Maggie McKay (Host): According to the Centers for Disease Control, autism affects approximately one in 44 children in the United States today. Autism refers to a range of conditions, characterized by challenges with repetitive behaviors, social skills, speech and nonverbal communication. But there is a lot more to know about this complex condition and how to manage it if your child is diagnosed with autism.

My guest today is Ashleigh Adkins, DNP-FNP, ARNP. She practices family medicine at Skagit Regional Health Smokey Point. She's received specialized autism training and earned the Seattle Children's Center of Excellence Autism Certificate. Ashleigh will tell us about the importance of early diagnosis, what screening should be done, and the breakthrough program she has created with Skagit Regional Health to help children with autism.

Maggie McKay (Host): This is Be Well, the podcast from Skagit Regional Health. Let me congratulate you on the completion of the Seattle Children's Center of Excellence Autism Certificate.

Ashleigh Adkins, DNP-FNP, ARNP: Thanks, Maggie.

Maggie McKay (Host): It's good to have you here. So just to start off, can you tell us what is autism and how common is it?

Ashleigh Adkins, DNP-FNP, ARNP: Well, as you described in your intro, autism spectrum disorder is a disability that some children develop that causes significant social communication behavioral challenges. Autism is becoming more and more common. And the worldwide estimate is that one in 44 children will be diagnosed with an autism spectrum disorder.

Maggie McKay (Host): So is that up the numbers from say five years ago? And why do you think?

Ashleigh Adkins, DNP-FNP, ARNP: Those numbers are climbing at a very quick rate. I actually just updated my information and it had changed from one in 54 children to one in 44 children, just in a matter of a year. And I think that why we're seeing that is luckily providers are becoming more and more in tune with diagnosing or at least being able to recognize children that are at a high risk for autism.

Maggie McKay (Host): Can you please tell us the importance of an early autism diagnosis and intervention?

Ashleigh Adkins, DNP-FNP, ARNP: Absolutely. So parents can identify their children with autism at quite an early age. But in the medical community, we first started to recognize autism around 18 to 24 months. We have in primary care specialty an assessment that we use called the M-CHAT screening. We do this assessment at the age of 18 months, and we repeat it at the age of 24 months. Once we identify a child that's high risk for autism, then the primary care doctor can get the child into a specialist that can further make the diagnosis of autism.

Maggie McKay (Host): So the sooner, the better to do this screening?

Ashleigh Adkins, DNP-FNP, ARNP: Absolutely. If your child's going in for frequent well-child visits, then your primary care doctor should be doing these assessments at the 18 and 24-month mark. And if they're not, then I would recommend that you ask your pediatrician to complete them.

Maggie McKay (Host): And Ashleigh, can you explain what the autism certification through Seattle Children's Hospital is and why it was created?

Ashleigh Adkins, DNP-FNP, ARNP: Yeah. So there's so many children that are starting to be recognized with autism. But unfortunately, Seattle Children's, our local children's hospital has quite a large wait list of children that are seeking assessment and diagnosis of this condition. Unfortunately, there's about a two-year wait to be seen by a neurodevelopmental specialist to be diagnosed with autism.

So what Seattle Children's did is they created this Center of Excellence Certificate, so that primary care doctors could start identifying children that were high risk for autism and make diagnoses so that these children can get early intervention.

Maggie McKay (Host): Instead of having to wait two years. That's great. When was that created?

Ashleigh Adkins, DNP-FNP, ARNP: The program was started in 2019. And I was aware of the program starting in 2019, I unfortunately wasn't able to attend the first session. But I was very excited in the spring of 2020 to complete the Center of Excellence Certification, and that's when I started my journey in autism diagnosis.

Maggie McKay (Host): Ashleigh, what's the partnership you have with the Skagit Regional Health Children's Therapy Program, also known as ADOS Assessment and Therapy?

Ashleigh Adkins, DNP-FNP, ARNP: We have a really great partnership within Skagit Regional Clinics. So we have our primary care specialties and then we also have a children's therapy program. With the children's therapy programs, I've been able to complete a more accurate diagnostic approach with the speech and language pathologist completing an ADOS assessment. And what an ADOS assessment does, is it evaluates the child in a play-based therapy observation. So I will observe the child in the office and discuss the parent's concerns. And then, I will have the speech and language pathologists complete an ADOS assessment, which would be on a separate day and it lasts about an hour and the therapist would take some time to play with the child and observe them playing and their social skills and how they interact with the therapist. And through some specialized tests, they can make a pretty good assessment on whether or not they are at a high risk for autism. So with the speech therapist’s assessment and my assessment in the office, then we can make a very thorough diagnosis of autism spectrum disorder.

Maggie McKay (Host): Ashleigh, is there anything you'd like to add that we didn't cover maybe to parents who are going through this process or about to be?

Ashleigh Adkins, DNP-FNP, ARNP: Yes, it's really difficult for parents when their child first receives this diagnosis. And that's why I love taking care of children and family with autism because I know it can be difficult to navigate this new world. Autism seems to have its own special club, if you will. And once you're in the club, then it opens up this whole new world and you really get to see how special children with autism really are. And so I love connecting with parents and being able to share with them and be able to assess the special characteristics that their child has and to be able to assist them with navigating this difficult diagnosis.

Maggie McKay (Host): I bet it's very rewarding. Thank you so much for shining a light on a condition that affects so many children and their families. I'm sure your information today has clarified a lot of questions parents and others may have

Ashleigh Adkins, DNP-FNP, ARNP: Thank you. I'm happy to be here.

Maggie McKay (Host): To learn more, go to SkagitRegionalHealth.org. Thanks for listening to Be Well, the podcast from Skagit Regional Health. And if you found this podcast helpful, please share it on your social channels and check out the full podcast library for topics of interest to you. I'm your host, Maggie McKay. Until next time, stay well.