Autism among us: Rising Concerns and the Public Health Response

# Airdate June 20, 2003 2:00-3:00pm Eastern

Script: **Version 4 6/20/03 SHORT \*\*\*FINAL\*\*\***

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|   | **VIDEO**             | # AUDIO                                 |
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|   | **13:30:00 SEGMENT    |                                         |
|   | 00**                  |                                         |
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|   | **Pre-program Test    |                                         |
|   | 30:00**               |                                         |
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| 1 | **14:00:00 SEGMENT    |                                         |
| . | 01**                  |                                         |
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|   | **5:00**              |                                         |
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| 2 | TAPE: Cut -- 1        | outq... Music sting                     |
| . | Pre-Con & Open        |                                         |
|   |                       | Walter Trout -- Cut #6 -- *\'Through    |
|   | RT: 5:47              | The Eyes of Love\'*                     |
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| 3 | CU BILL ROPER         | Roper:                                  |
| . |                       |                                         |
|   | CG:                   | Hello, I\'m Bill Roper. Welcome to      |
|   |                       | another session of Public Health Grand  |
|   | William Roper MD, MPH | Rounds, a collaboration of the Centers  |
|   |                       | for Disease Control and Prevention, and |
|   | WS Panel              | 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.                              |
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| 4 | #                     | But first here are some important       |
| . |                       | CONTACT numbers if you\'re having       |
|   | # SS:                 | trouble receiving the program. For      |
|   |                       | TECHNICAL assistance call:              |
|   | U.S. Technical Help:  |                                         |
|   |                       | 800 7-2-8 8-2-3-2. That\'s 800 7-2-8    |
|   | \(800\) 728-8232      | 8-2-3-2                                 |
|   |                       |                                         |
|   | # SS:                 | Or for INTERNATIONAL viewers, please    |
|   |                       | call:                                   |
|   | International         |                                         |
|   | Technical Help:       | 4-0-4 6-3-9 1-2-8-9                     |
|   |                       |                                         |
|   | \(404\) 639-1289      | \[PAUSE\]                               |
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| 5 | CU BILL ROPER         | Roper:                                  |
| . |                       |                                         |
|   | CG:                   | With reported autism rates RISING among |
|   |                       | children, many communities are          |
|   | William Roper MD, MPH | 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.       |
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| 6 | TAPE: Cut -- 2 Tease  | OUTCUE: \" every child receives.\"      |
| . |                       |                                         |
|   | RT: 1:36              |                                         |
|   |                       |                                         |
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| 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.                         |
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| 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                  |
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| 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.      |
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| 1 | CU HUGH TILSON        | And as always, we have with us my       |
| 0 |                       | 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?           |
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| 1 | CU HUGH TILSON        | Tilson:                                 |
| 1 |                       |                                         |
| . |                       | 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.                        |
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| 1 | CU BILL ROPER         | Roper:                                  |
| 2 |                       |                                         |
| . | **SS:**               | That\'s right, this is a LIVE           |
|   |                       | INTERACTIVE program and we really want  |
|   | **[United             | you to write us or call in your         |
|   | S                     | QUESTIONS and COMMENTS on this timely   |
|   | tates:]{.underline}** | subject.                                |
|   |                       |                                         |
|   | Voice (800) 793 --    | So please call us at 800 7-9-3 --       |
|   | 8598                  | 8-5-9-8                                 |
|   |                       |                                         |
|   | Fax (800) 553 -- 6323 | Our fax number is 800 5-5-3 -- 6-3-2-3  |
|   |                       |                                         |
|   | TTY (800) 815 -- 8152 | We also have a TTY number 800 8-1-5 --  |
|   |                       | 8-1-5-2                                 |
|   | **SS:**               |                                         |
|   |                       | And, you can also submit a question at  |
|   | [www.PublicHealthGr   | our website at www dot Public Health    |
|   | andRounds.unc.edu](ht | Grand Rounds dot U-N-C dot E-D-U, where |
|   | tp://www.PublicHealth | Hugh will be monitoring.                |
|   | GrandRounds.unc.edu/) |                                         |
