Handbook of Treatment Planning for Children with Autism and Other Neurodevelopmental Disorders

Notes on Language Use
Acknowledgments
Introduction
Contents
Contributors
Part I: Overview of Treatment Planning
	1: Treatment Planning for Children with Autism and Developmental Disability
		Introduction
		Treatment Planning
		Treatment Planning in General Medical Care: The Biomedical Model
		The Biopsychosocial Model
		Treatment Planning in Behavioral Health Care
		Treatment Planning in the Medical Home
		Elements of the SPoC
			SPoC: The Medical Summary
			SPoC: Goal Setting
			SPoC: Negotiated Actions
			SPoC: Coping Plan
			SPoC: Progress Monitoring
		Navigating Challenges in Treatment Planning
		Care Coordination
		Other Types of Service Plans
			Home- and Community-Based Services
			School-Based Services
			Court-Based Services
		Summary
		References
	2: Medical Home for Children with Autism Spectrum Disorder and Other Developmental Disabilities
		The Medical Home Concept
		Why the Medical Home Should Be the Locus of Care for Kids with Autism Spectrum Disorders and Other Developmental/Behavioral Disabilities
			Growing Numbers of Children Require Specialized Medical Care
			Pediatricians Are Uniquely Situated to Identify Care Needs
		Newborn Screening
			Screening for ASD
			The Medical Home Can Best Respond to Initial Concerns or a Positive Screen and Coordinate Care
			Role of the Medical Home in the Diagnostic Journey for Children with Developmental Delays
		Coordinating Referrals to Therapy Evaluations Before the Specialist Visit? Yes!
		Behavioral Therapy and Autism
		Autism-Specific Behavioral Therapy
			Applied Behavior Analysis (ABA)
			Verbal Behavior Therapy (VBT)
			Cognitive Behavioral Therapy (CBT)
			Developmental and Individual Differences Relationship (DIR) Therapy
			Relationship Development Intervention (RDI)
			Social Skills Groups
			Occupational Therapy for Sensory Processing
		Medical Specialty Referrals
		Care Coordination and the Medical Home
		The Medical Home “Toolbox”
		Autism Spectrum Disorder: The Diagnosis and Ongoing Care
		Pediatric Psychiatry Collaboratives
		Referrals Beyond the Medical Home Team
		Medical Home: Coordinated, Family-Centered Care That Improves Outcomes
		References
	3: The Family Perspective: Treatment Planning for Children with Autism Spectrum Disorder, Developmental Disabilities, and Medical Complexity
		Introduction
			A Lesson to Remember
			A Change in Perspective
		Overview
		Information for Parents and Caregivers
		Initial Red Flags: “My Child Versus the Typical Trajectory of Development”
		Developmental Disability: “What Are You Saying About My Child?”
		IDEA and Early Childhood Intervention Services: “My 3-Year-Old Can Go To School?”
		The Diagnostic Process: “We Have to See Another Specialist?”
			DSM-V Diagnostic Criteria for Autism Spectrum Disorder
			Diagnostic Considerations: The Evaluation of Differential Diagnoses and Comorbidities
			Recommendations for the Treatment of Autism Spectrum Disorder
		For Providers: The Provider-Family Relationship − “I’m an Expert About My Child Too Because I’m the Parent. Let’s Work Together”
		For Providers: What Your Patients Want You to Know
		Living with ASD, I/DD, and Medical Complexity: “Help Us By Respecting Us and Supporting Better Quality of Life”
			Preferred Language Matters
			Stages of Parental Development
			Proposed Stages for Parent Development for Families with a Child with Medical Complexity
			What Is Good Parenting?
			Parenting Styles
			Protective and Risk Factors
		Quality of Life
			Quality of Life for Children with ASD and Developmental Disabilities
			Quality of Life for Parents and Caregivers
		Instilling Hope: “What Is On the Horizon?”
