13:30:00 SEGMENT 00

Pre-program Test 30:00

1.       

14:00:00 SEGMENT 01

5:00

2.       

TAPE: Cut – 1 Pre-Con & Open 

RT: 5:47

outq… Music sting

Walter Trout – Cut #6 – 'Through The Eyes of Love'

3.       

CU BILL ROPER

CG:

William Roper MD, MPH

WS Panel

Roper:

Hello, I'm Bill Roper. Welcome to another session of Public Health Grand Rounds, a collaboration of the Centers for Disease Control and Prevention, and the School of Public Health at the University of North Carolina at Chapel Hill.  In these LIVE interactive forums we focus on PARTICULAR public health issues.   In today's program we're looking at AUTISM,

a condition which is on the rise among our children.  Is it because of BETTER DIAGNOSIS or is there some OTHER UNDERLYING CAUSE?  My colleagues here and I will examine these and other key questions.

4.       

SS:

U.S. Technical Help:

(800) 728-8232

SS:

International Technical Help:

(404) 639-1289

But first here are some important CONTACT numbers if you're having trouble receiving the program.  For TECHNICAL assistance call:

800 7-2-8  8-2-3-2.  That's 800 7-2-8  8-2-3-2

Or for INTERNATIONAL viewers, please call:

4-0-4  6-3-9  1-2-8-9

[PAUSE]

5.       

CU BILL ROPER

CG:

William Roper MD, MPH

Roper:

With reported autism rates RISING among children, many communities are mobilizing to ensure early diagnosis and provide adequate services.  Here's a snapshot of views on the task we're facing from Miami Dade County, Public Health Grand Rounds' case today.

6.       

TAPE: Cut – 2 Tease

RT: 1:36

OUTCUE: " every child receives."

7.       

CU BILL ROPER

Roper:

For many of us in public health, AUTISM SPECTRUM DISORDER or A-S-D, as it is now more accurately described, may indeed be unfamiliar territory.  It's an area where much of the expertise and experience in dealing with the condition lies OUTSIDE our profession. To help ANSWER your questions and address your concerns, we've brought in two experts.

8.       

CU JOSE CORDERO

Joining us today is Dr. Jose Cordero, Director of the National Center on Birth Defects and Developmental Disabilities at the Centers for Disease Control and Prevention

9.       

CU CRAIG NEWSCHAFFER

Also with us is Dr. Craig Newschaffer, Associate Professor in the Department of Epidemiology at Johns Hopkins Bloomberg School of Public Health.

10.   

CU HUGH TILSON

And as always, we have with us my colleague at 

U-N-C, Dr. Hugh Tilson, Clinical Professor of Epidemiology and Health Policy.   Hugh, do you want to introduce a new feature we have on set?

11.   

CU HUGH TILSON

Tilson:

Yes, Bill, I have my computer live on-line and so I'll be checking on the questions and comments from our viewers as they come in.

12.   

CU BILL ROPER

SS:

United States:

Voice    (800) 793 – 8598

Fax        (800) 553 – 6323

TTY      (800) 815 – 8152

SS:

www.PublicHealthGrandRounds.unc.edu

CU BILL ROPER

Roper:  

That's right, this is a LIVE INTERACTIVE program and we really want you to write us or call in your QUESTIONS and COMMENTS on this timely subject.  

So please call us at  800 7-9-3 – 8-5-9-8

Our fax number is 800 5-5-3 – 6-3-2-3

We also have a TTY number 800 8-1-5 – 8-1-5-2

And, you can also submit a question at our website at www dot Public Health Grand Rounds dot U-N-C dot E-D-U, where Hugh will be monitoring.

And now let's take a look at our OBJECTIVES for today's program.

13.   

TAPE: Cut – 3 Objectives

RT: 0:31

OUTCUE: " children with ASD."

14.   

14:05:00 SEGMENT 02

What is ASD? 8:00

15.   

CU BILL ROPER

Roper:

To start us off, let me ask you, Hugh, to tell us about a meeting you had with a multi-disciplinary group that's examining the whole issue of A-S-D.    What did you learn?

16.   

CU HUGH TILSON

CG:

Hugh Tilson, MD, DrPH

Tilson:

Bill, the group goes by the acronym of CADDRE – isn't that neat.  It's short for Centers for Autism and Developmental Disabilities Research and Epidemiology.  It brings together professionals with a multitude of different skills – clinicians, epidemiologists, leaders in public health and many other specialists – who are working collaboratively to try to find the CAUSES for autism, its PREVALENCE and also effective means of DIAGNOSIS. Here's what they say about the task ahead.

