Winter 2019
Altruism for autism

synapse: University of Nevada, Reno School of Medicine

Speech pathology staff on playground

In addition to evaluating three complicated cases per month, the UCAN Assessment Team provides training opportunities to community providers and learners. Row 1: Danielle Stage, M.D., pediatrician; Giselle Marquez (seated), speech pathology undergraduate student; and Dawn Swanson, licensed clinical social worker and NvLEND trainee; Row 2: Dan Gunnarson, Ph.D., clinical psychologist; Stephanie King (seated), speech pathology doctoral student; and Jan Marson, OTD, occupational therapist; Row 3: Debra Vigil, Ph.D., director of the UCAN team and associate professor of speech pathology and audiology; and Diane Thorkildson, MPH, UCAN clinic coordinator. Photo: Brin Reynolds

Gift creates new position for interdisciplinary autism assessment team

By Christy Jerz

According to the Centers for Disease Control and Prevention, autism spectrum disorder (ASD) affects 1 in 59 children. Despite a highly public profile, the disorder is a challenge to diagnose, often misdiagnosed or missed entirely. The University Center for Autism and Neurodevelopment (UCAN) Assessment Team is improving the distinction between autism and other neurodevelopmental disorders for people ages 18 months to 22 years.

Housed within the School of Medicine's Department of Speech Pathology and Audiology, UCAN has served northern Nevada since 2006, providing affordable access to assessment, individualized outcomes and a meaningful impact on local children and families. Team members represent the fields of child psychiatry, child psychology, marriage and family therapy, speech language pathology, social work, human development and occupational therapy.

Much like the U.S. Supreme Court, not every case makes it to the UCAN team.
Following a review of each case, Dr. Vigil and the program coordinator make a clinical decision to determine next steps - in most cases, connecting families with community organizations so they can begin receiving services immediately. Of the hundreds of calls that come in each year, the UCAN team focuses on the 36 most complicated cases, sometimes involving conflicting diagnoses.

A founding member of the UCAN team, Jan Marson, OTD, has witnessed the challenge of accurate ASD diagnoses throughout her multi-decade career. Marson serves as chair for the Nevada Rural Children's Mental Health Consortium, and is involved in child advocacy and policy development in the management and care of neurodevelopmental conditions in children and youth.

"Dr. Marson has been involved with kids for years and years in the Reno area, as well as our rural communities," said Debra Vigil, Ph.D., director of the UCAN team and associate professor of speech pathology and audiology. "She cares deeply about what happens to these children. That's where her heart is."

"Our UCAN team represents a variety of disciplines, but we were missing one critical member - a pediatrician," said Marson. "A pediatrician could provide valuable distinctions between autism and other disorders as well as make referrals for medically managed interventions, especially for families who don't have a pediatrician of their own. By having the right physician available, early intervention will help children lead better lives."

While the UCAN team was in wholehearted agreement, they were also keenly aware of their budget limitations. The program is mainly supported by federal and state grants and simply couldn't absorb the cost of a pediatrician. "That's when Dr. Marson said, ‘We need somebody, and I'll pay for it,'" said Vigil.

Marson gifted $5,000 to UCAN, the amount needed to invite a pediatrician into the assessment conversation each month. They found the right physician in UNR Med graduate Danielle Stage, M.D. '10, a Spanish-speaking pediatrician with Community Health Alliance.

Dr. Stage had recently completed the Nevada Leadership Education in Neurodevelopmental and Related Disabilities (NvLEND) training program. Housed within the College of Education's Nevada Center for Excellence in Disabilities, NvLEND improves the health of infants, children, and adolescents with autism and other disabilities by preparing practicing professionals, parents, and graduate trainees to assume leadership roles and clinical competence in their respective fields. Stage had also completed Autism Diagnostic Observation Schedule training, considered the gold standard instrument for assessing autism regardless of age, developmental level and language skills.

For the three cases that are accepted for evaluation each month, the UCAN assessment process is extensive. Prior to meeting with the team, families are administered various interviews and surveys, a sensory profile, cognitive testing, a speech and language evaluation, and observation. The child is observed in a natural environment, and additional behavioral and educational questionnaires are completed by parents and teachers.

During a four-hour evaluation on the University campus, the UCAN team administers and scores the Autism Diagnostic Observation Schedule (ADOS), conducts additional parent interviews and observation of the child and discusses diagnoses and recommendations with the parents. Families receive scheduled follow ups to ensure ongoing support for UCAN's treatment recommendations.

"Early intervention for young children with autism is effective for improving IQ, language ability and social interaction," said Vigil. "By starting as soon as a child is diagnosed, we're able to maximize the positive impact of the intervention."

Visit the UCAN Assessment Clinic website to learn more. For School of Medicine giving opportunities, contact Shari Netzel, director of development, at (775) 682-6077.