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Dr. Sarah Bauer-Huang: Hi. This is Dr. Bauer Huang. I'm a pediatric neurologist at St. Louis Children's Hospital. And I am a Mom Doc.

Melanie Cole: Hey, welcome to MomDocs. The podcast series from St. Louis Children's Hospital. I'm Melanie Cole. And today, we're talking about autism. Joining me today is Dr. Sarah Bauer Huang as she introduced herself. So Dr. Sarah, thank you so much for joining us. Tell us a little bit about the autism spectrum disorders, how common they are and why this is such a big umbrella now of many different disorders, how we're defining that.

Dr. Sarah Bauer-Huang: That's right. So overall there are different numbers depending on where you look, but about one in 54, one in 60 children might be diagnosed with autism. The issue has been that the diagnosis of autism has changed. And because of that, we are now capturing more patients or more children with this disorder.

So what before would have been called Asperger's syndrome, now is called autism spectrum disorder. So this is a disorder that has a difference in social and emotional relationships, differences in communication, and they can also have differences in how a child responds to their environment and sensory dysregulation.

Melanie Cole: So then tell us a little bit about the cause. And I'd like for you to clear up the vaccines and autism thing, because this is something that many parents have questions about. So will you clear this up for us?

Dr. Sarah Bauer-Huang: Oh yeah, definitely. So we know vaccines are not related to autism and they do not cause autism. There've been a number of studies that have been done to show that there is no relationship. And they've actually gone to look to see if there's any differences in how the autistic population responds to the vaccine versus non-autistic patients. And they have a very similar response. And the vaccines over time have actually a number of ingredients that there have been particular worries about from families, those ingredients aren't even included anymore. So from a provider point of view, I have no concerns about the vaccines in causing autism.

Melanie Cole: Well, thank you so much for clearing that up. So now let's talk about this condition itself. Tell us about screening. When does that typically happen? Are there some red flags that parents or caregivers would know? Is this something that the pediatricians themselves are the ones screening? Tell us about how this all works for diagnosis.

Dr. Sarah Bauer-Huang: Yes, definitely. So children are screened at different points during their development. So yes, pediatricians are screening typically at, I think it's 18 months and 24 months. There's a screener called the M-CHAT-R that families can also find online. We use it for children between 16 months and 30 months of age. And depending on how they score on that screener, there are recommendations for either an automatic referral for evaluation versus just a watch and repeat sort of plan.

Parents, if at any point, they are concerned about autism and there are certain signs that now that I work in that population, parents will see in hindsight they've noticed. So for example, a loss of language after they've had some language development, I think, is a red flag for myself that if I hear that, I will definitely wonder if autism could be explaining that.

Differences in how they have eye contact, the use of pointing, the way they respond to other children. The way they play, the play is a little bit different than other children. And then also the addition of some other motor patterns or stereotypies where it's more than what you would see in the typical population.

But I do want to say one thing that's important, that every child with autism has their own autism. Every child is different and it's a combination of symptoms that together allow us to come to the diagnosis. So if a family member has a concern about it or a pediatrician, my first recommendation is that they get referred to early intervention so that they're able to get therapies before they're even able to be seen for a formal evaluation. And then the family and pediatrician, they can refer the child for formal evaluation at the diagnostic center. And there are a number of diagnostic centers in the St. Louis area. One of which includes St. Louis Children's or WashU.

Melanie Cole: Tell us a little bit more about early intervention, Dr. Sarah, because that's something parents don't really know about. What's involved?

Dr. Sarah Bauer-Huang: Yeah. So early intervention is a state-run program. Some families may know it as Birth to Three or First Steps in Missouri. And it's basically a catch therapy program that allows babies up until three years of age access to therapy services. And so there are certain patients that are automatically qualifiers for early intervention.