17.   

TAPE: Cut-4 CADDRE

RT: 4:04

OUTCUE: "the best of public health."

18.   

CU BILL ROPER

Roper:

That's a good overview of the issues we face.  Let's now look at them in more detail.  First of all the issue of PREVALENCE.  Craig, are the numbers really going up?

19.   

CU CRAIG NEWSCHAFFER

CG:

Craig J. Newschaffer, PhD

Newschaffer:

Today there are definitely MORE CHILDREN diagnosed with autism.   Since autism became a recognized category for special education classification in 1989, the number of children receiving special education classified as having autism has increased by about TWENTY-FIVE PERCENT per year.   That said, unlike other childhood conditions such as asthma and diabetes, the DIAGNOSIS of autism is purely BEHAVIORALLY BASED.  Also, we now understand that autism is a SPECTRUM disorder.  So we now recognize both HIGHER FUNCTIONING individuals and SEVERELY IMPAIRED individuals as having autism.  This means there is more of a chance that the changes in prevalence we see over time could at least be driven by changes in our understanding of the condition and how to diagnose it. However, a REAL RISK INCREASE is a possibility that needs to be explored.

20.   

SS:

Prevalence

·        Autistic Disorder 10-20 per 10,000

·        All ASDs 20-60 per 10,000

It's still hard to know EXACTLY what the TRUE PREVALENCE of autism is, but a plausible range for autistic disorder, the longer-recognized, more severe form, is probably somewhere between 10 and 20 per 10-thousand, and the prevalence of all A-S-Ds may be in the range of TWO TO THREE TIMES that.  This is MUCH HIGHER than we thought it was just ten years ago.

21.   

CU BILL ROPER

Roper:

Thanks, Craig.  Jose, what do we know about the causes of autism?

22.   

CU JOSE CORDERO

CG:

José F. Cordero, MD, MPH

Cordero:

One thing we have good evidence for, and it was pointed out by the CADDRE scientist, is that NO RESEARCH as of yet has been able to establish an ASSOCIATION between CHILDHOOD IMMUNIZATIONS and AUTISM.   Three expert reviews released in 2000–2001 supported this, and similar conclusions were reported by the Institutes of Medicine.   So it is good news that so far research has shown NO CAUSAL LINK between autism and the M-M-R vaccine.  Still, we can't exclude the possibility that an association may be found in a small subset of the population.  For this reason, RESEARCH in this area is ONGOING.

23.   

Beyond that, as one speaker pointed out, we do know since the twin studies of the early 80s, that there is a GENETIC component to the disorder.  Autism is much more likely to co-occur in IDENTICAL twins than in FRATERNAL twins.  However, while the genetic component to A-S-D is undeniable, the gene-finding studies are far from complete. NO GENETIC MODEL has yet met the challenge of consistently explaining autism's GENDER DISPARITY and the variable way it manifests itself.

24.   

CU BILL ROPER

Roper:

What about NON-INHERITED causes? If not vaccines, is there any indication that anything OTHER than genes could be a risk factor?

25.   

CU JOSE CORDERO

Cordero:

It's possible.  In fact, the CADDRE group and other researchers will be looking very closely at whether there are any factors that could COMBINE with genetic predisposition to increase risk.  These factors might come in to play during PREGNANCY, or perhaps early in life.  There are some children with autism who develop NORMALLY during their first couple of years and then abruptly LOSE LANGUAGE and SOCIAL SKILLS. We call it regressive autism. But we must remember that the existence of this group doesn't mean there HAS to be some early-life, environmental risk factor for autism. It's entirely possible that regressive autism results from pathologic processes fully established at birth. 

26.   

CU BILL ROPER

Roper:

Thanks, Jose.  Since risk factor studies are still a work in progress, Craig, is there any practical PREVENTION STRATEGY now?

27.   

CU CRAIG NEWSCHAFFER

Newschaffer:

Given the lack of risk factor information, it's difficult to formulate preventive strategies for autism at the present time.  The American Academy of Pediatrics currently recommends that parents of children with A-S-D be counseled about the increased risk in SUBSEQUENT children, estimated to be somewhere from THREE to NINE PERCENT.  Since the genetic mechanisms behind autism appear to be very complex, it may be that even AFTER we've done more genetic research, it will still be a challenge to IDENTIFY families at particular risk.   Also if research does uncover any ENVIRONMENTAL risk factors, it may well be that these are important ONLY in small GENETICALLY SUSCEPTIBLE subgroups.   Nonetheless, the hope is that someday we will have some prevention strategies we can put in place.