		References
	4: Systems of Care for Children and Youth with Autism Spectrum Disorders
		Introduction
		Brief Historical Review of the Evolution of ASD Services
		Service System Roles in the Care of People with ASD
			Early Intervention Services
			Educational System
		Specialty Services
			Medical Specialties
			Psychological Specialties
			Occupational Therapists, Speech/Language Therapists, and Physical Therapists
			Private Providers
			Mental Health and Developmental Disorder/Intellectual Disability Agencies
			Academic Sector
			Residential Treatment Centers
		Role of Funding in Transforming and Shaping ASD Services
		Racial/Ethnic Disparities
		Framing ASD Services Within a Community-Based Systems of Care Model
		Conclusion
		References
	5: Progress Monitoring During the Treatment of Autism and Developmental Disorders
		Progress Monitoring Comorbid Conditions
			Anxiety Disorders
			Sleep Problems
			Challenging Behaviors
			Depression
			Attention Deficit/Hyperactivity Disorder
		Progress Monitoring Methods
		Progress Monitoring Challenges
		Progress Monitoring Limitations
			Limited Validity
			Potential Bias
			Limited Measures that Evaluate ASD Symptoms
		Individualized Progress Monitoring
		Progress Monitoring Throughout the Life Span
		Developments in Progress Monitoring
		Treatment Outcome Measures for ASD
		ASD-Specific Measures
			Autism Treatment Evaluation Checklist
			Childhood Autism Rating Scale
			Psychoeducational Profile
			Social Responsiveness Scale
		Developmental Measures
			Bayley Scales of Infant and Toddler Development
		Adaptive Measure
			Vineland Adaptive Behavior Scales
		Behavioral Measures
			Aberrant Behavior Checklist
			Behavior Assessment System for Children
			Children’s Sleep Habits Questionnaire
		Anxiety and Depression Measures
			Child Depression Inventory
			Multidimensional Anxiety Scale for Children
			Pediatric Anxiety Rating Scales
		Attention Deficit/Hyperactivity Disorder Measures
			ADHD Symptoms Rating Scale
		Summary
		References
Part II: Professional Perspectives on Treatment
	6: Allergy and Immunology in Autism Spectrum Disorder and Other Neurodevelopmental Disorders
		Introduction
		Brief Review of Basic Immunology
		Referring to an Allergist/Immunologist
		Primary Immunodeficiencies
			Humoral Immunity
				Common Variable Immunodeficiency (CVID)
				IgA Deficiency
				Agammaglobulinemia
				Hyper-IgM Syndromes
				IgG Subclass Deficiency
			T Cells and Cellular Immunity
				Combined Immunodeficiency (CID) and Severe Combined Immunodeficiency (SCID)
			Innate Deficiencies
				Chronic Granulomatous Disease (CGD)
				Leukocyte Adhesion Deficiency (LAD)
				Complement and Its Deficiencies
		Selected Neurodevelopmental Disorders with Associated Immune Defects
			Cornelia de Lange Syndrome
			Fetal Alcohol Syndrome
			Rubinstein-Taybi Syndrome (RTS)
			Smith-Magenis Syndrome
			Trisomy 21 (Down Syndrome)
			22q11.2 Deletion Syndrome
		Autism Spectrum Disorder and the Immune System
		Vaccinology
		Allergy
			Allergic Disease in ASD
			Food Allergy
			Allergic Rhinitis
			Rhinosinusitis
			Asthma
			Atopic Dermatitis (AD)
		Allergy Testing
			Serum Allergy Testing
			Skin Testing Process
			Oral Food Challenge
			Limitations and Potential Pitfalls
			Food Allergy Testing
			Medications Which Interfere with Skin Testing
		Future Treatment Options
		Conclusion
		References
	7: The Pediatric Cardiologist’s Role in the Care of Children with Autism and Other Intellectual and Developmental Disabilities
		The Role of Cardiology in the Pediatric Medical Home
		Scope of Congenital Heart Disease
		Mortality of Congenital Heart Defects
		Recommendations for Making Referrals
			Infants
			Toddlers and Preschoolers
			Older Children and Adolescents
			The Cardiovascular Examination
		Association of Congenital Heart Defects and Autism Spectrum Disorders
		Cardiac Considerations in Select Mental Disorders
			Attention Deficit Hyperactivity Disorder (ADHD)
			Anxiety Disorders
			Depression
		Responding to Symptoms
			Chest Pain
			Syncope
			Palpitations
		The Assessment and Treatment of Common Cardiac Conditions
			Clinical Examination
			Electrocardiogram
			Echocardiogram
			Cardiac Computerized Tomography Imaging (Cardiac CT)
			Cardiac Magnetic Resonance Imaging (Cardiac MRI)
			Managing Side Effects of Cardiac Medications
			Cardiac Catheterization
			Cardiac Surgery
		Additional Guidance for the Primary Care Pediatrician