|   |                       | And now let\'s take a look at our       |
|   | CU BILL ROPER         | OBJECTIVES for today\'s program.        |
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| 1 | TAPE: Cut -- 3        | OUTCUE: \" children with ASD.\"         |
| 3 | Objectives            |                                         |
| . |                       |                                         |
|   | RT: 0:31              |                                         |
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| 1 | **14:05:00 SEGMENT    |                                         |
| 4 | 02**                  |                                         |
| . |                       |                                         |
|   | **What is ASD? 8:00** |                                         |
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| 1 | CU BILL ROPER         | Roper:                                  |
| 5 |                       |                                         |
| . |                       | 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?                     |
+---+-----------------------+-----------------------------------------+
| 1 | CU HUGH TILSON        | Tilson:                                 |
| 6 |                       |                                         |
| . | CG:                   | Bill, the group goes by the acronym of  |
|   |                       | CADDRE -- isn\'t that neat. It\'s short |
|   | Hugh Tilson, MD, DrPH | 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.                         |
+---+-----------------------+-----------------------------------------+
| 1 | TAPE: Cut-4 CADDRE    | OUTCUE: \"the best of public health.\"  |
| 7 |                       |                                         |
| . | RT: 4:04              |                                         |
|   |                       |                                         |
+---+-----------------------+-----------------------------------------+
| 1 | CU BILL ROPER         | Roper:                                  |
| 8 |                       |                                         |
| . |                       | 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?                        |
+---+-----------------------+-----------------------------------------+
| 1 | CU CRAIG NEWSCHAFFER  | Newschaffer:                            |
| 9 |                       |                                         |
| . | CG:                   | Today there are definitely MORE         |
|   |                       | CHILDREN diagnosed with autism. Since   |
|   | Craig J. Newschaffer, | autism became a recognized category for |
|   | PhD                   | 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.  |
+---+-----------------------+-----------------------------------------+
| 2 | **SS:**               | It\'s still hard to know EXACTLY what   |
| 0 |                       | the TRUE PREVALENCE of autism is, but a |
| . | Prevalence            | plausible range for autistic disorder,  |
|   |                       | the longer-recognized, more severe      |
|   | -   Autistic Disorder | form, is probably somewhere between 10  |
|   |     10-20 per 10,000  | and 20 per 10-thousand, and the         |
|   |                       | prevalence of all A-S-Ds may be in the  |
|   | -   All ASDs 20-60    | range of TWO TO THREE TIMES that. This  |
|   |     per 10,000        | is MUCH HIGHER than we thought it was   |
|   |                       | just ten years ago.                     |
+---+-----------------------+-----------------------------------------+
| 2 | CU BILL ROPER         | Roper:                                  |
| 1 |                       |                                         |
| . |                       | Thanks, Craig. Jose, what do we know    |
|   |                       | about the causes of autism?             |
+---+-----------------------+-----------------------------------------+
| 2 | CU JOSE CORDERO       | Cordero:                                |
| 2 |                       |                                         |
| . | CG:                   | One thing we have good evidence for,    |
|   |                       | and it was pointed out by the CADDRE    |
|   | José F. Cordero, MD,  | scientist, is that NO RESEARCH as of    |
|   | MPH                   | 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.                |
+---+-----------------------+-----------------------------------------+
| 2 |                       | Beyond that, as one speaker pointed     |
| 3 |                       | 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.                                 |
+---+-----------------------+-----------------------------------------+
| 2 | CU BILL ROPER         | Roper:                                  |
| 4 |                       |                                         |
| . |                       | What about NON-INHERITED causes? If not |
|   |                       | vaccines, is there any indication that  |
|   |                       | anything OTHER than genes could be a    |
|   |                       | risk factor?                            |
+---+-----------------------+-----------------------------------------+
| 2 | CU JOSE CORDERO       | Cordero:                                |
| 5 |                       |                                         |
| . |                       | 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.                   |
+---+-----------------------+-----------------------------------------+
| 2 | CU BILL ROPER         | Roper:                                  |
| 6 |                       |                                         |
| . |                       | Thanks, Jose. Since risk factor studies |
|   |                       | are still a work in progress, Craig, is |
|   |                       | there any practical PREVENTION STRATEGY |
|   |                       | now?                                    |
+---+-----------------------+-----------------------------------------+
| 2 | CU CRAIG NEWSCHAFFER  | Newschaffer:                            |
| 7 |                       |                                         |