28.   

14:13:00 SEGMENT 03

Forging a Partnership 8:00

29.   

CU BILL ROPER

Roper:

Thanks, Craig.  Let's move on now to our case study. Hugh, you recently visited Miami Dade County where you saw firsthand a very wide-ranging partnership that's been developed to address the rise in A-S-D. Tell us about that.

30.   

CU HUGH TILSON

CG:

Hugh Tilson, MD, DrPH

Tilson:

Bill, we did indeed discover a truly remarkable partnership already in place to improve DIAGNOSIS and TREATMENT OF AUTISM in the community in Miami Dade.    It's a partnership in the spirit of the larger Public Health system that involves the Health Department, the school system, and the academic community.  What's UNIQUE about this collaboration are two components housed in the University of Miami.  Two more nifty acronyms…FDLRS, which stands for Florida Diagnostic Learning Resource System, and CARD, the Center for Autism and Related Disabilities.  Here's how they work together.

31.   

TAPE: Cut-5 Miami Dade County

RT: 3:10

OUTCUE: " have a medical home?" 

32.   

CU BILL ROPER

Roper:

Jose, in order to support such partnerships as the one in Miami Dade County, CDC has launched a number of initiatives to address autistic spectrum disorder.  Tell us about this effort.

33.   

CU JOSE CORDERO

SS:           

CDC ASD Initiatives

·        Population-based surveillance in 8 states

·        6 centers of excellence in autism and developmental disabilities epidemiology

SS:

NIH ASD Initiatives

·        5 centers of excellence in autism clinical and basic science research

·        Autism Coordinating Committee

Cordero:

Since 1997, the Department of Health and Human Services has placed a high priority on A-S-Ds.   RESEARCH FUNDING for autism has gone up considerably, from ELEVEN to FIFTY-SIX million DOLLARS within the National Institutes of Health alone.  At the same time, both the CDC and NIH have developed NEW INITIATIVES, building a federal foundation for the public health response to autism.  As part of the Children's Health Act of 2000, CDC is supporting the development of population-based A-S-D SURVEILLANCE projects in eight states and has funded six centers of excellence in autism and developmental disabilities epidemiology to conduct surveillance and to begin a large, multi-centered autism case-control study.  These CDC projects should provide more accurate A-S-D PREVALENCE estimates, and we hope they will lead to the discovery of MODIFIABLE risk factors.  The Children's Health Act also charged the NIH to fund at least FIVE CENTERS of EXCELLENCE in autism clinical and basic science research, and to form an AUTISM COORDINATING COMMITTEE where representatives from five NIH institutes, the CDC, the Food and Drug Administration, and the U.S. Department of Education could regularly exchange ideas.  

34.   

CU JOSE CORDERO

In addition, through the Individuals with Disabilities Education Act or "IDEA", ALL STATES now receive FEDERAL SUPPORT for EARLY INTERVENTION programs that provide early detection and coordinate intervention to infants and toddlers with developmental delays.  Additional IDEA support helps fund evaluation and preschool placements for children with disabilities aged three to five years.  Both of these programs, while not EXCLUSIVELY focused on autism, have been an important means of raising EARLY WARNINGS that can lead to diagnoses of A-S-Ds.  In Florida, for example, the FDLRS system focuses on the three-to- five-year-old children but they work closely with the Early Intervention Program, which is coordinated by the state health department, to manage the service transition for those children identified before age three.

35.   

CU BILL ROPER

Roper:

Thanks, Jose.  It sounds like these programs can be a key resource in PARTNERSHIPS developed at the state and local level.  What do you think, Craig?

36.   

CU CRAIG NEWSCHAFFER

SS:

Early Intervention Programs Run by:

·        Health Dept in 26 states

·        Education Dept in 13 states

·        Human/Social Service Dept in 5 states

Newschaffer:

I think that's true.  It's important to realize that these programs can be and are organized differently from state to state.  For example, the Early Intervention Program is run through the health department in 26 states, including Florida. It's run through the state education department in 13 others.  A human or social service department is the lead agency in five more.  And the remaining states have still different arrangements.  But, as we saw in Florida, the KEY to a successful program lies in the extent and effectiveness of partnerships that are formed across health and educational departments as well as with available clinical and academic resources.

