CHICA Automated System helps pediatricians screen for Autism

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Studies show that early intervention can substantially improve the long-term prognosis for children with autism, but most are not diagnosed until they are 4-1/2 to 5 years of age, according to the CDC’s Autism and Developmental Disabilities Monitoring Network.

The Child Health Improvement through Computer Automation system (CHICA) is an automated system that helps pediatricians screen for the symptoms of autism in children as young as 24 months.

Narissa Bauer, M.D, assistant professor of pediatrics at the Indiana University School of Medicine says,

“Autism isn’t like strep throat where you can do a quick throat swab and then have a diagnosis. Autism is a behavioral diagnosis and can look very different depending on the child. Some behaviors are subtle, especially early on. CHICA prompts parents to think about whether they have concerns about certain health risks, such as autism, which makes it easier for the doctor to focus on key issues during a hectic visit.”

CHICA is an open-source system that can potentially interface with any electronic medical system. Patients are given a 20-item questionnaire, which is personalized based on previous medical records. At the 24-month visit, CHICA automatically screens for autism. The system automatically prompts the physician to refer the patient for further testing if any concerns are raised.

Stephen M. Downs, M.D., M.S, and Jean and Jerry Bepko, Professor of Pediatrics and Director of Children’s Health Services Research at the I.U. School of Medicine say,

“What’s important here is that CHICA will help pediatricians identify autism earlier when treatment is more likely to be effective.”

Doctors are required to screen for autism at 24 months, according to national standards, but many cases continue to go undiagnosed. Signs of autism can be very subtle in children that young, and it can be easy to miss the signs during a busy check-up that also requires several vaccinations and other screenings. Early diagnosis can help parents gain access to services and treatments that can improve the child’s chances for making progress.

“It’s natural to worry about your child’s development. Parents bring concerns to the pediatrician, and while pediatricians know how children should be developing, visits are brief,”

says Dr. Bauer.

The CHICA system was implemented in 2004, and has supported the care of over 36,000 patients at community clinics associated with Wishard-Eskenazi Health in Indianapolis, Indiana. Half of the families served are black, a third are Hispanic, and more than two-thirds have Medicaid. Studies have shown that children with autism from minority families tend to be diagnosed at later ages than those from Caucasian families. Doctors are hopeful that CHICA can help all children gain access to the services they need at a time when they will be most beneficial.

Downs says,

“Even with CHICA, we find physicians sometimes miss opportunities to screen. So we hope CHICA can go beyond alerting to positive responses to autism prescreening and create alerts directed to a nurse or developmental specialist for support and follow-up.”