BACKGROUND: Pediatricians, neurologists, and geneticists are important sources for autism surveillance, screening, and referrals, but practical time constraints limit the clinical utility of behavioral observations. We analyzed behaviors under favorable conditions (ie, video of autism evaluations reviewed by experts) to determine what is optimally observable within 10-minute samples, asked for referral impressions, and compared these to formal screening and developmental testing results.

METHODS: Participants (n = 42, aged 15 to 33 months) were typically developing controls and children who screened positive during universal autism screening within a large community pediatric practice. Diagnostic evaluations were performed after screening to determine group status (autism, language delay, or typical). Licensed psychologists with toddler and autism expertise, unaware of diagnostic status, analyzed two 10-minute video samples of participants’ autism evaluations, measuring 5 behaviors: Responding, Initiating, Vocalizing, Play, and Response to Name. Raters were asked for autism referral impressions based solely on individual 10-minute observations.

RESULTS: Children who had autism showed more typical behavior (89% of the time) than atypical behavior (11%) overall. Expert raters missed 39% of cases in the autism group as needing autism referrals based on brief but highly focused observations. Significant differences in cognitive and adaptive development existed among groups, with receptive language skills differentiating the 3 groups.

CONCLUSIONS: Brief clinical observations may not provide enough information about atypical behaviors to reliably detect autism risk. High prevalence of typical behaviors in brief samples may distort clinical impressions of atypical behaviors. Formal screening tools and general developmental testing provide critical data for accurate referrals.

The purpose of this case report is to describe the conceptualization and treatment of comorbid anxiety diagnoses, selective mutism, and procedural anxiety in a young female presenting to a pediatric family therapy clinic with common variable immunodeficiency disease (CVID) and behavioral concerns. Treatment included a comprehensive interview assessing domains of functioning. Treatment plans for both selective mutism and procedural anxiety were informed by behavior learning theories. In collaboration with parents and teachers, evidence-based interventions were implemented concurrently across the clinic, home, and school settings to facilitate generalization. Over the course of 8 sessions, coping skills were successfully employed in the home setting to decrease procedural anxiety. Behavioral techniques implemented by clinician, parents, and the patient’s teacher to reinforce functional communication resulted in the reestablishment of speech in the school setting. Comorbid treatment of anxiety disorders proved successful and was effectively applied within an academic medical setting in a child with CVID. Application of evidence-based interventions informed by behavioral learning theories brought about improvements in both functional communication and procedural anxiety. Close collaboration among pediatric psychologists, school personnel, and parents was critical to achieving positive treatment outcomes across multiple settings. (PsycINFO Database Record (c) 2013 APA, all rights reserved)