37.   

14:21:00 SEGMENT 04

Early Diagnosis 10:00

38.   

CU BILL ROPER

CG:

William Roper MD, MPH

Roper:

Thanks, Craig.  One of our objectives today is to identify the role that HEALTHCARE PROFESSIONALS need to play in addressing autism.  And clearly that's one of the goals of the Miami Dade partnership.  Hugh tells us how they're going about that.

39.   

CU HUGH TILSON

Tilson:

Well Bill, as Peter Mundy said, one of the three groups they're targeting is indeed the MEDICAL community.  There, the PRIORITY has been EARLY DIAGNOSIS of children with autism and developing the necessary techniques and training that make it possible. Let's hear how they're doing that.

40.   

TAPE: Cut-6 Early Diagnosis

RT: 3:28

OUTCUE: " the earliest you can get them, the better it is."

41.   

CU BILL ROPER

Roper:

A lot of discussion there about the need for a SCREENING TOOL.  Jose, currently WHAT SCREENING TOOLS do we have available for testing YOUNG kids?

42.   

CU JOSE CORDERO

SS:

Autism Screening Tools

·        M-CHAT

·        Social Communication Questionnaire

Cordero:

The American Academies of Neurology and Pediatrics currently recommend that children FAILING ROUTINE DEVELOPMENTAL EXAMS be screened with either the M-CHAT, short for Modified Checklist for Autism in Toddlers, or the Social Communication Questionnaire.   While these don't include direct observations of the child, they do ask parents questions of whether kids show SIGNS of this kind of behavior.

43.   

However, existing tools vary in the manner in which they are administered and the extent to which they have been validated.  There are several things we need to do to come up with the best approaches.  First, like with any other screening strategy, we need to carefully evaluate the EFFECTIVENESS of EXISTING APPROACHES as they are applied in the community.   Next we need to be constantly INNOVATING and coming up with better tools.  To this end, researchers are now closely following cohorts of infant siblings of children with autism as well as doing studies that compare pre-diagnostic videotapes of children with and without autism to see if there are behaviors that discriminate those with autism at VERY YOUNG AGES.

44.   

Given the inherent uncertainties of behaviorally-based screening, there's also a lot of interest in POTENTIAL AUTISM BIOMARKERS.  One promising direction is to look for BIOMARKERS AT BIRTH, that may help discriminate between children LATER diagnosed with autism and those with typical development. One study did show differences between these groups of children although it DID NOT DIFFERENTIATE between autism and mental retardation.  Still, this is an EXCITING area of research.

45.   

CU BILL ROPER

Roper:

Thanks, Jose.  In the case we heard a lot about the CONTINUING DIFFICULTIES in putting early detection into practice.  Craig, what can we do to IMPROVE things in that area?

46.   

CU CRAIG NEWSCHAFFER

SS:            (BUILD)

Improving Early Detection

·        Increase awareness about autism and early intervention

Craig:

In addition to supporting the research Jose mentioned, we need to find ways to boost the efforts that exist IN OUR COMMUNITIES.   For example, Early Intervention programs are limited in the extent that they can ACTIVELY reach out and screen kids.  The programs are a resource to which pediatricians, nurses, pre-school teachers, and parents can refer kids with concerns. So we need to work to INCREASE AWARENESS ABOUT AUTISM and resources like the Early Intervention program in these groups.

47.   

SS:

·        Encourage more initial developmental screening and referral to early intervention

SS:           (BUILD)

Improving Early Detection

·        Assure Early Intervention programs use latest techniques for ASD early-recognition

SS:

·        Assure sufficient clinical expertise

As many of the Miami Dade County people suggested, we also need to find ways of encouraging and enabling pediatricians to do MORE INITIAL DEVELOPMENTAL SCREENING and then refer on to Early Intervention.

We then need to assure Early Intervention programs are aware of the latest thinking on and techniques for A-S-D early-recognition. 

Next there has to be sufficient pools of clinical expertise in the community to MAKE DEFINITIVE DIAGNOSES.  Helping to develop these clinical resources and finding ways to improve access to them is also an important challenge.  

48.   

CU BILL ROPER

Roper:

One speaker made the point that EARLY DETECTION followed by EARLY INTERVENTION improves outcomes for children with the disorder.  Anything you'd like to add to that, Craig?

