All Kids Welcome in Autism Care Clinic
It’s a beautiful thing to see a young mind develop, says Matthew Biel, MD, MSc, a child psychiatrist. From birth through the first few years of life, children’s brains are growing and changing rapidly, and “during that time, the neural networks and systems that underlie cognitive function for decades to come are developing explosively,” he says.
Which is why Biel and his colleagues at the Autism and Communications Disorders Clinic, a program within Georgetown’s Departments of Pediatrics and Psychiatry, are on a mission: they want to identify autism as early as possible so as to provide interventions during this critical period of early brain growth.
Autism is a disorder of neural development, so early intervention can help to rewire neural systems to change brain functioning, Biel says. Recent studies show that high-quality early intervention programs, involving speech therapy, occupational therapy, behavioral therapy, and social skills development can produce adaptations that make substantial changes in the way these children learn, communicate, and build relationships.
“Intervention can really change the way that kids function in those critical years, presumably through effects on brain development. Children who are non-verbal and really socially disconnected can develop communication skills and social abilities that totally transform their interactions with their families, teachers, and peers,” Biel says. “Autistic children can learn to use language effectively, to communicate non-verbally, to play cooperatively, and attend to social cues, and develop an interest in other people. It is really quite remarkable the strides that they can make.”
Effective tools for screening for autism and for making diagnoses now exist, but the field is moving toward diagnosing children before age 2, and perhaps even before age 1, using new diagnostic techniques in children who are considered to be at particularly high-risk for autism—for example, younger siblings of older children with autism. Earlier diagnosis would offer the promise of even more effective treatment, Biel says.
But evidenced-based screening and diagnosis, particularly early diagnosis, is not available for all affected children, says Biel. The problem is especially acute in disadvantaged groups, he adds. “We are learning that autism spectrum disorders occur at similar rates – perhaps as high as 1-2 percent – across ethnic and racial groups, but autism is not recognized in time in many children lacking resources,” Biel says.
To counteract this disparity, the 10-year-old Autism and Communications Disorders Clinic, part of the Georgetown University Center for Child and Human Development (GUCCHD), offers advanced autism screening and intervention to all comers, largely due to the generous support that the program receives from the Department of Pediatrics and its philanthropic supporters, says Biel.
That means the clinic is the only one of its kind in the D.C. area that will treat children who have no insurance, who are homeless or undocumented, as well as those with Medicaid and private insurance.
Biel and colleagues — clinical psychologist Diane Jacobstein, PhD, who has been working for decades with the underserved, occupational therapist Janet Thomas, and speech pathologist Rita Solorzano — work with the hope that they can positively change children’s development, often substantially, if autism is diagnosed early in life and receives intervention.
They have seen such success in many of the more than 400 children they have evaluated since the clinic opened. Each child is assessed over two extensive evaluation sessions and then the family is guided through the process of obtaining intervention services and appropriate school placement. That child returns to the clinic each year for follow-up care.
But the Georgetown clinicians recognize that the clinic is not the complete answer to disparity of autism recognition and treatment in the area. They say pediatricians in the community, who are treating disadvantaged children, need support to recognize the signs of autism in their patients, and both pediatricians and families need better access to appropriate intervention services.
So Biel and his colleagues are reaching out beyond the clinic, into the neighborhoods where undiagnosed children live. Their first foray is to northwest D.C., to the Columbia Heights and Mount Pleasant neighborhoods that are home to a large Latino population.
There Biel, Jacobstein, and Bruno Anthony, PhD, director of research and evaluation at GUCCHD, are designing ways to improve identification of autism in Latino children. To do this work, they received a three-year, $940,000 grant from the Maternal and Child Health Bureau, part of the federal Health Resources and Services Administration.
The investigators will be working with pediatricians at Unity Health Care’s Upper Cardozo Medical Center in Washington, D.C., a large, not-for-profit outpatient clinic that serves significant numbers of Latino youth in the District. They have created a model to support community pediatricians in more effectively using evidence-based practices in screening for autism and developmental delays.
“The methods we use in the clinic are often not used in the community, and we are interested in understanding why,” Biel says. “A number of barriers exist: pediatricians are pressed for time, they are not reimbursed for using screening tools, or they may lack confidence that children who are referred for care for autism will receive it. For children and families, poverty, lack of insurance, and language barriers are issues that impact access to care and likelihood of receiving adequate care.”
In this new program, the Georgetown researchers will conduct focus groups in the community and with Unity Health Care physicians, and they will use Latino “family navigators” in the clinic to help families find the specialized care they need.
Biel and his clinic colleagues also provide developmental assessment, early childhood mental health, and autism training for Georgetown School of Medicine students and residents from the Pediatrics, Psychiatry, and Child Psychiatry training programs. Biel also gives lectures on normal and abnormal child development to medical students throughout their four years at the medical school.
Biel is interested in the intersection between pediatrics and child psychiatry, and he sees child psychiatrists as capable of playing a vital role as advocates for the emotional development of all children. “Autism is a fascinating field both from a developmental neuroscience perspective and from a public health perspective,” he says.
“I am interested in thinking about how can we understand the developmental processes that occur with autism so that we can do a better job of identifying it early and using methods of intervention most likely to help children close developmental gaps,” Biel says. “With timely intervention we can change the lives of many children and families.”
By Renee Twombly, GUMC Communications