Abstracts

Rationale: Children with epilepsy onset prior to age three are at high risk for developmental delays and Autism Spectrum Disorder (ASD). Even though ASD can be reliably diagnosed in children by age two, many children are not diagnosed until four. According to the Autism Treatment Network registry, the average age of autism diagnosis for children with epilepsy is age 7. Furthermore, children with a serious medical condition may be diagnosed later. Including a neurodevelopmental psychologist in a comprehensive epilepsy clinic will streamline services for families and facilitate early diagnosis and treatment. To address these needs, the Pediatric Epilepsy Center at Nationwide Children's Hospital added a neurodevelopmental psychologist. Here we describe the role, implementation, and impact of the neurodevelopmental psychologist in an epilepsy clinic. Methods: The neurodevelopmental psychologist attends the comprehensive epilepsy clinic day. When developmental or autism concerns are mentioned during the appointment with the medical provider, the psychologist is consulted. The psychologist then meets with the child and family to discuss concerns. If warranted, the psychologist completes the evaluation that same day or schedules an appointment for the family to return and complete the evaluation within 2-3 weeks after the initial visit within the epilepsy center. Developmental evaluations are also completed during the inpatient hospitalization for children with newly diagnosed infantile spasms with subsequent and follow up evaluations performed during epilepsy appointments. Diagnoses made during this clinic time are logged. Results: Data is presented from the previous 3.5 years, after the psychologist began attending the comprehensive clinic day. Out of the 18 evaluations with children suspected of having ASD, 9 children were diagnosed with autism. One child had a previous diagnosis of ASD, but needed an updated evaluation to obtain services after moving. The ages of patients newly diagnosed with ASD ranged from 2 to 4 years of age. Further analysis will examine improvement in access to care, follow-through with referrals for intervention, and caregiver satisfaction with our model. Conclusions: There are children with epilepsy who have ASD and developmental delays, but have not received a formal evaluation, diagnosis, or appropriate treatment. In our patients, the age of autism diagnosis was much younger than the mean age of seven from the ATN data. Six of the eight newly diagnosed children have enrolled in treatment that uses techniques of Applied Behavior Analysis (ABA) services, which occurred earlier due to a more timely diagnosis. The approach presented demonstrates the feasibility of including a neurodevelopmental psychologist in a comprehensive epilepsy clinic and the impact it can have on age of diagnosis and access to appropriate intervention services. Including a neurodevelopmental psychologist also creates a medical home for children with epilepsy and developmental delays and decreases the need to access another service line within a large hospital. Screening and evaluation of development are critical to increase access to treatment to improve the developmental outcome of children diagnosed with epilepsy. Future goals for the neurodevelopmental psychologist include implementing developmental screening for all young children with epilepsy, increased ASD assessments during epilepsy clinic appointments, and continued developmental follow up with children with infantile spasms. Funding: none