Parents Predicts: The Big Issues for 2014

A look ahead at the children's health and development stories you'll be hearing about next year.

How "Obamacare" affects children and families

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Alexandra Grablewski

The Affordable Care Act (ACA) -- a loaded topic if ever there was one. At press time, the much-maligned website was working 90 percent of the time, compared to 43 percent in October. So it stands to reason that most of the people who are seeking new coverage during this open enrollment period (which ends March 31 for coverage starting in 2014) will be able to get the information they're looking for. But site functionality isn't the biggest issue when it comes to children; it's whether all children will be covered under ACA, and whether families will indeed be able to select a better and more affordable plan. To help cut through the inevitable confusion, the American Academy of Pediatrics (AAP) has created a helpful interactive map linking to state-specific fact sheets that will help parents learn more about the insurance options in their state. The map will also take them to each state's health insurance marketplace.

Come January 1, 2014, a key part of ACA will be implemented: Insurance companies will not be able to deny coverage to anyone because of gender or a pre-existing condition. This is fantastic news not just for parents of children with chronic or life-threatening health issues, but for women as well. When we interviewed Health & Human Services Secretary Kathleen Sebelius in 2012, this is what she had to say about this part of the law: "Right now [September 2012], a lot of women can be charged up to 50 percent more for exactly the same coverage that a man has -- even if that coverage doesn't include maternity care -- because the practice of 'gender rating' is legal until 2014. But after that, insurers will not be able to charge women more for their health coverage. Also, starting in 2014, no one can be denied coverage because they have a pre-existing condition. For women, a pre-existing condition could mean you're a breast cancer survivor, you're a victim of domestic violence, or you've had a Cesarean section in the past. Right now, insurance companies can refuse to insure you or refuse to pay for any kind of complication that may arise in the future from those circumstances. But those rules will change across the board. What I like to say is, 'Being a woman will no longer be a pre-existing condition.'"

Early detection of autism

We've seen great progress in detecting autism in the toddler years and we know that starting interventions leads to significant improvements in social and cognitive functioning. Pediatricians have been vigilant about screening for autism, typically at 18 months and 24 months, with the goal of beginning interventions as early as possible to maximize the positive effects on development. Parents have also become well informed on the early signs of autism, thanks in part to programs like the "Learn the Signs. Act Early" initiative led by the Centers for Disease Control and Prevention and the National Center on Birth Defects and Developmental Disabilities.

The next steps for research, however, hold even more promise. A paper published in 2013 provided evidence that early signs of autism can be detected in the first 6 months of life. The key indicator was observing how babies typically increase their visual attention on people's eyes in the first months of life, whereas babies later diagnosed with autism went on to focus less on people's eyes. This study took a bold step forward by studying these infants over time so that prediction of a formal diagnosis of autism could be confirmed, lending substantial weight to the findings. In addition, a number of the babies had older siblings with autism, and therefore were at an elevated risk -- and the method was able predict which high-risk babies were later diagnosed.

This study is provocative in a number of ways and will stimulate a number of research directions in the next year and beyond. There are three to consider.

  1. It may provide an important clue that will focus research on the early brain processes that lead to the development of autism. Having a way to demonstrate a measurable process -- decreasing attention to the eyes in infancy -- may provide a platform for directing new research on the underlying neurobiology of the disorder.
  2. Although this technique holds substantial potential for early detection, it does require specialized equipment and expertise. New studies will be needed to gauge its potential as a screen for early signs of autism. Researchers will also need to figure out whether it is best suited (in the nearer future) for screening infants at high risk (such as those who have an older sibling with autism), rather than all infants.
  3. The idea of identifying infants at risk for autism will lead to partnerships to design and initiate interventions within the first year of life. The potential here may be profound -- studies consistently show that the earlier an appropriate intervention is started, the more benefits that will accrue developmentally. The idea that we may be able to intervene in infancy raises exciting possibilities for early detection of autism.

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