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Two
new clinical reports from the American Academy of Pediatrics (AAP)
will help pediatricians recognize autism spectrum disorders (ASDs) earlier
and guide families to
effective interventions, which will ultimately improve the lives of
children with ASDs and their
families.
The first clinical report, “Identification
and Evaluation of Children With Autism Spectrum
Disorders,” provides detailed information on signs and symptoms so
pediatricians can recognize and
assess ASDs in their patients. Language delays usually prompt parents to
raise concerns to their
child’s pediatrician – usually around 18 months of age. However,
there are earlier subtle signs that
if detected could lead to earlier diagnosis. These include:
· not
turning when the parent says the baby’s name;
· not
turning to look when the parent points says, “Look at…” and not pointing
themselves to
show parents an interesting
object or event;
· lack of
back and forth babbling;
· smiling
late; and
· failure to
make eye contact with people.
Most children, at some time during early
development, form attachments with a stuffed animal,
special pillow or blanket. Children with ASDs may prefer hard items
(ballpoint pens, flashlight,
keys, action figures, etc.). They may insist on holding the object at all
times.
The report advises pediatricians to be cognizant
of signs of ASD, as well as 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, which means pediatricians conduct formal
ASD screening on all
children at 18 and 24 months regardless of whether there are any concerns.
“Red Flags” that are absolute
indications for immediate evaluation include:
· 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. “Autism doesn’t go away,
but therapy can help the child cope in regular environments,” said
Chris Plauche Johnson, MD,
MEd, FAAP, and co-author of the reports. “It helps children want to
learn and communicate.”
Educational strategies and associated therapies, which are the
cornerstones of treatment for ASDs,
are reviewed in the second AAP clinical report, “Management of
Children With Autism Spectrum
Disorders.” Early intervention is crucial for effective treatment.
The report 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 should also be included.
Pediatricians who treat children with ASDs should
recognize that many of their patients will use
nonstandard therapies. The report says it’s important for
pediatricians 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, but they should
also help families to
understand how to evaluate scientific evidence and recognize
unsubstantiated treatments.
“Many parents are interested in CAM
treatments such as various vitamin and mineral supplements,
chelation therapy, and diet restrictions. It’s important for
pediatricians to maintain open
communication and continue to work with these families even if there is
disagreement about
treatment choices, ” said co-author of the reports Scott M. Myers,
MD, FAAP. “At the same time,
it’s also important to critically evaluate the scientific evidence of
effectiveness and risk of harm and
convey this information to the families, jus t as one should for treatment
with medication and for
non- medical interventions.”
Although use of the
gluten-free/casein- free diet for children with ASDs is popular, there is little
evidence to support or refute this intervention. More studies are in
progress, and it is anticipated that
these studies will provide substantially more useful information regarding
the efficacy of the glutenfree/
casein- free diet.
Tantrums, aggressive behaviors, and self-injury
are common among children with ASDs, and
medical factors may cause or exacerbate these behaviors. Behavior
management strategies are often
the most effective treatment for challenging behaviors. In some children,
medications are effective
in addition to the behavioral strategies. The report addresses the medical
issues that some children
with ASDs encounter such as seizures, gastrointestinal problems, and sleep
disturbance, and
provides guidance for medication management.
Both reports will be available on
www.aap.org
and
will also be part of the new AAP practical
resource for pediatricians "AUTISM: Caring for Children with Autism
Spectrum Disorders: A
Resource Toolkit for Clinicians,” which includes screening and
surveillance tools, guideline
summary charts, mana gement checklists, developmental checklists,
developmental growth charts,
early intervention referral forms and tools, sample letters to insurance
companies and family
handouts.
October, 2007 |
