There is a small but bright room on the fourth floor of the Physicians Building at Mercy Fort Smith.
It is filled with toy cars sporting foam bodies and plastic wheels. There is a shiny red phone. What appears to be a giant green frog shaped like an egg. Many other items crafted with the typical 18- or 24-month old in mind.
But many of the children who enter this room will not react in the way a typical child would.
Some will pick up a car and chew on the wheels. Others will ignore the toys all together and instead focus on a brightly painted chair, turning it upside down and dragging it around the room.
Still others will spin or clap their hands displaying no tendencies toward social awareness or interaction.
In all there are three signs Dr. Jon Hendrickson and speech pathologist Rebekah Shaver look for in this room to tell whether they are dealing with a true case of autism.
One is speech delay without compensation. Another is repetitive behavior.
"But probably the one that parents need to be most aware of is lack of joint attention," Hendrickson said. "It’s visible around 12 to 18 months. Most kids will want to point or interact or share. Lack of that is a red flag."
THE CoBALT PROGRAM
Hendrickson and Shaver comprise the Fort Smith chapter of CoBALT, or Community-Based Autism Liaison and Treatment. Fort Smith's addition to the statewide program serves a vital role in early intervention for autistic children.
Without CoBALT's more intensive observation, it can take "one to two years just to even be seen" by more intensive therapy centers like Dennis Developmental Center in Little Rock and Outreach Developmental Center in Lowell, Hendrickson said.
The reason for this is that the "waiting lists are huge." A March 2012 finding from the U.S. Centers for Disease Control and Prevention supports that claim, stating that one in 88 children are diagnosed with some form of autism spectrum disorder (ASD) by the age of eight.
It's CoBALT's job to get the true cases the attention they need as soon as possible and relieve some of the "logjam" in the system, Hendrickson said.
"There’s a little bit of comfort in knowing what the label is," added Shaver. "And it does help parents to get some services like Medicaid if they’re labeled as autistic."
GETTING PLUGGED IN
How it works: a physician will conduct an early screening and should any developmental delays be present, the child will be referred to CoBALT for the "Tier 2" screening that Hendrickson and Shaver conduct to determine if autism is present.
If a child is found to be autistic, he is "plugged in to resources right away because early childhood intervention has been shown to help these kids dramatically catch up," Hendrickson said.
The program launched with Dr. Eldon Schulz, an academic faculty member at the University of Arkansas for Medical Sciences (UAMS), who made CoBALT a reality thanks to DHS/DDS Recovery Act Funds.
Including Fort Smith, nine teams were mobilized and operational at the end of 2011. This month marks Fort Smith's one-year anniversary.
Hendrickson volunteered for CoBALT, which requires a pediatrician and a speech pathologist for certification, tapping Shaver to assist. From there the pair attained certification via applied testing – seeing actual patients while under observation and passing a second observation at their home site on the fourth floor of the Mercy Fort Smith Physicians Building.
"It’s exciting for me because it’s nice to see the relief on family’s faces. The not-knowing is almost worse. Your mind starts imagining all kinds of things, and when you can label and start getting therapy, it just really helps," Hendrickson said.
"Talking with the parents we can give them some good ideas and get them plugged in to services that they’re not in that are really beneficial," Shaver added.
Shaver, a former speech pathologist for the Mountainburg School District who runs her own practice, contributes to the program in spite of having total blindness in her right eye and 20/200 central visual acuity – legal blindness – in her left.
Shaver had received more than two dozen eye surgeries by the time she was 30, but is now "about five years" away from retirement after having worked as a speech pathologist her entire working life.
In November she received the Consumer of the Year award from the Department of Human Services Division of Services for the Blind – one of only 13 Arkansas recipients for 2012.
Hendrickson, a pediatrician at Pediatric Partners in Suite 201 of the Mercy Fort Smith Physicians Building, uses his day off to volunteer for the program.
Both agree they wouldn't have it any other way.
"You know, at the end of your career you get a little burned out, so it’s nice to have something that’s exciting to you where you feel like you’re being useful," Shaver said.
Hendrickson added, "It's very rewarding. For both of us."