A Framework for Developing a Curriculum Regarding Autism Spectrum Disorders for Primary Care Providers

Validity of the patient health questionnaire 9-item in autistic youths: a pilot study

BACKGROUND

Autistic adolescents have greater predisposition to depression and suicidality than neurotypical adolescents. Early detection is essential for timely treatment. The Patient Health Questionnaire 9-item (PHQ-9) is a brief screen for depression. The study examines the validity of the PHQ-9 for detecting major depressive disorder (MDD) in autistic youths.

METHODS

English speaking youths aged 10-18 years, with DSM-IV/DSM-5/ICD-10 diagnosis of Autism Spectrum Disorder (ASD), and their parents presenting to a child psychiatric service were invited to participate between May 2018 to August 2020. Participants completed the respective self- and parent-rated PHQ-9 independently. MDD was verified using the MINI-Kid (Mini-International Neuropsychiatric Interview, Kid version).

RESULTS

One hundred one youth, mean (SD) age 14.6 (2.3), were enrolled. 27 (27%) met criteria for current MDD. Mean total PHQ-9 scores, percentage ratings for severity of symptoms of depression, functional impairment, dysthymia and suicidality were compared. Areas under the ROC curve and statistically optimal cutoffs were determined. Parents rated depressive symptoms severity lower than their children. The PHQ-9 displayed low sensitivity with high false negative rates at conventional, adjusted and proposed cutoffs.

CONCLUSIONS

Future studies should improve on the validity and reliability of existing depression screening tools, or develop more appropriate screening methods of depression, for autistic youths.

Evaluating a pilot eLearning program as an educational tool for child health and developmental surveillance in general practice

This article was migrated. The article was marked as recommended. BACKGROUND AND OBJECTIVE: To evaluate a pilot eLearning program (Sydney Local Health District Well Child Health program) and whether it could improve the knowledge of general practitioners and trainees in child health and developmental surveillance. METHOD: A mixed method quantitative and qualitative study was performed involving comparisons of pre and post-course test results, and analysis of feedback surveys following a face-to-face general practice training workshop along with in-depth telephone interviews. RESULTS: Comparisons of pre and post-test scores of 25 course participants demonstrated a significant mean score increase of 2.92 out of 14.00 (CI 1.56-4.28; P < 0.001). Qualitative results from 18 feedback surveys and 8 telephone interviews provided mostly positive feedback regarding the information content and usefulness in meeting educational needs. DISCUSSION: With increased uptake and completion, the Sydney Local Health District Well Child Health eLearning program has the potential to be an effective medical education tool for general practitioners and can lead to an increase in knowledge of child health and developmental surveillance.

Pharmacogenomic testing: aiding in the management of psychotropic therapy for adolescents with autism spectrum disorders

Adolescents with autism have higher rates of anxiety than the general adolescent population. They often struggle to express psychological symptoms verbally where their symptoms may manifest as withdrawal and agitation. Adolescent patients with autism have higher rates of polypharmacy and high-risk psychiatric medication use (eg, atypical antipsychotics) than other patients with psychiatric illness. Primary care pediatricians are at the front lines of psychiatric management for patients with autism. Yet, they have inadequate access to pediatric psychiatry for complex medication management. Pharmacogenomic testing can provide personalized drug metabolism profiles for a majority of psychotropic medications. Primary care based pharmacogenomic testing for adolescents with autism on one or more psychiatric medications may help individualize and optimize complex medication regimens, while promoting drug safety.

A Pilot Study for Understanding the Perceptions of Australian General Practitioners Regarding Psychopharmacology for Children With Autism Spectrum Disorders

BACKGROUND

General practitioners (GPs) are increasing involved in the care of children with autism spectrum disorders (ASDs), and prescribe and/or manage psychotropic medications for these children. Few published reports of perceptions of GPs regarding use of these medications exist in the literature.

OBJECTIVE

Qualitative analysis of comments by 177 GPs regarding psychopharmacology use in children with ASDs.

METHODS

A postal questionnaire survey containing both close- and open-ended questions was conducted in New South Wales, Australia.

RESULTS

Respondent GPs were more likely to be females graduated from Australian medical schools and reported an interest either in child or in mental health. The respondents demonstrated good understanding of the issues surrounding psychopharmacology use in children with ASD based on contemporary literature on this topic. The main themes included concerns regarding medication safety, evidence for their use, and role of these medications as an adjuvant to behavior management. GPs reported a lack of experience of these medications, and would often prescribe only under the supervision of specialists. GPs with greater confidence and involvement with children of ASDs prescribed more medications; whereas GP reporting more concerns with regard to medications prescribed less.

CONCLUSION

Respondent GPs have good understanding of psychotropic medications but need support from specialists for managing these medications in children with ASDs. Future larger studies should explore the utility of collaborative models of care for GPs to work in close partnerships with specialists.