| . |                       | 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.                                  |
+---+-----------------------+-----------------------------------------+
| 2 | **14:13:00 SEGMENT    |                                         |
| 8 | 03**                  |                                         |
| . |                       |                                         |
|   | **Forging a           |                                         |
|   | Partnership 8:00**    |                                         |
+---+-----------------------+-----------------------------------------+
| 2 | CU BILL ROPER         | Roper:                                  |
| 9 |                       |                                         |
| . |                       | 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.                             |
+---+-----------------------+-----------------------------------------+
| 3 | CU HUGH TILSON        | Tilson:                                 |
| 0 |                       |                                         |
| . | CG:                   | Bill, we did indeed discover a truly    |
|   |                       | remarkable partnership already in place |
|   | Hugh Tilson, MD, DrPH | 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.         |
+---+-----------------------+-----------------------------------------+
| 3 | TAPE: Cut-5 Miami     | OUTCUE: \" have a medical home?\"       |
| 1 | Dade County           |                                         |
| . |                       |                                         |
|   | RT: 3:10              |                                         |
+---+-----------------------+-----------------------------------------+
| 3 | CU BILL ROPER         | # Roper:                                |
| 2 |                       |                                         |
| . |                       | 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.                                 |
+---+-----------------------+-----------------------------------------+
| 3 | CU JOSE CORDERO       | Cordero:                                |
| 3 |                       |                                         |
| . | **SS:**               | Since 1997, the Department of Health    |
|   |                       | and Human Services has placed a high    |
|   | CDC ASD Initiatives   | priority on A-S-Ds. RESEARCH FUNDING    |
|   |                       | for autism has gone up considerably,    |
|   | -   Population-based  | from ELEVEN to FIFTY-SIX million        |
|   |     surveillance in 8 | DOLLARS within the National Institutes  |
|   |     states            | of Health alone. At the same time, both |
|   |                       | the CDC and NIH have developed NEW      |
|   | -   6 centers of      | INITIATIVES, building a federal         |
|   |     excellence in     | foundation for the public health        |
|   |     autism and        | response to autism. As part of the      |
|   |     developmental     | Children\'s Health Act of 2000, CDC is  |
|   |     disabilities      | supporting the development of           |
|   |     epidemiology      | population-based A-S-D SURVEILLANCE     |
|   |                       | projects in eight states and has funded |
|   | **SS:**               | six centers of excellence in autism and |
|   |                       | developmental disabilities epidemiology |
|   | NIH ASD Initiatives   | to conduct surveillance and to begin a  |
|   |                       | large, multi-centered autism            |
|   | -   5 centers of      | case-control study. These CDC projects  |
|   |     excellence in     | should provide more accurate A-S-D      |
|   |     autism clinical   | PREVALENCE estimates, and we hope they  |
|   |     and basic science | will lead to the discovery of           |
|   |     research          | MODIFIABLE risk factors. The            |
|   |                       | Children\'s Health Act also charged the |
|   | -   Autism            | NIH to fund at least FIVE CENTERS of    |
|   |     Coordinating      | EXCELLENCE in autism clinical and basic |
|   |     Committee         | 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.                                  |
+---+-----------------------+-----------------------------------------+
| 3 | CU JOSE CORDERO       | In addition, through the Individuals    |
| 4 |                       | 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.            |
+---+-----------------------+-----------------------------------------+
| 3 | CU BILL ROPER         | Roper:                                  |
| 5 |                       |                                         |
| . |                       | 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?  |
+---+-----------------------+-----------------------------------------+
| 3 | CU CRAIG NEWSCHAFFER  | Newschaffer:                            |
| 6 |                       |                                         |
| . | **SS:**               | I think that\'s true. It\'s important   |
|   |                       | to realize that these programs can be   |
|   | Early Intervention    | and are organized differently from      |
|   | Programs Run by:      | state to state. For example, the Early  |
|   |                       | Intervention Program is run through the |
|   | -   Health Dept in 26 | health department in 26 states,         |
|   |     states            | including Florida. It\'s run through    |
|   |                       | the state education department in 13    |
|   | -   Education Dept in | others. A human or social service       |
|   |     13 states         | department is the lead agency in five   |
|   |                       | more. And the remaining states have     |
|   | -   Human/Social      | still different arrangements. But, as   |
|   |     Service Dept in 5 | we saw in Florida, the KEY to a         |
|   |     states            | 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.                              |
+---+-----------------------+-----------------------------------------+
| 3 | **14:21:00 SEGMENT    |                                         |
