Early Autism Screening and Identification (EASI) Clinic: A Nurse Practitioner and Physician Clinic Model

Background: Early identification of children with autism spectrum disorders (ASDs) facilitates earlier treatment and better outcome.  Many parents can identify differences in their child’s development as early as 12 months old.   Families report increased satisfaction with earlier diagnosis and a simplified referral and evaluation process.  There is great need for a “real world” clinical model to facilitate an early clinical evaluation given the current lag in time for diagnostic evaluations at tertiary centers.  We report an interdisciplinary evaluation model using pediatric nurse practitioner (PNP) and developmental/behavioral pediatric (DBP) partnership.

Objectives: To describe characteristics of a referred sample of toddlers (<  3 years old) to the EASI (Early Screening and Identification) clinic.  These young children have screened positive for ASD and/or have increased risk for the diagnosis (e.g., older sibling has an ASD). 

Methods: This is a record review of consecutive EASI clinic evaluations from January 2010 through September 2011. We describe characteristics of the children seen and methods of evaluation.  The EASI clinic has a small team including a PNP, DBP attending, speech/language therapist and social worker.     The evaluation is arena style, with disciplines working together while the attending observes through a one way mirror.  Several evaluations can occur simultaneously to increase the capacity of the clinic.  Evaluations include a comprehensive medical, developmental history and examination, standardized general and autism-specific screening questionnaires, Childhood Autism Rating Scale (CARS) and comprehensive language evaluation. The PNPs have been trained in standardized administration of the Screening Tool for Autism in Toddlers (STAT) to provide structured observations.  The team discusses findings, which informs the DSM-IV-TR and agree on recommendations.   All families of newly diagnosed children are invited to an informational workshop and are provided with resources for family support and community services.

Results: Data from 163 children seen 2010 -2011 will be analyzed (83% male; ages 14 – 37 months, mean age 26 months).  Over 70% were Caucasian, 14% African American, 4% each Latino and Asian, and 5% combination.  Most referrals came from Pennsylvania (68%) and New Jersey (31%) and 1% from Delaware. The chief complaints were language delay (89%), social delays (25%), regression of speech or social skills (14%), developmental delay (13%) or repetitive behaviors (10%).  Of the toddlers referred,  11% had an older sibling with ASD  and 17% were premature.  Family satisfaction questionnaires have reported a high degree of satisfaction with this model.  We will assess the relationship between ages of referral, risk factors (baby sibling, prematurity, and other diagnoses), other developmental skills, scores on standardized risk questionnaires, scores on the CARS and the STAT. 

Conclusions: This descriptive study reports a model of interdisciplinary evaluation  for young toddlers which may be effective for determining risk status and/or diagnosis of an ASD.  Findings from this study may assist us in determining means of “exporting” this model to other locations where there are nurse practitioners with an interest in collaboration and early ASD identification to implement the model.