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Geneva Centre for Autism, 6 The Hospital for Sick Children BACKGROUND: Feeding difficulties affect up to 80% of children with ASD starting as early as 6 months of age. Food selectivity (FS) is the most commonly reported phenomenon by families and can lead to parental stress, strained parent-child interactions, and long-term health consequences such as nutrient deficiency, diabetes, and cardiovascular disease. FS is often chronic and resistant to treatment, but behavioural interventions for FS are supported. While successful, such interventions can be costly and resource intensive, and results may not be maintained over time. Video modeling intervention (VMI) is a promising new approach that incorporates video modeling (VM), where a child is expected to imitate the behaviour of interest after viewing a video recording of it. VM has been successful in teaching a variety of skills to children with ASD, including, play, communication, and daily living skills, but to our knowledge has not been attempted as a VM strategy targeting feeding behaviours in ASD. OBJECTIVES: This project serves as the starting point in investigating whether a VMI will increase food variety in preschoolers with ASD and a history of food refusal. Our objective is to develop a novel VM tool incorporating applied behavioural analysis strategies to deliver feeding intervention to preschoolers with ASD. DESIGN/METHODS: An iPad application with an animated model will be developed based on operant conditioning and systematic desensitization. Input was collected from a developmental panel (behavioural therapist, occupational therapist, speech language pathologist, engineer, animator, family team leader) to design the initial prototype. Themes generated from two focus groups consisting of clinicians with expertise in ASD and parents of preschoolers with ASD will address LEApp's core design. Initial user testing and feedback regarding the application will be collected to revise LEApp. RESULTS: Our preliminary prototype (Figure 1 and 2) was created based on an initial literature review and with concepts derived from feeding intervention outlined by our developmental panel. The application will be modified pending the results of the focus group discussions. CONCLUSION: Project LEApp represents the first step in the creation and exploration of a novel tool that has the potential to impact an essential skill early in the lives of children with ASD. By involving children, their parents and multidisciplinary specialists throughout the process, LEApp has the potential not only to impact feeding outcomes, but can also be shared and utilized universally by families in any setting, thus filling a need in existing feeding intervention.

BACKGROUND Families in inner-city neighborhoods experience socioeconomic challenges that inhibit access to healthcare providers who could detect development concerns in children. Additionally, studies show low-income, single motherhood to be a significant risk factor for childhood developmental issues. With wait times for developmental assessments and publicly funded services ranging from 9 to 18 months, children may not receive diagnosis and support in a timely manner. School-based health clinics (SBHCs) are easy access points for children to receive necessary services, such as diagnoses and management of health and developmental concerns especially for inner city children facing barriers to health care access. OBJECTIVES To measure the efficacy of SBHCs in alleviating barriers to developmental services for children from inner-city, single-mother households, by comparing wait times to children from two-parent households. DESIGN/METHODS A retrospective chart review of 700 children from two inner-city SBHCs was conducted over 7 years. Family demographic data were collected through the registration process and analyzed. Wait times for developmental assessments were determined from the first developmental concern to assessment by a developmental paediatrician. Independent t-tests were used to compare wait times for children from single-mother households to children from two-parent households. RESULTS The mean age of children seen was 6.9 years (two-parent households) and 7.6 years (single-mother households). 35% of children from single-mother households (n=169), and 36% of children from two-parent households (n=369) received referrals to the SBHC developmental paediatrician. The mean wait times were 129.08 days for single-mother households, and 105.81 days for two-parent households. No significant difference was found in wait time from first developmental concern to seeing a developmental paediatrician (p>0.05). CONCLUSION The SBHC program is a novel healthcare delivery model alleviating barriers to developmental healthcare access for both single-mother and two-parent families. Wait times experienced by SBHC users to see developmental specialists were shorter than the times reported in the literature. The lack of significant difference in wait times between children from single-mother and two-parent households demonstrates how SBHCs alleviate barriers to single-mother households as effectively as two-parent households.

BACKGROUND The number of school-aged children diagnosed with ADHD in Canada has been on the rise over the past three decades. Evidence suggests that children with ADHD dealing with risk factors, such as poverty and prolonged wait-times are more likely to have poorer outcomes due to challenges in accessing healthcare services. Schools are ideal for the early identification of children with ADHD, as they are often the setting in which attention and behavioural issues come to light. School-Based Health Centres (SBHCs) are embedded within the school system and are an ideal entry point for children with ADHD into the healthcare system. OBJECTIVES To examine the prevalence of ADHD and as well as demographic characteristics and time to assessment of children at two inner-city SBHCs in Toronto. DESIGN/METHODS A retrospective chart review was performed on 869 children from November 2010- March 2016 from two SBHCs. Frequency measures were used to determine the proportion of children that received a new diagnosis of ADHD. Within this population, the patient’s age, gender, ethnicity, parental income, home arrangement, parental education and newcomer status were described. Diagnostic wait-times within the SBHC were calculated using two specific data points – a child’s first clinic visit data and the clinic date they saw a general paediatrician, who would provide the ADHD diagnosis. RESULTS Of the 869 children, 9.6% of children received a new diagnosis of ADHD. The mean age of diagnosis was 7.6 years and 80% of the children were male. 74.6% of children’s families identified them as an ethnicity other than white. 60.2% of the patients’ household income was <$30,000/year. 44.5% of the families were composed of single-parent households. 52.8% of the patients’ mothers and 47.6% of fathers had completed a high school level of education or less. 34% of the children were not born in Canada, and of those, 57% had been in the country for only 0–3 years. The average wait time for a child to see a general paediatrician for a developmental assessment from initial visit date was 62.3 days. CONCLUSION The prevalence of ADHD at 2 SBHCs was higher than that reported in the general population. A number of barriers to health care access were identified in this cohort of children including low income, single parent homes and newcomer status. SBHCs serve as an accessible health care model that can provide timely diagnosis and management to vulnerable children with ADHD which may improve outcomes.