New Clinical Reports on Autism

There are two new clinical reports from the American Academy of Pediatrics (AAP) on Autism. These reports will help pediatricians recognize an autism spectrum disorder (ASD) earlier and guide families to effective interventions, which ultimately will improve the lives of affected children and their families.

The first report, titled “Identification and Evaluation of Children with Autism Spectrum Disorders,” provides detailed information on signs and symptoms so pediatricians can recognize and assess ASD in their patients. Educational strategies and associated therapies, which are the cornerstones of treatment, are reviewed in the second report, titled “Management of Children with Autism Spectrum Disorders.”

Language delays, typically around 18 months of age, usually prompt parents to raise concerns to their child’s pediatrician. However, there are earlier subtle signs that could lead to earlier diagnosis if detected. These include not turning when the parent says the baby’s name, not turning to look when the parent points out something and not pointing to show parents an interesting object or event, lacking back-and-forth babbling, smiling late, and failing to make eye contact with people.

Most children form attachments with a stuffed animal, special pillow or blanket at some time during early development. Children with ASD may prefer hard items, such as ballpoint pens, flashlights, keys and action figures. They may insist on holding the object at all times.

The report advises pediatricians to be cognizant of signs of ASD and other developmental concerns at every well-child visit by simply asking the parents if they or their child’s other caregivers have any concerns about their child’s development or behavior. If concerns are present that may relate to ASD, the clinician is advised to use a standardized screening tool.

The report also introduces universal screening. Pediatricians are urged to conduct formal ASD screenings on all children at 18 and 24 months regardless of whether there are any concerns.

Red flags that indicate the need for immediate evaluation are no babbling or pointing or other gesture by 12 months, no single words by 16 months, no two-word spontaneous phrases by 24 months, and loss of language or social skills at any age.

Early intervention can make a huge difference in the child’s prognosis, said report co-author Chris Johnson, MD, FAAP. “Autism doesn’t go away, but therapy can help the child cope in regular environments. It helps children want to learn and communicate.”

Early intervention is crucial for effective treatment. The report on managing children with ASD strongly advises intervention as soon as an ASD diagnosis is seriously considered rather than deferring until a definitive diagnosis is made. The child should be actively engaged in intensive intervention at least 25 hours per week, 12 months per year, with a low student-to-teacher ratio allowing for sufficient one-on-one time. Parents also should be included.

Pediatricians who treat children with ASD should recognize that many of their patients will use nonstandard therapies, according to the report. Therefore, it’s important for them to become knowledgeable about complementary and alternative medicine (CAM) therapies, ask families about current and past CAM use, and provide balanced information and advice about treatment options, including identifying risks or potential harmful effects. They should avoid becoming defensive or dismissing CAM in ways that convey a lack of sensitivity or concern, while helping families to understand how to evaluate scientific evidence and recognize unsubstantiated treatments.

Both reports can be accessed on the AAP website via the following links:
Identification and Evaluation of Children with Autism Spectrum Disorders (Clinical Report)
Management of Children with Autism Spectrum Disorders (Clinical Report)

Source: Advance for OT Practitioners

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