American Academy of Pediatrics, Oct. 11-14, 2008

American Academy of Pediatrics 2008 National Conference & Exhibition

The American Academy of Pediatrics 2008 National Conference & Exhibition took place Oct. 11 to 14 in Boston and attracted about 11,000 attendees, including more than 7,000 pediatricians. Highlights included sessions on autism, immunization, early brain development, and the Patient Centered Medical Home initiative, which is aimed at increasing the number of primary care physicians.

"Autism -- and the controversy surrounding it -- is a big topic for the academy," said the academy's new president, David Tayloe, Jr., M.D., of Goldsboro, N.C. "Because autism spectrum disorders now affect one out of every 160 children, some segments of the autism community have concluded that vaccines might cause autism, even though there have been 14 studies showing that there's no scientific link. This controversy creates a lot of pressure on the academy to represent an immunization program. In November 2007, we released a policy statement on autism along with a tool kit designed to help pediatricians do a better job at making the diagnosis and steering parents in the direction of evidence-based therapy."

One of the sessions -- "It Is Autism?" -- addressed a common dilemma faced by pediatricians: how to respond to parents who want to know if their children are autistic or have some other developmental disorder. Led by Susan Hyman, M.D., of the University of Rochester School of Medicine, and Amy Wetherby, Ph.D., of Florida State University, the session acknowledged the importance of discussing both the functional and biologic aspects of autism.

"Autism is a very heterogeneous or varied diagnosis," Hyman said in a statement. "It's made by application of behavioral symptoms. There are biologic causes for each of the symptoms of autism so that every child who has a behavioral diagnosis of autism, as defined by meeting DSM-IV criteria, needs to be considered for the biologic causes. When I look at a child with autism-related disorders, I separate the comorbid diagnoses into two categories: One is functional diagnoses and the other is biologic diagnoses."

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Other sessions addressed the environmental factors that influence early brain development, highlighting research showing that a lack of parental interaction during the first two years of life -- especially with mothers -- can lead to a mental health disorder called reactive attachment disorder. "It's usually obvious by kindergarten and is very difficult to treat. Children with reactive attachment disorder are highly impulsive and very aggressive," Tayloe said.

"This research has led to changes in our practices," Tayloe added. "Soon after birth, and certainly at the two-week checkup, we explain to mothers and fathers how important it is whenever their baby is awake to hold the baby in front of them and talk to him or her. The amount of time a baby gets with a loving parent talking and smiling about 14 inches from their face appears to be extremely important to early brain development."

Tayloe also cited the practice-changing work done by the national Patient Centered Medical Home initiative. "This project involves the business community, the major health insurance companies, the federal government, and primary care physician organizations (internal medicine, family medicine, pediatrics, osteopathic medicine)," he said. "This initiative is trying to do something about the fact that the number of medical students choosing primary care professions is shrinking quickly, making it increasingly difficult for patients to find primary care physicians. The AAP invented the term 'medical home' in 1967, so we are at the table assisting the Patient Centered Medical Home movement in reaching its goals."

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Many conference-goers expressed excitement about the upcoming presidential election. "In the last eight years, children have lost ground," Tayloe said. "The amount of discretionary federal money going to children has dropped 10 percent. So we're hoping for a brighter day. Of course, no one yet knows what changes a new administration will bring. But we don't think it could get any worse."

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Physician's Briefing