		Assisting the Child and Family in Preparing for Appointments
		Future Directions and Upcoming Research
		References
	8: Oral Health Treatment Planning: Dental Disease Prevention and Oral Health Promotion for Children with Autism Spectrum Disorder and Developmental Disabilities
		Introduction
		Common Oral Conditions
			Gingivitis
			Malocclusion
			Tooth Decay (Dental Caries or Cavities)
		Addressing the Risk Factors for Tooth Decay
			Characteristics of ASD Associated with Tooth Decay
			Addressing Challenges to Good Oral Hygiene Behaviors
			Limiting Dietary Sugars
			Medication and Tooth Decay
			Access to Dental Care
		Additional Risk Factor Modification Strategies
			Strategies for Home
			Strategies for the Dentist’s Office
				Strategies During Dental Care
		Specifics of Dental Treatment
			Noninvasive Dental Treatment
			Protective Stabilization
			Sedation and General Anesthesia
			Referrals for Specialty Dental Treatment
		Transition to Adult-Centered Dental Care
		Future Directions
		References
	9: The Registered Dietitian Nutritionist’s Treatment of Children with Developmental Disabilities or Autism Spectrum Disorders
		Introduction
		Brief Overview of Pediatric Nutrition
		The Role of the RDN in Treating Children with Developmental Disabilities
		Overview of Feeding Problems in Children with ASD
			A Sensory Processing Connection to ASD and Nutritional Risk
			A Motor Connection to ASD and Nutritional Risk
			A Behavioral Connection to ASD and Nutritional Risk
		Dietary Intake in Children with ASD
		Referring Children to the RDN
			Comprehensive Screening
			Preparing the Family for an RDN Appointment
			What to Expect at the Appointment
		The RDNs Treatment of Children with ASD
		Obesity
		Gastrointestinal Dysfunction
		Sleep Disturbances
		Dietary Treatment of ASD
		Conclusion
		References
	10: Commonly Encountered Endocrine Problems in Children with Developmental Disabilities
		Introduction
		Common Disorders Treated by Endocrinologists
			Trisomy 21
				Brief Overview and Epidemiology
				Referral to the Pediatric Endocrinologist
			Turner Syndrome
				Definition and Epidemiology
				Problems Within the Scope of Pediatric Endocrinology
			Prader-Willi Syndrome
				Definition and Epidemiology
				Problems Within the Scope of Pediatric Endocrinology
			Russell-Silver Syndrome
				Definition and Epidemiology
				Problems Within the Scope of Pediatric Endocrinology
			Optic Nerve Hypoplasia Spectrum and Septo-optic Dysplasia
				Definition and Epidemiology
				Problems Within the Scope of Pediatric Endocrinology
		Other Disorders
			Attention-Deficit Hyperactivity Disorder
				Definition and Epidemiology
				Problems Within the Scope of Pediatric Endocrinology
			Fetal Alcohol Spectrum Disorder
				Definition and Epidemiology
				Problems Within the Scope of Pediatric Endocrinology
		Endocrine-Related Adverse Effects of Medications Commonly Used in the Treatment of Developmental/Behavioral Disorders
			Discussion on Meds Causing Weight Gain
				Overweight and Obesity
				Medications
		Closing Remarks
		References
	11: The INSPIRED Hospital Care of Children with Developmental Disability
		Introduction
		Call for Accommodations
		The INSPIRED Hospital Care Framework
			I, INFORM: Preparing for Hospitalization
			N, NETWORK: Interdisciplinary Care
			S, SCREEN/ASSESS: Tell Me More About You
			P, PREPARATION: Day-to-Day Experience in the Hospital
			I, IMPLEMENT: The Plan in Action
			R, REVIEW: How Did We Do?
			E, EVALUATE: Evaluate and Address Barriers to Care
			D, DREAM: Dream for a Better Tomorrow
		References
	12: Planning for Special Education Services: A Primer for Health-Care Professionals
		Introduction
		A Historical Perspective: A Rocky Start
		The Education for All Handicapped Children’s Act: Public Law (PL) 94-142
		Educationally Necessary Services
		Implementing PL 94-142: Referral and Evaluation
		Amendments to PL 94-142
		Individual Transition Plan (ITP)
		Public Law 105-17 (1997 Amendments to PL 94-142)
		Understanding the Individualized Educational Plans (IEPs) and the Individualized Accommodation Plans (IAPs)
		What Is Included in an IEP Versus What Is Included in an IAP
		Public Law 108-446 (2004 Amendments to PL 94-142)
		Individuals with Disabilities Education Improvement Act of 2004 (IDEIA or IDEA 2004)
		Response to Intervention (RTI), Positive Behavioral Interventions and Supports (PBIS), and Multi-Tiered System of Supports (MTSS)
		What Is PBIS?