So of course, you know, some of our babies that graduate from the NICU, some of our heart babies that I also take care of are automatic qualifiers. Some of our genetic patients are also automatic qualifiers. And so what this means is it's team of therapists and developmental specialists that usually would be in the home, although with COVID, definitely telemedicine is part of what they do now as well. And they are working with the family to know where that child is developmentally, provide therapy services, and be honestly the best surveillance for developmental differences in these children.

What I love about our early intervention team in St. Louis is that there are specific programs for infants and toddlers where there's a concern for autism. So for example, there's a program called It Takes Two to Talk that is run by an occupational therapist. And then there's an occupational therapist called the Infant Toddler Autism Program. And so both of these programs do not require a diagnosis of autism. And if there's a concern, it's something that we can definitely initiate those therapy services prior to a diagnosis.

Melanie Cole: Such important information. So what does this mean for family members, siblings? How can these types of therapy, early intervention, and as the child grows a little bit, getting the parents, the school involved in helping this child really integrate into society?

Dr. Sarah Bauer-Huang: Yeah, that is the goal of all of these therapies. And the reason we do it so early is that we're not trying to change who this child is. That is not the goal of any of the therapies that we recommend with autism or any other developmental difference. But the goal really is to let them succeed in their environment, do what they're supposed to be doing. So that means getting to school, having appropriate play and to be integrated within the family.

So many of the early childhood or early intervention programs that focus on these children actually focus on the family. So they focus on that relationship between the parents and the child, and they use that relationship to help foster these moments of communication that you want to bring out in the child, for example.

So a lot of this actually is more family-oriented in terms of this therapy support. As the child gets closer to three years of age, they will transition to the school district. And it's really important that, if a child has a diagnosis of autism, that it has been formally diagnosed before three, we actually prefer to diagnose it, you know, even before two if possible. So that they're getting the appropriate therapy, which is ABA. Because at three, the school takes over. And so having the correct team in place and being able to support these families is really important. And so the early intervention team, that Birth To Three team, helps with that transition as do the physicians that work with these families.

Melanie Cole: So as we wrap up, and this is such great information for families and the communities to hear, Dr. Sarah, what tips do you have for families when they have a child that is on the spectrum and they're, you know, in this COVID time and they're getting them signed up for school and they've done early intervention, what would you like them to know about just really some tips and help bring their child through all of these types of therapies?

Dr. Sarah Bauer-Huang: Yeah, the first thing I would say is they are doing everything they can. I have to say that these parents are the best advocates for their children and the work that they do is beautiful and amazing, and that they need to take a step back and just enjoy being with their family and enjoy being with their child because I do worry that families try to overcompensate and they try to make every single moment a therapy moment. And that is not the goal. The goal is to love your child and give them those experiences that you would have anyway. So that's one thing.

But other tips that I talk about, number one, is just keeping your therapy team in your back pocket. Being in communication with that team to know what works. If they're in school, finding out what works at school and what works at home, and then really talking back and forth. For example, there are children that really benefit from a routine. And so the routine at school, they may have better behavior actually at school than at home. In those cases, what you do is you talk to the school and say, "What are you doing? How is it working at school? Let me bring that back home and see if we can make that happen at home." So I think just having very strong communication between all of the caregivers, which includes the family, the school and the therapist to support the child is very important.

And I also always talk about, especially for these early diagnoses, these children that are still under two years of age, it's so, so important that reading and exposure to vocabulary, making every moment when you're with that child rich with language and social interaction is very important. And the ABA therapist that work with the family and work with the child can definitely give the family some really good pointers on how to enrich those moments. But again, at the end of the day, I want my families to love and enjoy the time that they have with their children and so for it to be a positive experience.

Melanie Cole: Absolutely well said. Thank you so much, Dr. Sarah, for joining us today. Really important information. I love the tips for families. That's just really great information.

That concludes another episode of MomDocs with St. Louis Children's Hospital. Be sure to follow us on your social channels and share these shows with your friends and family, because we're learning from the experts at St. Louis Children's Hospital together. For more advice and articles, you can always check out the MomDocs website at ChildrensMD.org. I'm Melanie Cole.