49.   

CU CRAIG NEWSCHAFFER

Newschaffer:

The research shows us that cognitive status still appears to be the single strongest predictor of functional outcome in children with A-S-Ds.  But, it has been clearly demonstrated that BEHAVIORALLY-BASED INTERVENTIONS started EARLY IN LIFE can curtail problematic behaviors and foster communication and social skill growth for children REGARDLESS of where they fall on the autism spectrum.  Nonetheless, there certainly is more room for work intended to DEVELOP and REFINE best practices – especially better TARGETING OF STRATEGIES to SUB-GROUPS OF CHILDREN with particular combinations of limitations or strengths.

50.   

14:31:00 SEGMENT 05

Involving Parents 7:00 

51.   

CU BILL ROPER

Roper:

Thanks, Craig.  As we've heard a number of people say, most PARENTS of children with autism are the FIRST to realize that something IS wrong with their child even if they can't always define it clearly.  How is the Miami Dade County group approaching parents, Hugh?

52.   

CU HUGH TILSON

Tilson:

Well, Bill, you're right parents often do pick up the FIRST CLUES even if they don't know EXACTLY what they're seeing.  And for that reason Miami Dade County is actually suggesting that pediatricians INFORM parents early on if they suspect A-S-D.  They don't think parents like Marie-Ilene Whitehurst should have to put pressure on their pediatricians, as she did when she noticed her second child, Thomas was NOT meeting his developmental milestones.

53.   

TAPE: Cut – 7 A Parent's Reaction

RT: 2:35

OUTCUE: "and we need to help get the message out."

54.   

CU BILL ROPER

Roper:

Craig, if parents sense there's something DEVELOPMENTALLY WRONG with their child, as Marie-Ilene Whitehurst did, is there a CHECK LIST of SIGNS they can look for?

55.   

CU CRAIG NEWSCHAFFER

SS:

ASD Communication Indicators

·        Hasn't babbled, pointed or made gestures by one year

SS:

·        Hasn't spoken a word by 16 months

SS:

·        Hasn't spoken a two-word phrase by 2 years

SS:

·        Doesn't respond to name

SS:

·         Loses language or social skills

Newschaffer:

I wouldn't call it a checklist but there are some specific behaviors that may indicate a young child is at risk for A-S-D. The first set is related to COMMUNICATION.

If the child hasn't BABBLED, POINTED or MADE GESTURES by ONE YEAR.

If he or she HASN'T SPOKEN A WORD by 16 months

Or hasn't spoken a TWO-WORD PHRASE by 2 year.

If the child doesn't RESPOND to his or her NAME

Or LOSES LANGUAGE or SOCIAL SKILLS.

56.   

SS:

Other Indicators

·        Poor eye contact

SS:

·        Doesn't know how to play with toys

SS:

·        Lines up toys or other objects

SS:

·        Unusually attached or interested in particular toys/objects

SS:

Other Indicators

·        Doesn't smile socially

SS:

·        Has odd movement patterns

SS:

·        May appear at times to have a hearing impairment

OTHER INDICATORS that may be significant are:

If the child shows POOR EYE CONTACT

Or DOESN'T KNOW HOW TO PLAY with toys

Or LINES UP TOYS or OTHER OBJECTS

Or is UNUSUALLY ATTACHED or INTERESTED IN PARTICULAR TOYS or objects.

If the child DOESN'T SMILE SOCIALLY

Or has ODD MOVEMENT PATTERNS

Or may APPEAR at times to have a HEARING IMPAIRMENT.

All of these could be early signs of A-S-D or OTHER DEVELOPMENTAL PROBLEMS and are worth some follow-up, ESPECIALLY if they occur in combination..

57.   

14:38:00 SEGMENT 06

School & Beyond 7:00 

58.   

CU BILL ROPER

CG:

William Roper MD, MPH

Roper:

Thanks Craig.  Since there is no cure for autism, DETECTION is really just the BEGINNING in these individuals' lives.  Hugh, what is Miami Dade's APPROACH to children once they move into the school system?

59.   

CU HUGH TILSON

Tilson:

Bill, the SCHOOLS are indeed the THIRD LEG of the stool that supports children with autism, along with parents and the medical and health community.  And that's very much the approach that Dade County has adopted.  Let's hear about it.

60.   

TAPE: Cut-8 School & Beyond

RT: 3:24

**Give Tilson his laptop!***

OUTCUE: "… not just in my home."