		Functional Behavioral Assessments (FBAs) and Behavior Intervention Plans (BIPs)
		Individual Health Plans (IHPs)
		Individual Health Plans/Emergency Care Plans
		IHPs as Part of Section 504 of the Rehabilitation Act of 1973
		IHPs as Part of IDEA
		DSM-5 Versus ICD-11 Codes
		Summary
		References
	13: Pediatric Gastroenterology and Children with Autism Spectrum Disorder and Developmental Disabilities
		Introduction
		Universal Monitoring from GI Perspective
			Monitoring Physical Exam
			Growth Chart Monitoring: Identification of Failure to Thrive and Obesity
				Failure to Thrive
				Overweight and Obesity
			Abdominal Exam
			Skin and Physical Exam Findings Consistent with Micro- and Macronutrient Deficiencies
			Taking Stool Histories: Frequency and Consistency Including Bristol Stool Chart
			Screening Lab and Imaging Evaluation
		Treatment Planning for GI Care: Referrals
			Concerning Findings That Warrant Immediate Referral for Hospital Admission/ED (Emergency Department) Evaluation
			Referral to Outside Providers
		Overview of Specific GI Conditions
			Organic Conditions
				Failure to Thrive
				Vomiting
				Celiac Disease
				Gas and Bloating
				Inflammatory Bowel Disease
				Disorders of the Liver
				Jaundice
				Acute Hepatitis and Liver Failure
				Chronic Hepatitis
			Functional GI Conditions
				Selective Eating: Avoidant/Restrictive Food Intake Disorder
				Rumination
				Pica
				Constipation and Encopresis
				Functional Abdominal Pain
		Interventions and Working with Families
			Talking to Families
		Complementary and Alternative Medicine (CAM)-Based Approaches
			Diets
				Red Dye Diet
				Gluten-Free and Casein-Free Diet Without Evidence of Celiac Disease or Allergies
				Ketogenic Diet
				Microbiome Management
				Fecal Transplant
				Probiotics
		Conclusion
		References
	14: An Approach to the Genetic Evaluation of Children with Autism Spectrum Disorders
		Introduction
		An Overview of the Genetics of ASD
		A Review of Basic Concepts in Genetics and Genetic Testing
			The Building Blocks of Inheritance
			Review of Selected Genetic Tests
			The Karyotype
			Chromosome Microarray (CMA)
			Fluorescence In Situ Hybridization (FISH)
			Next-Generation Sequencing: Whole Exome Sequencing (WES) and Targeted Next-Generation Gene Panel Sequencing (NGS)
			Whole Genome Sequencing (WGS)
		The Genetic Evaluation of Children with ASD
			The History with a Focus on Genetics
			The Review of Systems
			Detailed Family History
			Physical Examination
			Genetic Testing for Patients with ASD
			Vignette 1: Marcus: The Evaluation of a Child with ASD Without an Obvious Syndrome or Other Causes
			CMA for ASD
			Fragile X Testing
			Vignette 1: Marcus’ Outcome
			Vignette 2: Lucia: The Evaluation of a Child with ASD and Classic Features of a Microdeletion Syndrome
			Vignette 2: Lucia’s Outcome
			Vignette 3: MaKayla: The Evaluation of a Child with ASD and Evidence for a Specific Single Gene Syndrome
			Vignette 3: MaKayla: Outcome
			Vignette 4: Ali: The Evaluation of a Macrocephalic Child with Evidence for a Specific Single Gene Syndrome
			Vignette 4: Ali: Outcome
			Vignette 5: Juan: The Evaluation of a Child with ASD Who May Have a Single Gene Disorder but Whose Findings Are Not Indicative of a Specific Diagnosis
			Vignette 5: Juan: Outcome
		Diagnostic Yields and Genetic Testing Algorithms for ASD
		ASD-Related Genetic Counseling
		Future Directions
		References
	15: Prematurity and Autism Spectrum Disorder
		Introduction
		Overview of Autism Spectrum Disorders from the Neonatologist’s Perspective
		The Brain of the Preterm Infant and ASD
			Injury and Infection
		Encephalopathy of Prematurity and Risk of ASD in Preterm Infants
			Neuroimaging for Identifying Neonates at Risk of ASD in Neonates Born Preterm
		Late Preterm Infants and ASD
		Monitoring for Early Signs of ASD
		Other Risk Factors Associated with Prematurity and ASD
			Advanced Paternal Age
			Assisted Reproductive Technology
			Maternal Medication Use
			Maternal Obesity
			Parental Psychiatric History
