate a possible developmental problem.’ You have that in front of you to show parents, which opens the door to a conversation.””
WesternU students will treat patients with autism no matter what health care field they enter, so it’s important to know how to identify signs of autism early, Sears said. Signs of autism are often very subtle, and some children will not be diagnosed until they’re older. Early identification and beginning development behavior therapy early is critical, he said.
“”They do much better, they achieve greater gains more quickly, and their ultimate gains can reach a higher level if you start prevention early,”” Sears said.
Dr. Sears points parents to therapies the second he suspects autism. An autism diagnosis might take a year or more, which means a year of potential therapy if you wait, he said.
Some studies have shown positive impacts of a gluten-free and casein-free diet. Gluten is the protein in wheat and casein is the protein in mammal milk, by far the most common causes of childhood allergies, Sears said.
“”If you have a child with food allergies, taking them off these foods often will create some remarkable behavior improvements,”” he said.
Pediatricians must pay attention to gastrointestinal problems. Doctors used to tell autistic patients that diarrhea and constipation are common in autism and they must deal with it.
“”Now we realize we do need to address it,”” Sears said. “”If you do have a kid with autism that has GI problems, they deserve a thorough workup and evaluation and treatment plan, because if you’re healing the gut, you’re going to go into some degree of healing the brain.””
Dr. Sears recommended additional resources – the Autism Research Institute, www.autism.com, and Talk About Curing Autism (TACA), www.tacanow.org, a nonprofit dedicated to educating, empowering and supporting families affected by autism.
“”The huge message I have is families with autism cannot do it alone,”” Sears said. “”They have to have help from other families with autism. Who better to help a family with a child who’s just been diagnosed than another family who’s had a child diagnosed for five years and knows what to do?””
The lessons about autism shared by Dr. Sears align with WesternU’s mantra of humanism, said Gail Singer-Chang, PsyD, MA, MS, College of Osteopathic Medicine of the Pacific Assistant Professor and Chair, Department of Social Medicine & Healthcare Leadership. She is the parent of an autistic child.
“”No cause, perhaps, needs a little bit more humanism than autism,”” she said. “”I really do believe that our speaker today, Dr. Bob Sears, embraces this idea of humanism and patient-centered care. This is the type of diagnosis that truly requires a patient-centered focus, because no one thing is going to work in every case.
“”Every one of these patients is so different,”” Singer-Chang said. “”There is not a cookie-cutter treatment for autism. Because of that, a practitioner needs to know that patient in order to design individual treatment.””
The Dr. Robert L. Austin Endowed Lectureship in Pediatric Medicine and Pediatric Health Policy was presented by Clinton E. Adams, DO, FAAFP, FACHE, vice president for clinical affairs and COMP dean, and by Daniel C. Robinson, PharmD, dean of the College of Pharmacy.
The lectureship was established in Austin’s memory by his wife, Gloria, their children, Charles, Douglas and Lynette, and their families, and is designed to honor and perpetuate his lifelong love of medical practice and his pursuit of pediatric knowledge in the health professions. He was a faculty member at COMP until his retirement in 1981.