| 7 | 04**                  |                                         |
| . |                       |                                         |
|   | **Early Diagnosis     |                                         |
|   | 10:00**               |                                         |
+---+-----------------------+-----------------------------------------+
| 3 | CU BILL ROPER         | Roper:                                  |
| 8 |                       |                                         |
| . | CG:                   | Thanks, Craig. One of our objectives    |
|   |                       | today is to identify the role that      |
|   | William Roper MD, MPH | 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.              |
+---+-----------------------+-----------------------------------------+
| 3 | CU HUGH TILSON        | Tilson:                                 |
| 9 |                       |                                         |
| . |                       | 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.                    |
+---+-----------------------+-----------------------------------------+
| 4 | TAPE: Cut-6 Early     | OUTCUE: \" the earliest you can get     |
| 0 | Diagnosis             | them, the better it is.\"               |
| . |                       |                                         |
|   | RT: 3:28              |                                         |
+---+-----------------------+-----------------------------------------+
| 4 | CU BILL ROPER         | Roper:                                  |
| 1 |                       |                                         |
| . |                       | 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?  |
+---+-----------------------+-----------------------------------------+
| 4 | # CU JOSE CORDERO     | Cordero:                                |
| 2 |                       |                                         |
| . | **SS:**               | The American Academies of Neurology and |
|   |                       | Pediatrics currently recommend that     |
|   | Autism Screening      | children FAILING ROUTINE DEVELOPMENTAL  |
|   | Tools                 | EXAMS be screened with either the       |
|   |                       | M-CHAT, short for Modified Checklist    |
|   | -   M-CHAT            | for Autism in Toddlers, or the Social   |
|   |                       | Communication Questionnaire. While      |
|   | -   Social            | these don\'t include direct             |
|   |     Communication     | observations of the child, they do ask  |
|   |     Questionnaire     | parents questions of whether kids show  |
|   |                       | SIGNS of this kind of behavior.         |
+---+-----------------------+-----------------------------------------+
| 4 |                       | However, existing tools vary in the     |
| 3 |                       | 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.                             |
+---+-----------------------+-----------------------------------------+
| 4 |                       | Given the inherent uncertainties of     |
| 4 |                       | 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.                       |
+---+-----------------------+-----------------------------------------+
| 4 | CU BILL ROPER         | Roper:                                  |
| 5 |                       |                                         |
| . |                       | 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?            |
+---+-----------------------+-----------------------------------------+
| 4 | #                     | Craig:                                  |
| 6 |  CU CRAIG NEWSCHAFFER |                                         |
| . |                       | In addition to supporting the research  |
|   | **SS: (BUILD)**       | Jose mentioned, we need to find ways to |
|   |                       | boost the efforts that exist IN OUR     |
|   | [Improving Early      | COMMUNITIES. For example, Early         |
|   | D                     | Intervention programs are limited in    |
|   | etection]{.underline} | the extent that they can ACTIVELY reach |
|   |                       | out and screen kids. The programs are a |
|   | -   Increase          | resource to which pediatricians,        |
|   |     awareness about   | nurses, pre-school teachers, and        |
|   |     autism and early  | parents can refer kids with concerns.   |
|   |     intervention      | So we need to work to INCREASE          |
|   |                       | AWARENESS ABOUT AUTISM and resources    |
|   |                       | like the Early Intervention program in  |
|   |                       | these groups.                           |
+---+-----------------------+-----------------------------------------+
| 4 | # SS:                 | As many of the Miami Dade County people |
| 7 |                       | suggested, we also need to find ways of |
| . | # Encourage more ini  | encouraging and enabling pediatricians  |
|   | tial developmental sc | to do MORE INITIAL DEVELOPMENTAL        |
|   | reening and referral  | SCREENING and then refer on to Early    |
|   | to early intervention | Intervention.                           |
|   |                       |                                         |
|   | **SS: (BUILD)**       | We then need to assure Early            |
|   |                       | Intervention programs are aware of the  |
|   | [Improving Early      | latest thinking on and techniques       |
|   | D                     | for A-S-D early-recognition.            |
|   | etection]{.underline} |                                         |
|   |                       | Next there has to be sufficient pools   |
|   | -   Assure Early      | of clinical expertise in the community  |
|   |     Intervention      | to MAKE DEFINITIVE DIAGNOSES. Helping   |
|   |     programs use      | to develop these clinical resources and |
|   |     latest techniques | finding ways to improve access to them  |
|   |     for ASD           | is also an important challenge.         |
|   |     early-recognition |                                         |
|   |                       |                                         |