		Inhospital Interventions to Mitigate the Risk of ASD in Preterm Infants
		Fatty Acid Supplementation
		Neurodevelopmental Trajectory of Preterm Infants and Toddlers
			Post-NICU Care
			Ongoing Developmental Monitoring
		Recommendations
		References
	16: The Neurological Perspective: Autism Spectrum Disorders and Other Developmental Disabilities
		Introduction
		Epilepsy
		Pharmacological Management of Epilepsy
		Beyond the Pharmacological Management of Epilepsy
		Motor Disorders
		Motor Disorders: Developmental Coordination Disorder/Dyspraxias
			Motor Disorders: Stereotypies
		Sleep Disorders
		Neurological Considerations in the Diagnosis of ASD
			Screening for ASD
			Clinical Evaluation of ASD Symptoms
		Neurobiology: Insights from MRI Findings and Electrophysiologic Studies
			Neuroimaging
			Electrophysiological Studies
		Management
		Future Directions
		References
	17: The Management of Chronic Pain in Children with Autism and Developmental Disability
		Introduction
		Pain in Specific Developmental Disorders
			Autism Spectrum Disorder
			Cerebral Palsy
			Pain in Other Developmental Disorders
		Overview of Pain in Children with ASD/DD
		The Assessment and Management of Pain in Children with ASD/DD
			The Assessment of Pain in Children with ASD/DD
			The Management of Pain in Children with ASD/DD
			Pharmacological Management
			Physical Management of Pain
			Psychological Management of Pain
		Research Challenges in the Study of Pain Management in Children with ASD or DD
		Conclusion
		References
	18: Overview of Physical Therapy for Children with Autism and Other Intellectual and Developmental Disabilities
		Introduction
		Initiating Physical Therapy Services
		The Physical Therapy Assessment
			Infants and Toddlers
			School Age
			Transition to Adult Care
			The Functional Approach to Diagnosis
			Treatment Planning
		Physical Therapy for Specific Disorders
			Developmental Disability
			A Brief Review of General Movements
			PT Treatment for Children with Developmental Delay
			Autism Spectrum Disorder
		Cerebral Palsy
			The Evaluation of CP
			The Treatment of CP
		Future Directions in PT
		References
	19: Planning for Treatment of Children with Autism and Other Developmental Disabilities with the Child and Adolescent Psychiatrist
		Preparing for the Appointment
		How to Prepare a Family for a Referral
		What to Expect from the Initial Encounter with a Psychiatrist
		Components that Guide the Psychiatric Treatment Plan
			The Assessment
			Other Medical Disorders
		The Evolving Evaluation
		Advocating and Navigating the School System
		Telemedicine
		Psychiatry Coordinated Services
		Secondary Psychiatric Diagnoses
			Irritability in Autism
			Anxiety Disorders in ASD
			Attention-Deficit/Hyperactivity Disorder (ADHD)
			Disruptive Behavior Disorders
			Depression
			Obsessive-Compulsive Disorder (OCD)
			Psychosis and Schizophrenia
			Catatonia
			Akathisia
		Medication Management
			Antipsychotics
			Antidepressants
			Stimulants and Alpha-2 Agonists
			Antiepileptics
			Other Medications and Biological Treatments
				Buspirone
				Amantadine
				Melatonin
			Behavioral Therapies for ASD
			Limitations of ABA Therapy
			Other Psychotherapeutic Interventions for ASD
			Engaging Outside Supports
		References
	20: Autism Spectrum Disorders: Treatments and Psychological Interventions
		Introduction
			Sam’s Journey
		Treatment Planning
			Early Intervention Programs
			Speech–Language Pathology
			Occupational Therapy
			Occupational Therapy for Children from Birth to 3 Years: Early Intervention
			Sensory Processing Disorder
			Feeding Issues and Neurodevelopmental Disorders
			Intensive Interventions
			Applied Behavioral Analysis (ABA)
			The Early Start Denver Model (ESDM)
			TEACCH
			Floortime
			Behavioral Assessment
			Wandering and Neurodevelopmental Disorders
			Referral for Co-occurring Development Concerns
			Treatment for Psychological Comorbidities
			Psychotherapy
			Intellectual Disability and ASD
			Learning Disabilities and ASD
			ADHD and Autism Spectrum Disorder
			Genetics
		Summary
		References
