Do you hear what I hear? ECHO and autism

Abstract

Autism spectrum disorder (ASD) is now estimated to occur in 1 of every 59 children in the US. The direct and indirect costs of caring for children and adults affected by ASD in 2015 dollars exceeded the cost of hypertension and stroke (Pediatrics 2020;145:e20193447). For these reasons and so many others, it is vital that general pediatricians and other primary care providers (PCPs) are able to recognize, screen, refer, and care for the many comorbidities that affect children and adolescents with ASD. In this volume of The Journal, Mazurek et al report on the perceived barriers and supports that PCPs experience in caring for children with ASD. Although the results are not necessarily surprising to those of us who practice in community settings, the fact that individual level issues such as lack of knowledge and confidence exceed system level issues such as time and reimbursement is compelling. The identified barriers were captured as part of an ECHO (Extension for Community Healthcare Outcomes) Autism project that has brought mentorship and support through videoconference technology to PCPs caring for underserved children in urban and rural settings. ECHO Autism teaches PCPs how to screen with the STAT (Screening Test for Autism in Toddlers). In many, but not all states, a positive screen on a STAT allows for referral to intervention therapies such as Applied Behavioral Analysis (ABA) prior to a more formal neurodevelopmental or developmental/behavioral evaluation. For most insurance coverage, including Medicaid, an Autism Diagnostic Observation Schedule (ADOS-2) is required to be able to continue to provide therapies that have been shown to improve outcomes and increase skill acquisition. Finding a certified ADOS-2 evaluator is more difficult in rural areas. Finally, once identified, the majority of states impose a $200 000 life-time cap on services and $50 000 per year (https://www.ncsl.org/research/health/autism-and-insurance-coverage-state-laws.aspx). The ECHO Autism project promises to increase the number of children that can be reliably screened prior to 36 months of age, but without strong advocacy at the state and federal level, many children with ASD will neither be able to receive diagnostic evaluations or sufficient therapy to improve their functional outcomes. Article page 240 ▸ Primary Care Providers' Perceived Barriers and Needs for Support in Caring for Children with AutismThe Journal of PediatricsVol. 221PreviewA mixed methods approach was used to examine perspectives of 114 primary care providers regarding barriers and needs for support in caring for children with autism. The most common barriers related to lack of knowledge and resources for diagnosing and treating children with autism, and inadequate visit time and reimbursement. Full-Text PDF