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