	21: Occupational Therapy for Children with Autism Spectrum Disorder and Intellectual and Developmental Disability
		Introduction to Occupational Therapy
		Referral and Funding for Occupational Therapy Services
		Occupational Therapy Evaluation
			Vignette 1 – Matt – The Early Years – Mastering Feeding
				Matt – The Early School Years – Self-Care Skills
				Matt – The Teenage Years – Increasing Independence
		Occupational Therapy Intervention
			Vignette 2 – Tena – A Toddler at Risk for ASD
				Tena – The Early School Years – Increasing Challenges
				Tena – The Teenage Years – Self Advocacy
		References
	22: Treating Sleep Disturbances in Children with Developmental Disorders
		Introduction
		Sleep Disturbances in Children with ASD
			Sleep Disturbances in Children with Internalizing Disorders
				Anxiety
				Mood Disorders
			Sleep Disturbances in Children with Externalizing Disorders
				Attention-Deficit Hyperactivity Disorder
				Night Wakings in ASD and Developmental Disabilities (DD)
				Disruptive and Aggressive Behaviors
		Comorbid Conditions
			Respiratory Conditions
			Vision Impairment
			Epilepsy
			Down Syndrome
			Craniofacial Abnormalities
			Gastroesophageal Reflux Disease
			Neuromuscular Disorders
			Rett Syndrome
			Angelman Syndrome
			Smith–Magenis Syndrome
			Tuberous Sclerosis Complex
			Williams–Beuren Syndrome
			Prader–Willi Syndrome
			Neoplasms of the Central Nervous System
			Delayed Sleep Phase
		Molecular Basis of Sleep Disturbances in Children with ASD
		Interventions for the Treatment of Sleep Disturbance
			Behavioral Interventions
			Pharmacological Interventions
				Melatonin and Related Medications
				Alpha-2 (α2) Agonists
				Antipsychotic Medications
				Antidepressants
				GABA Receptor Agonists
				Anti-epileptic Medications
				Cannabis
				Antihistamines
		Clinical Pearls
		Conclusion
		References
	23: The Role of the SLP in the Evaluation and Treatment of Individuals with ASD and Other Neurodevelopmental Disorders
		Evaluation and Treatment/Intervention Planning
			Age Birth – Three
			Age 3–5
			Elementary School
			Beyond Elementary (Adolescent/Adult)
		References
	24: Urologic Care of Children with Autism Spectrum Disorders or other Neurodevelopmental Disorders
		Introduction
		Initial Observation and Patient History (A Urologist’s View)
		Review of Systems and Physical Exam
		Laboratory Testing
		Diagnostic Imaging
		Additional Urologic Tests
		A Review of Normal Toilet Training
		Treatments of Urologic Conditions
			Urinary Incontinence
			Enuresis
			Behavioral Therapy
			First-Line Therapy
			Second-Line Therapy
			Urinary Tract Infections
			Cryptorchidism and Hypospadias
		Common Urologic Conditions in Patients with Specific Neurodevelopmental Disorders
			Tuberous Sclerosis Complex
			Fragile X Syndrome
			Down Syndrome
			Neurofibromatosis Type 1
			Prader–Willi Syndrome
			CHARGE Syndrome
			Rett Syndrome
			Spina Bifida
			Initial Evaluation: Management of Spina Bifida in Newborns and Infants
			Management of Spina Bifida During Childhood
			Management of Spina Bifida During Adolescence and Adulthood
			Reconstructive Surgery in Patients with Spina Bifida
		Clinical Pearls
		Bibliography
	25: Treatment Planning for Transition to Adult Services
		Introduction
		Planning for Transition to Adult Heath Care
		The Cornerstone of Care: The Physician–Patient Relationship
		Welcoming Emerging Adults to Your Practice
			Understanding Emerging Adults
			Supported Decision Making and Medical Decision-Making Capacity with Emerging Adults
			Preparing Medical Staff to Welcome Emerging Adults
			Honing Communication Skills
			Preparing the Office to Welcome Emerging Adults
			Treatment Planning and Coordinating Care
			Anticipating Challenges to Care from Outside the Office
		Special Issues in the Treatment of Emerging Adults
			Substance-Related and Addictive Disorders
			Nicotine Products
			Gambling Disorder
			Gaming Disorder
			Addressing Sexuality with Emerging Adults
		Future Directions for the Transition of PLWD to Adult Medical Care
		References
Index