|   | **SS:**               |                                         |
|   |                       |                                         |
|   | -   Assure sufficient |                                         |
|   |     clinical          |                                         |
|   |     expertise         |                                         |
+---+-----------------------+-----------------------------------------+
| 4 | # CU BILL ROPER       | Roper:                                  |
| 8 |                       |                                         |
| . |                       | 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?      |
+---+-----------------------+-----------------------------------------+
| 4 | #                     | Newschaffer:                            |
| 9 |  CU CRAIG 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.                              |
+---+-----------------------+-----------------------------------------+
| 5 | **14:31:00 SEGMENT    | #                                       |
| 0 | 05**                  |                                         |
| . |                       |                                         |
|   | **Involving Parents   |                                         |
|   | 7:00**                |                                         |
+---+-----------------------+-----------------------------------------+
| 5 | CU BILL ROPER         | Roper:                                  |
| 1 |                       |                                         |
| . |                       | 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? |
+---+-----------------------+-----------------------------------------+
| 5 | # CU HUGH TILSON      | Tilson:                                 |
| 2 |                       |                                         |
| . |                       | 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.                             |
+---+-----------------------+-----------------------------------------+
| 5 | # TAPE: Cut -- 7      | OUTCUE: \"and we need to help get the   |
| 3 | A Parent\'s Reaction  | message out.\"                          |
| . |                       |                                         |
|   | RT: 2:35              |                                         |
+---+-----------------------+-----------------------------------------+
| 5 | CU BILL ROPER         | Roper:                                  |
| 4 |                       |                                         |
| . |                       | 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?                      |
+---+-----------------------+-----------------------------------------+
| 5 | CU CRAIG NEWSCHAFFER  | Newschaffer:                            |
| 5 |                       |                                         |
| . | **SS:**               | I wouldn\'t call it a checklist but     |
|   |                       | there are some specific behaviors that  |
|   | [ASD Communication    | may indicate a young child is at risk   |
|   | In                    | for A-S-D. The first set is related to  |
|   | dicators]{.underline} | COMMUNICATION.                          |
|   |                       |                                         |
|   | -   Hasn\'t babbled,  | If the child hasn\'t BABBLED, POINTED   |
|   |     pointed or made   | or MADE GESTURES by ONE YEAR.           |
|   |     gestures by one   |                                         |
|   |     year              | If he or she HASN\'T SPOKEN A WORD by   |
|   |                       | 16 months                               |
|   | **SS:**               |                                         |
|   |                       | Or hasn\'t spoken a TWO-WORD PHRASE by  |
|   | -   Hasn\'t spoken a  | 2 year.                                 |
|   |     word by 16 months |                                         |
|   |                       | If the child doesn\'t RESPOND to his or |
|   | **SS:**               | her NAME                                |
|   |                       |                                         |
|   | -   Hasn\'t spoken a  | Or LOSES LANGUAGE or SOCIAL SKILLS.     |
|   |     two-word phrase   |                                         |
|   |     by 2 years        |                                         |
|   |                       |                                         |
|   | **SS:**               |                                         |
|   |                       |                                         |
|   | -   Doesn\'t respond  |                                         |
|   |     to name           |                                         |
|   |                       |                                         |
|   | **SS:**               |                                         |
|   |                       |                                         |
|   | -   Loses language or |                                         |
|   |     social skills     |                                         |
+---+-----------------------+-----------------------------------------+
| 5 | **SS:**               | OTHER INDICATORS that may be            |
| 6 |                       | significant are:                        |
| . | [Other                |                                         |
|   | In                    | If the child shows POOR EYE CONTACT     |
|   | dicators]{.underline} |                                         |
|   |                       | Or DOESN\'T KNOW HOW TO PLAY with toys  |
|   | -   Poor eye contact  |                                         |
|   |                       | Or LINES UP TOYS or OTHER OBJECTS       |
|   | **SS:**               |                                         |
|   |                       | Or is UNUSUALLY ATTACHED or INTERESTED  |
|   | -   Doesn\'t know how | IN PARTICULAR TOYS or objects.          |
|   |     to play with toys |                                         |
|   |                       | If the child DOESN\'T SMILE SOCIALLY    |
|   | **SS:**               |                                         |
|   |                       | Or has ODD MOVEMENT PATTERNS            |
