BALTIMORE – All young children with epilepsy should also undergo screening for autism spectrum disorders and developmental delay, a study has shown.
In a pair of pediatric epilepsy units, 77% of children screened positive for development delay, and 36% screened positive for autism. About one-third of those children were previously undiagnosed.
Because the conditions often occur concurrently, a screening of children 5 years and younger can make a life-changing difference, Anne Berg, Ph.D., said at the annual meeting of the American Epilepsy Society.
"Our hope is that we can begin catching these problems earlier to get beneficial interventions in place, which, hopefully, will lead to better long-term outcomes for these children," she said at a press briefing.
Dr Berg of Children’s Memorial Hospital, Chicago, said that allied health professionals are well positioned to take charge of a screening program, leaving physicians free to concentrate on the children’s medical needs.
"We suspect that pediatricians are following the American Academy of Pediatrics guidelines and getting these children to neurologists, but once the children arrive, the pediatricians think the neurologist will do the screening," Dr. Berg noted. However, "the neurologist assumes the pediatrician has done the screening. Other professionals, like nurse practitioners and child development specialists, can help to fill in that gap."
Pediatric nurse practitioners Catherine Dezort and Breanne Fisher, also of Children’s Memorial, undertook the study along with Dr Berg. They examined developmental status in 44 children with epilepsy who were seen at the hospital’s ketogenic diet clinic or EEG monitoring unit.
All of the children were younger than 5 years; the mean age was 31 months. Most (32) were established patients, and the remainder were new-onset epilepsy patients who had the screening done as part of their first epilepsy unit visit. The patients were divided equally between boys and girls.
Parents were asked to complete the Ages and Stages Questionnaires, a developmental assessment, and the Modified Checklist for Autism in Toddlers. "We were struck by the number of young children with cognitive, behavioral, and social deficits [along with epilepsy] in these units," Ms. Dezort said.
Of the 34 children with a positive developmental screen, 26 had delay in at least one area of communication, 28 had a gross motor delay, and 31 had a fine motor delay. A problem-solving or personal-social delay was seen in 25 children.
Sixteen also screened positive for an autism spectrum disorder. "However, 12 of these scored positive for autism because of their underlying developmental status," Ms. Fisher said. Only four were actually referred for further autism evaluation.
"Autism screening should be interpreted carefully, keeping in mind the child’s underlying neurological status," she added, because some children display autisticlike behaviors that are actually related to a seizure disorder.
Autism occurred concurrently with at least one type of delay; no children screened positive for autism alone.
The researchers also found that 38% of established patents and 33% of the new patients with either positive screen were not getting adequate – or, in some cases, any – supportive services, Ms. Fisher said.
"We made referrals for further evaluations, and now all of them are getting services," she said. Referrals included physical therapy; speech therapy; occupational therapy; psychiatric services – including psychiatrists, psychologists, and social workers – or an educational specialist.
The study provides a workable model for early identification and intervention, Ms. Dezort said.
"We would recommend that everyone up to 18 years old [with an epilepsy diagnosis] be screened and treated," she said. "In fact, we’re now screening all of our new patients for behavioral, cognitive, and psychiatric comorbidities, and we’re looking at ways to increase screening in all of our epilepsy patients, not just those who come to our clinics.
"We think screening is an excellent role for allied health professionals and an excellent, easily adaptable model for other settings," Ms. Dezort added.
None of the investigators reported any relevant financial disclosures.