The Journal of the Arkansas Medical Society Issue 11 Vol 114 | Page 13

A C L O S E R history, and a physical examination with focus on dysmorphology and neurologic findings. If there are clues of possible medical etiology such as specific genetic conditions, neurologic, metabolic and/or mitochondrial issues, further work up may be considered. Note that children with communication delay or possible autism should have a formal audiological evaluation, even if they passed their newborn hearing screen. Periodic lead level checks should be done for children with active pica symptoms. 6 In the absence of specific clues, chromosomal microarray is recommended. For males, DNA testing for Fragile X is recommended. 7 COMMUNITY RESOURCES Pediatric subspecialists (such as developmental and behavior pediatricians (DBP), neurology and psychiatry) and experienced PCPs can perform diagnostic evaluations in conjunction with child psychologists, educators, speech- language pathologists, occupational and physical therapists. 1 In Arkansas, diagnostic evaluations led by DBP physicians are accessed primarily at the UAMS Dennis Development Center in Little Rock. The UAMS Schmieding Center in Lowell provides diagnostic evaluations led by neuropsychologists. Information for both programs are found on http://pediatrics.uams. edu/clinical-programs-affiliates/. Alternatively, consultation for child neurology and child psychiatry are also available within the UAMS and Arkansas Children’s Hospital system. Information regarding these programs may be searched for at http://www. archildrens.org/a-to-z-services-list. Subspecialty care in Arkansas is very limited, tending to cluster L O O K AT Q U A L I T Y A CLOSER LOOK AT QUALITY in metropolitan areas. To address this gap, the UAMS Developmental Behavioral Pediatrics section is working with the state to extend developmental specialty care into the community through the DBP Outreach Clinics and Arkansas Co- BALT program. For outreach clinics, developmental teams (DBP, social worker and pediatric nurse) conduct quarterly clinics in underserved areas around the state. The team conducts diagnostic interviews and follow-up with children needing developmental monitoring. For outreach clinic appointments, PCPs may send referrals to the Dennis Developmental Center. The Arkansas Co-BALT program trains and mentors mini-teams of community-based clinicians to provide developmental evaluations. Mini-teams include a PCP and either a speech-language pathologist or nurse. These teams receive an intensive three-day training course on conducting diagnostic interviews and specific developmental assessments from the Co-BALT home team in Little Rock. Schedule appointments by contacting teams directly at www.cobaltar.org. The Individuals with Disabilities Education Act (IDEA) requires each state to provide a free and appropriate public education, in the least restrictive environment, to all eligible children with disabilities from birth to 21 years. Part C of IDEA pertains to EI services for children birth to 2 years, 11 months. The Arkansas EI program is called First Connections, (https://dhs.arkansas. gov/dds/Firstconnectionsweb/#fc- home). Referrals may be completed online or by phone 1-800-643-8258 or 1-501-682-8158; fax referrals to 1-501-683-4745. As GD and his family pursue services, his PCP stands as the center of his medical home, providing referral to community resources, helping explain evaluation results, coordinating services and monitoring GD’s progress. s Drs. Lopez, Fussell and Schulz are faculty in the Section of Developmental Behavioral Pediatrics at UAMS; Dr. Rodgers is Chief Medical Officer for AFMC. REFERENCES 1. Council on Children With Disabilities, et al. Identifying Infants and Young Children With Developmental Disorders in the Medical Home: An Algorithm for Developmental Surveillance and Screening. Pediatrics 2006;118(1):405-420. 2. Committee on Children With Disabilities. Developmental Surveillance and Screening of Infants and Young Children. Pediatrics 2001;108;192. 3. Levetown M. Communicating With Children and Families: From Everyday Interactions to Skill in Conveying Distressing Information. Pediatrics 2008;121; e1441. 4. Hasnat MJ and Graves P. Disclosure of developmental disability: A study of parent satisfaction and the determinants of satisfaction. J. Paediatr. Child Health (2000) 36, 32–35. 5. Sices L, Egbert L and Mercer MB. Sugar-coaters and Straight Talkers: Communicating About Developmental Delays in Primary Care Pediatrics 2009;124; e705. 6. Barbaresi WJ, Katusic SK and Voigt RG. Autism: A Review of the State of the Science for Pediatric Primary Health Care Clinicians. Arch Pediatr Adolesc Med. (2006)160. 7. Schaefer GB and Mendelsohn NJ. Clinical genetics evaluation in identifying the etiology of autism spectrum disorders: 2013 guideline revisions. American College of Medical Genetics Practice Guidelines. Genetics in Medicine. (2013) 15:5. NUMBER 11 MAY 2018 • 253