|   | -   Lines up toys or  |                                         |
|   |     other objects     | # Or may APPEAR                         |
|   |                       |  at times to have a HEARING IMPAIRMENT. |
|   | **SS:**               |                                         |
|   |                       | All of these could be early signs of    |
|   | -   Unusually         | A-S-D or OTHER DEVELOPMENTAL PROBLEMS   |
|   |     attached or       | and are worth some follow-up,           |
|   |     interested in     | ESPECIALLY if they occur in             |
|   |     particular        | combination..                           |
|   |     toys/objects      |                                         |
|   |                       |                                         |
|   | **SS:**               |                                         |
|   |                       |                                         |
|   | [Other                |                                         |
|   | In                    |                                         |
|   | dicators]{.underline} |                                         |
|   |                       |                                         |
|   | -   Doesn\'t smile    |                                         |
|   |     socially          |                                         |
|   |                       |                                         |
|   | **SS:**               |                                         |
|   |                       |                                         |
|   | -   Has odd movement  |                                         |
|   |     patterns          |                                         |
|   |                       |                                         |
|   | **SS:**               |                                         |
|   |                       |                                         |
|   | -   May appear at     |                                         |
|   |     times to have a   |                                         |
|   |     hearing           |                                         |
|   |     impairment        |                                         |
+---+-----------------------+-----------------------------------------+
| 5 | **14:38:00 SEGMENT    | #                                       |
| 7 | 06**                  |                                         |
| . |                       |                                         |
|   | **School & Beyond     |                                         |
|   | 7:00**                |                                         |
+---+-----------------------+-----------------------------------------+
| 5 | CU BILL ROPER         | Roper:                                  |
| 8 |                       |                                         |
| . | CG:                   | Thanks Craig. Since there is no cure    |
|   |                       | for autism, DETECTION is really just    |
|   | William Roper MD, MPH | the BEGINNING in these individuals\'    |
|   |                       | lives. Hugh, what is Miami Dade\'s      |
|   |                       | APPROACH to children once they move     |
|   |                       | into the school system?                 |
+---+-----------------------+-----------------------------------------+
| 5 | CU HUGH TILSON        | Tilson:                                 |
| 9 |                       |                                         |
| . |                       | 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.                               |
+---+-----------------------+-----------------------------------------+
| 6 | TAPE: Cut-8 School &  | # OUTCUE: \"... not just in my home.\"  |
| 0 | Beyond                |                                         |
| . |                       |                                         |
|   | RT: 3:24              |                                         |
|   |                       |                                         |
|   | **\*\*Give Tilson his |                                         |
|   | laptop!\*\*\***       |                                         |
+---+-----------------------+-----------------------------------------+
| 6 | CU BILL ROPER         | # Roper:                                |
| 1 |                       |                                         |
| . |                       | So Craig, the CHALLENGE of autism       |
|   |                       | extends BEYOND school to adulthood.     |
+---+-----------------------+-----------------------------------------+
| 6 | CU CRAIG NEWSCHAFFER  | Newschaffer:                            |
| 2 |                       |                                         |
| . |                       | 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.                                 |
+---+-----------------------+-----------------------------------------+
| 6 |                       | # Lastly, the cas                       |
| 3 |                       | e also dramatically underscores the fac |
| . |                       | t 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 w |
|   |                       | ill require a stronger that usual partn |
|   |                       | ership with Education Departments and o |
|   |                       | ther educational groups because that\'s |
|   |                       |  where much of the expertise lies. The  |
|   |                       | shoe is to some extent on the other foo |
|   |                       | t for Public Health. We\'re used to hav |
|   |                       | ing the expertise and disseminating it  |
|   |                       | to others. So now in addition to moving |
|   |                       |  ahead with our own research, we need t |
|   |                       | o help COORDINATE and IMPROVE ACCESS to |
|   |                       |  the knowledge and expertise of others. |
+---+-----------------------+-----------------------------------------+
| 6 | CU BILL ROPER         | # Roper:                                |
| 4 |                       |                                         |
