In The Politics of Autism, I discuss evaluation and diagnosis of young children. Screening is an important part of the process.
The American Academy of Pediatrics (AAP) has updated its clinical recommendations on autism spectrum disorder for the first time in 12 years, analyzing the latest research on the neurodevelopmental disorder that affects an estimated 1 in every 59 children.
“Identification, Evaluation, and Management of Children with Autism Spectrum Disorder,” a clinical report published in the January 2020 Pediatrics, emphasizes the importance of early identification of autism, which can be diagnosed as young as 18 months of age. The report, along with an executive summary (both published online Dec. 16), reflects significant changes in the field since the previous recommendations were published in 2007.
In that time, research examining the possible causes of autism spectrum disorder has progressed rapidly, with increasing understanding of the interplay between genetic make-up and environment.
Physicians now have a greater understanding of the medical and behavioral conditions that often co-occur with autism, and the body of research supporting evidence-based interventions has grown substantially. The updated clinical report reflects this new evidence and offers recommendations to physicians in identifying and managing the disorder, and in treating common co-occurring conditions.
Because early identification is so important, the AAP continues to recommend developmental and behavioral surveillance of children at every well child visit, developmental screening at 9-, 18-, and 30-month visits, as well as specific screening for autism spectrum disorder at ages 18 and 24 months.
“We know that the earlier we can start therapies for children who show signs of developmental delays, the better likelihood of positive outcomes,” said Susan L. Hyman, MD, FAAP. lead author of the report, which was authored by the AAP Council on Children with Disabilities and the AAP Section on Developmental and Behavioral Pediatrics.
“There is no reason to wait for a diagnosis of autism before starting some services, such as speech or behavioral therapies,” said Dr. Hyman, a developmental and behavioral pediatrician at the University of Rochester and Golisano Children’s Hospital. “Interventions work best when they are early, when they are intense, and when they involve the family.”
More than 5 million Americans are affected by autism spectrum disorder, and its prevalence has increased to 1 in 59 children, an increase from 1 in 155 in 2007.The disorder is characterized by deficits in social communication and interaction and restrictive repetitive patterns of behavior.
Many individuals with autism have co-occurring conditions that can and should be treated, according to the AAP. This includes intellectual disability, language disorders, attention-deficit/hyperactivity disorder and anxiety, and disorders of sleep, feeding, gastrointestinal symptoms and seizures. The AAP report states that 40% of individuals with autism spectrum disorder have an intellectual disability. As many as 40% to 60% of school-aged children and adults with autism are reported to have anxiety disorders.
The AAP supports the use of behavioral interventions for skill building, based on the most recent research, and noted the combinations of therapies and approaches that include parents that are increasingly used in community settings.
“Families play a key role in treatment and advocacy for a child with autism spectrum disorder,” said Susan E. Levy, MD, MPH, FAAP, a co-author of the report, developmental and behavioral pediatrician at Children's Hospital of Philadelphia and a professor of pediatrics at the Perelman School of Medicine at the University of Pennsylvania.
“They also need the support of the professional team, the clinicians, educators and therapists who are working alongside them.”
The AAP recommends that pediatricians:
While research has led to more knowledge about autism spectrum disorder, the AAP acknowledges that much work remains to be done.
- Conduct developmental and behavioral surveillance 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 at 18 and 24 months old.
- Help ensure that children with autism spectrum disorder are provided with 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.
- Engage with families and youth to plan a transition to the adult system of medical and behavioral care.
- Inform patients and families about the evidence for interventions, refer families for possible participation in clinical research and refer families to support organizations.
“There need to be more equitable and affordable therapies for all families, from the time of diagnosis through employment and adult life,” Dr. Hyman said. “All children deserve options and hope for productive, satisfying lives.”