61.   

CU BILL ROPER

Roper:

So Craig, the CHALLENGE of autism extends BEYOND school to adulthood.

62.   

CU CRAIG NEWSCHAFFER

Newschaffer:

That's correct.  The Miami case clearly underscores the fact that AUTISM is a LIFELONG IMPAIRMENT and considerable support is required to navigate routine educational and social situations. Now in terms of the level of impairment and consequent service needs of individuals with A-S-D, while these are variable, they're still quite high for even the least severe cases.  One recently published cost study on autism in Britain estimated the LIFETIME COSTS to society for a person with autism there to be NEARLY FOUR MILLION DOLLARS.  It is difficult to come up with this type of estimate here in the US, but, undoubtedly, the annual cost of autism in this country must amount to billions of dollars.  As doctor Allessandri's closing comment implied, even while we work hard to improve early detection and intervention and educational programs for school-age children, we also now need to make a concerted effort to IMPROVE SUPPORTS and create MORE OPPORTUNITIES for ADULTS with AUTISM.

63.   

Lastly, the case also dramatically underscores the fact that here's a disorder for which the LION SHARE of the intervention is NOT MEDICAL, but rather it's EDUCATIONAL.  So public health approaches to autism will require a stronger that usual partnership with Education Departments and other educational groups because that's where much of the expertise lies.  The shoe is to some extent on the other foot for Public Health. We're used to having the expertise and disseminating it to others.  So now in addition to moving ahead with our own research, we need to help COORDINATE and IMPROVE ACCESS to the knowledge and expertise of others.

64.   

CU BILL ROPER

Roper:

Thanks, Craig.  Jose, what do you see as the important CHALLENGES for PUBLIC HEALTH in dealing with autism in school and beyond?

65.   

CU JOSE CORDERO

Cordero:

Being able to identify children with autism early in childhood is really the key.  As the Miami case has suggested, when children are identified early they can begin receiving special education services BEFORE entry into the school system, which ultimately decreases the burden on public school systems.  In freeing up educational resources, a higher level of services can be made available to a greater number of students.  In addition, many adults with this condition are HIGH FUNCTIONING and have special skills and talents that they should have the opportunity to develop and use productively.  For this reason, public health needs to create collaborations at the community level to ensure EMPLOYMENT OPPORTUNITIES for ADULT INDIVIDUALS living with autism.

66.   

14:45:00 SEGMENT 07

Q&A Discussion 8:00 

67.   

CU BILL ROPER

SS:

United States:

Voice    (800) 793 – 8598

Fax        (800) 553 – 6323

TTY      (800) 815 – 8152

SS:

www.PublicHealthGrandRounds.unc.edu

Roper:

Thanks, Jose.  In a moment it'll be YOUR turn to ask questions and tell us about YOUR EXPERIENCES and BEST PRACTICES.  So let me remind you how to contact us.

our number is 800 7-9-3 – 8-5-9-8

Our fax number is 800 5-5-3 – 6-3-2-3

We also have a TTY number 800 8-1-5 – 8-1-5-2

And, you can also submit a question at our website at www dot Public Health Grand Rounds dot U-N-C dot E-D-U.

68.   

SS:

Discussion Forum

www.PublicHealthGrandRounds.unc.edu

Also, I'd like to remind you about our Discussion Forum on the WEB. Content experts from C-D-C and U-N-C will facilitate the on-line discussion.  THAT will start TODAY and run through July 3^rd   You're invited to ASK questions and SHARE your best practices.  Just go to w-w-w dot Public Health Grand Rounds, one-word, dot u-n-c dot e-d-u and click on the "Discussion Forum".

69.   

SS:

Resources

www.PublicHealthGrandRounds.unc.edu

While you're there, you can also to access our

ON-LINE Resources Page.  You'll find a selection of LINKS to useful resources on the web.

70.   

Hugh you've been checking our website.  Do you have any interesting questions for us?

Tilson:

[QUESTION]

Roper:

We have a call from [STATE]. Go ahead, please.

71.   

14:53:00 SEGMENT 08

Wrap-Up 7:00

72.   

CU BILL ROPER

Roper:

Unfortunately that's all the calls we have time for.

From PRIOR grand rounds, we know MANY OF YOU will have ADDITIONAL questions and comments. So please join us at our website discussion forum.  If you're looking for information, check out our Resource Page.  And now I'd like to ask each of our guests to share a few FINAL WORDS about our topic today, autism spectrum disorder.  Let me start with you, Jose.