| . |                       | Thanks, Craig. Jose, what do you see as |
|   |                       | the important CHALLENGES for PUBLIC     |
|   |                       | HEALTH in dealing with autism in school |
|   |                       | and beyond?                             |
+---+-----------------------+-----------------------------------------+
| 6 | CU JOSE CORDERO       | Cordero:                                |
| 5 |                       |                                         |
| . |                       | 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.   |
+---+-----------------------+-----------------------------------------+
| 6 | **14:45:00 SEGMENT    | #                                       |
| 6 | 07**                  |                                         |
| . |                       |                                         |
|   | **Q&A Discussion      |                                         |
|   | 8:00**                |                                         |
+---+-----------------------+-----------------------------------------+
| 6 | CU BILL ROPER         | # Roper:                                |
| 7 |                       |                                         |
| . | **SS:**               | Thanks, Jose. In a moment it\'ll be     |
|   |                       | YOUR turn to ask questions and tell us  |
|   | **[United             | about YOUR EXPERIENCES and BEST         |
|   | S                     | PRACTICES. So let me remind you how to  |
|   | tates:]{.underline}** | contact us.                             |
|   |                       |                                         |
|   | Voice (800) 793 --    | our number is 800 7-9-3 -- 8-5-9-8      |
|   | 8598                  |                                         |
|   |                       | Our fax number is 800 5-5-3 -- 6-3-2-3  |
|   | Fax (800) 553 -- 6323 |                                         |
|   |                       | We also have a TTY number 800 8-1-5 --  |
|   | TTY (800) 815 -- 8152 | 8-1-5-2                                 |
|   |                       |                                         |
|   | **SS:**               | And, you can also submit a question at  |
|   |                       | our website at www dot Public Health    |
|   | [www.Public](ht       | Grand Rounds dot U-N-C dot E-D-U.       |
|   | tp://www.Public/)Heal |                                         |
|   | thGrandRounds.unc.edu |                                         |
+---+-----------------------+-----------------------------------------+
| 6 | **SS:**               | Also, I\'d like to remind you about our |
| 8 |                       | Discussion Forum on the WEB. Content    |
| . | Discussion Forum      | experts from C-D-C and U-N-C will       |
|   |                       | facilitate the on-line discussion. THAT |
|   | [www.PublicHealthGr   | will start TODAY and run through July   |
|   | andRounds.unc.edu](ht | 3^rd^ You\'re invited to ASK questions  |
|   | tp://www.PublicHealth | and SHARE your best practices. Just go  |
|   | GrandRounds.unc.edu/) | 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\".  |
+---+-----------------------+-----------------------------------------+
| 6 | # SS:                 | While you\'re there, you can also to    |
| 9 |                       | access our                              |
| . | Resources             |                                         |
|   |                       | ON-LINE Resources Page. You\'ll find a  |
|   | [www.PublicHealthGr   | selection of LINKS to useful resources  |
|   | andRounds.unc.edu](ht | on the web.                             |
|   | tp://www.PublicHealth |                                         |
|   | GrandRounds.unc.edu/) |                                         |
+---+-----------------------+-----------------------------------------+
| 7 |                       | Hugh you\'ve been checking our website. |
| 0 |                       | Do you have any interesting questions   |
| . |                       | for us?                                 |
|   |                       |                                         |
|   |                       | Tilson:                                 |
|   |                       |                                         |
|   |                       | \[QUESTION\]                            |
|   |                       |                                         |
|   |                       | Roper:                                  |
|   |                       |                                         |
|   |                       | We have a call from \[STATE\]. Go       |
|   |                       | ahead, please.                          |
+---+-----------------------+-----------------------------------------+
| 7 | **14:53:00 SEGMENT    |                                         |
| 1 | 08**                  |                                         |
| . |                       |                                         |
|   | **Wrap-Up 7:00**      |                                         |
+---+-----------------------+-----------------------------------------+
| 7 | CU BILL ROPER         | Roper:                                  |
| 2 |                       |                                         |
| . |                       | 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.                              |
+---+-----------------------+-----------------------------------------+
| 7 | CU JOSE CORDERO       | Cordero:                                |
| 3 |                       |                                         |
| . |                       | 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.            |
+---+-----------------------+-----------------------------------------+
| 7 | CU BILL ROPER         | Roper:                                  |
| 4 |                       |                                         |
| . |                       | Craig, what\'s your TAKE HOME MESSAGE?  |
|   |                       |                                         |
+---+-----------------------+-----------------------------------------+
| 7 | CU CRAIG NEWSHAFFER   | Newschaffer:                            |
