Autism Spectrum Disorder (Early childhood–17 years) • Autism Spectrum Disorder (ASD) • Older terminology: Autistic Disorder, Asperger’s syndrome, Pervasive developmental disorder CLINICAL PEARLS • Core symptoms include social communication deficits and restricted, repetitive or sensory behaviors. Children with ASD can present in diverse ways with varying levels of severity in language skills, intellectual abilities and functioning. • Assessment and treatment should be interdisciplinary. Early diagnosis and intervention can improve outcomes. • Care coordination and advocacy in educational and community-based settings is important. • Medical and behavioral health conditions can co-occur in children with autism, requiring individualized assessment and treatment planning. • Behavioral, other therapeutic and school-based interventions are the mainstay of ASD treatment. • No medication specifically addresses the core symptoms of ASD. Children with ASD can be treated with psychotropic medications when there is a specific target symptom or co-occurring behavioral health condition. • Clinicians should ask about the use of complementary and alternative treatments in order to discuss the risks and potential benefits.15 SCREENING AND ASSESSMENT • Universal screening for autism should occur at the 18 and 24-month well-child visits, or anytime a parent raises concern about autism. If screening indicates concerns for ASD, refer for a comprehensive evaluation for autism.5 • Diagnostic assessments for ASD should consider or rule out the following: language disorders, intellectual disability/global developmental delays, hearing impairment, ADHD/disruptive behavior disorders, trauma, reactive attachment disorder, obsessive compulsive disorder and other anxiety disorders, childhood-onset schizophrenia, and other medical conditions. • Medical assessment of children with ASD should include a comprehensive physical examination, hearing screen and genetics evaluation. • Additional evaluations are warranted if there are unusual symptoms such as history of developmental regression, facial dysmorphology, staring spells/seizures, or family history of disabilities/genetic syndromes).15
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