73.   

CU JOSE CORDERO

Cordero:

CDC is committed to UNDERSTANDING the CAUSES of AUTISM, and finding the best treatments for autism.  ALL of us need to work to educate ourselves and others about the benefits of developmental screening and early intervention to help children with autism develop and reach their full potential.  I would also like to emphasize the importance of EXPANDING EPIDEMIOLOGIC SURVEILLANCE for autism throughout the United States.  Being able to accurately determine the prevalence and rates of autism, and conducting additional research that can help ISOLATE its CAUSES, are essential not only for the TREATMENT of autism, but for PREVENTION.  And at CDC, prevention is a central part of our mission.

74.   

CU BILL ROPER

Roper:

Craig, what's your TAKE HOME MESSAGE?

75.   

CU CRAIG NEWSHAFFER

Newschaffer:

As an EPIDEMIOLOGIST, I certainly agree with Jose that epidemiologic SURVEILLANCE is key.  It will give us the improved data we need for program planning.  ETIOLOGIC RESEARCH  is also crucial because this is the work that might give us CLUES  to prevention.

I think the Miami Dade County case shows us that at the LOCAL LEVEL innovation happens when all interested parties – Public Health professionals, clinicians, the Education System, social services and parents – find a way to come together.  This is a CHALLENGE given competing interests and constrained resources, but clearly this an attempt we need to make. 

76.   

CU BILL ROPER

Roper:

And Hugh, what words would you like to leave us with?

77.   

CU HUGH TILSON

Tilson:

Well, Bill, I couldn't miss the chance to THANK our terrific PUBLIC HEALTH GRAND ROUNDS team. THANKS too to all the good people in Miami Dade County, Florida. They're doing truly GROUNDBREAKING and IMPORTANT work for kids and adults with autism.  And I'd like to give THEM the FINAL WORD on this important challenge for public health.

78.   

TAPE: Cut-9 Final Words

RT:

OUTCUE: " step in the right direction."

79.   

CU BILL ROPER

Roper:

As public health professionals, we find ourselves uniquely placed to steer the community as a whole toward a more positive approach to autism spectrum disorder.  Many of us see children at an early age. With appropriate training, we can RECOGNIZE the SIGNS of A-S-D and help insure EARLY DETECTION. At the same time we need to FOSTER PARTNERSHIPS with the medical community, educational departments and academic institutions which have shown to be most effective in identifying and treating A-S-D.  By taking these actions, Public Health can become a better partner in the community.

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Website Address

www.PublicHealthGrandRounds.unc.edu

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E-mail

GrandRounds@sph.unc.edu

Before we go, my thanks to all our guests for joining us today.  I'd also like to thank you, our viewers, for being with us.  We know you represent the FULL SPECTRUM of community public health partners from teachers and parents to public health nurses.  Let us know what you think of today's program by going to our website and filling out the online evaluation form.  The address is: W-W-W dot Public Health Grand Rounds, one word, dot U-N-C dot E-D-U

If you want to receive continuing education credit, you must complete an on-line EVALUATION form.

If you have any difficulties, please e-mail us at

GrandRounds, one word, at S-P-H dot U-N-C dot        E-D-U.

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Website Address

www.PublicHealthGrandRounds.unc.edu

Again, when you visit our WEBSITE, take advantage of our Resource Page and the DISCUSSION FORUM where you can get additional questions answered and share your own ideas about our program.  This forum will be open between now and July 3^rd.

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Public Health Grand Rounds

Disease, Disaster, and Detection:  Partnering with Public Health Laboratories

September 26, 2003

2:00pm – 3:00pm ET

Public Health Grand Rounds will be back on September 26^th with another important topic.  Our program is titled Disease, Disaster, and Detection:  Partnering with Public Health Laboratories and we'll be looking at LOCAL HEALTH LABORATORIES and their IMPACT on the public's health.  So please mark that date on your calendars.

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Until then, on behalf of everyone at C-D-C, the Public Health Training Network and the School of Public Health at the University of North Carolina at Chapel Hill, I'm Bill Roper wishing you a good day from Atlanta.

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Production Credits

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Partners

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A Special Thanks To: (1)

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A Special Thanks To: (2)

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A Good Day From Atlanta

Music & Closing Credits

Soul Ballet – "Soul Ballet"

Cut #10 – "Round 12:01"@:27in