| 5 |                       |                                         |
| . |                       | 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.             |
+---+-----------------------+-----------------------------------------+
| 7 | CU BILL ROPER         | Roper:                                  |
| 6 |                       |                                         |
| . |                       | And Hugh, what words would you like to  |
|   |                       | leave us with?                          |
+---+-----------------------+-----------------------------------------+
| 7 | CU HUGH TILSON        | Tilson:                                 |
| 7 |                       |                                         |
| . |                       | 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.                                 |
+---+-----------------------+-----------------------------------------+
| 7 | TAPE: Cut-9 Final     | OUTCUE: \" step in the right            |
| 8 | Words                 | direction.\"                            |
| . |                       |                                         |
|   | RT:                   |                                         |
+---+-----------------------+-----------------------------------------+
| 7 | CU BILL ROPER         | Roper:                                  |
| 9 |                       |                                         |
| . |                       | 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.        |
+---+-----------------------+-----------------------------------------+
| 8 | **SS:**               | Before we go, my thanks to all our      |
| 0 |                       | guests for joining us today. I\'d also  |
| . | Website Address       | like to thank you, our viewers, for     |
|   |                       | being with us. We know you represent    |
|   | www.PublicHeal        | the FULL SPECTRUM of community public   |
|   | thGrandRounds.unc.edu | health partners from teachers and       |
|   |                       | parents to public health nurses. Let us |
|   | **SS:**               | know what you think of today\'s program |
|   |                       | by going to our website and filling out |
|   | E-mail                | the online evaluation form. The address |
|   |                       | is: W-W-W dot Public Health Grand       |
|   | <Gra                  | Rounds, one word, dot U-N-C dot E-D-U   |
|   | ndRounds@sph.unc.edu> |                                         |
|   |                       | 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.                        |
+---+-----------------------+-----------------------------------------+
| 8 | **SS:**               | Again, when you visit our WEBSITE, take |
| 1 |                       | advantage of our Resource Page and the  |
| . | Website Address       | DISCUSSION FORUM where you can get      |
|   |                       | additional questions answered and share |
|   | www.PublicHeal        | your own ideas about our program. This  |
|   | thGrandRounds.unc.edu | forum will be open between now and July |
|   |                       | 3^rd^.                                  |
+---+-----------------------+-----------------------------------------+
| 8 | **SS:**               | Public Health Grand Rounds will be back |
| 2 |                       | on September 26^th^ with another        |
| . | # Publi               | important topic. Our program is titled  |
|   | c Health Grand Rounds | Disease, Disaster, and Detection:       |
|   |                       | Partnering with Public Health           |
|   | Disease, Disaster,    | Laboratories and we\'ll be looking at   |
|   | and Detection:        | LOCAL HEALTH LABORATORIES and their     |
|   | Partnering with       | IMPACT on the public\'s health. So      |
|   | Public Health         | please mark that date on your           |
|   | Laboratories          | calendars.                              |
|   |                       |                                         |
|   | # September 26, 2003  |                                         |
|   |                       |                                         |
|   | 2:00pm -- 3:00pm ET   |                                         |
+---+-----------------------+-----------------------------------------+
| 8 |                       | Until then, on behalf of everyone at    |
| 3 |                       | 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.            |
+---+-----------------------+-----------------------------------------+
| 8 | **SS:**               | Music & Closing Credits                 |
| 4 |                       |                                         |
| . | Production Credits    | Soul Ballet -- \"Soul Ballet\"          |
|   |                       |                                         |
|   | **SS:**               | Cut #10 -- **\"Round 12:01\"**@:27in    |
|   |                       |                                         |
|   | Partners              |                                         |
|   |                       |                                         |
|   | **SS:**               |                                         |
|   |                       |                                         |
|   | A Special Thanks To:  |                                         |
|   | (1)                   |                                         |
|   |                       |                                         |
|   | **SS:**               |                                         |
|   |                       |                                         |
|   | A Special Thanks To:  |                                         |
|   | (2)                   |                                         |
|   |                       |                                         |
|   | **SS:**               |                                         |
|   |                       |                                         |
|   | A Good Day From       |                                         |
|   | Atlanta               |                                         |
+---+-----------------------+-----------------------------------------+