Autism spectrum disorder (ASD) is a common neurodevelopmental disorder with reported prevalence in the United States of 1 in 59 children (approximately 1.7%). Core deficits are identified in 2 domains: social communication/interaction and restrictive, repetitive patterns of behavior. Children and youth with ASD have service needs in behavioral, educational, health, leisure, family support, and other areas. Standardized screening for ASD at 18 and 24 months of age with ongoing developmental surveillance continues to be recommended in primary care (although it may be performed in other settings), because ASD is common, can be diagnosed as young as 18 months of age, and has evidenced-based interventions that may improve function. More accurate and culturally sensitive screening approaches are needed. Primary care providers should be familiar with the diagnostic criteria for ASD, appropriate etiologic evaluation, and co-occurring medical and behavioral conditions (such as disorders of sleep and feeding, gastrointestinal tract symptoms, obesity, seizures, attention-deficit/hyperactivity disorder, anxiety, and wandering) that affect the child’s function and quality of life. There is an increasing evidence base to support behavioral and other interventions to address specific skills and symptoms. Shared decision making calls for collaboration with families in evaluation and choice of interventions. This single clinical report updates the 2007 American Academy of Pediatrics clinical reports on the evaluation and treatment of ASD in one publication with an online table of contents and section view available through the American Academy of Pediatrics Gateway to help the reader identify topic areas within the report.
Key Findings from the AAP Autism Guidelines
There were many important findings from the AAP Autism guidelines, but here are some additional key ones.
- The pediatric health care provider is a resource for information and should collaborate with families
- That children should be formally and regularly screened for Autism as early as possible.
- Conduct developmental and behavioral observations during all well visits with children, developmental screening at the 9-, 18-, and 30-month visits, and standardized screening of patients for Autism spectrum disorder (ASD) at 18 and 24 months old.
- Girls may have lesser intensity of symptoms and fewer externalizing behaviors and therefore may be under diagnosed.
- When developmental concerns are identified, pediatricians should refer children to early intervention (0-3 years of age) or school services to initiate services.
- Constipation is common in Autism
- Pediatricians often see young children with severe food selectivity and sleep problems who are later diagnosed with ASD
- Individuals with ASD are at increased risk for seizures.
- Almost 16% of young children with ASD have a head circumference greater than the 97th percentile
- Intervention for children either diagnosed with Autism or even before a formal diagnosis, if they are at-risk, should start as soon as possible.
- The research shows that the earlier intervention begins, the better their outcomes as they get older.
There needs to be better identification of co-occurring health conditions now associated with ASD including, ADHD, OCD, anxiety and sleep and intestinal disorders, seizures, etc.
That families should consider performing genetic testing that may help better understand the type of Autism a child has, which could affect what type of interventions the child is provided.
- Children with ASD need evidence-based services to address social, academic and behavioral needs at home and school, with access to appropriate pediatric and mental health care, respite services and leisure activities.
There is a need for a combination of developmental and behavioral approaches, as well as parent-mediated therapies.
- At school age, social skills should be addressed through pragmatic language therapy, teaching play and interaction with peers.
- Wandering is a major behavioral and health risk issue and should be addressed through anticipatory guidance throughout the lifespan.
- Addressing GI and feeding issues is important
- Families should be supported to work on transitions to post-secondary education, work and adult health providers
- Pediatricians need to inform patients and families about the evidence for interventions and give referrals to organizations and providers that can see these children quickly