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Early Warning Signs of Autism Spectrum Disorder

At a family function, your cousin asks your advice about the development of her 2-year-old son. She has noticed that he has a hard time communicating, is rigid in his behavior, and often has temper tantrums. Her pediatrician does not seem very concerned, but she wants your opinion, given you are working in pediatrics.

Early warning signs alert providers to the risk of a possible autism spectrum disorder (ASD). Recognizing these warning signs is necessary in order to know when to screen or further evaluate children for autism and how to appropriately counsel families.

Screening for Autism Spectrum Disorder

In the course of a typical primary care clinic, a pediatric resident performs a screening for autism as recommended by the American Academy of Pediatrics (AAP). She uses the Modified Checklist for Autism in Toddlers (M-CHAT) to screen two of her patients, ages 18 and 24 months. The resident explains the screening process to caregivers, learns to interpret the results, and determines the next steps.

Early identification of autism spectrum disorder (ASD) and referral for subsequent specialized developmental services greatly improves long-term outcomes for children with ASD. The American Academy of Pediatrics (AAP) recommends ongoing developmental surveillance at every visit, developmental screening at 9, 18, and 24 or 30 months, and autism-specific screening at 18 and 24 months.

Communicating Concerns: Screening and Diagnosis Results

Tommy is a 2-year-old boy with an M-CHAT screen that indicates concern that he might have an autism spectrum disorder (ASD). His developmental history is notable for delayed onset of speech, an intense interest in geometric shapes, and a tendency to hum, grunt, and flap his hands when he is excited. Family history is notable for a paternal uncle with a history of speech delay and a first cousin with learning disabilities.

Primary care physicians are responsible for conducting developmental screening in children. If one suspects that a child might have ASD, the physician must be prepared to have a potentially complicated and difficult conversation with the child’s family.

Making an Autism Spectrum Disorder Diagnosis

Billy is a 3 1/2 year old boy whose mother brings him to see you because of concerns about behavior problems at home and in school. After listening to the mother’s concerns, observing Billy in your office, and reviewing his history, you refer Billy for a comprehensive evaluation for autism spectrum disorder (ASD). You follow up with Billy’s mother and with specialists involved in his evaluation to ensure the process is completed and to learn results.

The diagnosis of ASD is made on the basis of detailed information obtained from the child’s caregivers, careful observation and assessment of the child, and the use of standardized tools designed to aid in the diagnosis of ASD.

Early Intervention and Education

Tim is a 2-year, 5-month-old boy who presents to your office for follow up after receiving a new diagnosis of autism. He has been receiving early intervention services, and his parents would like guidance on treatment in light of his new diagnosis. When Tim reaches his third birthday, his parents also have questions about the transition to preschool in his local school district. You continue to follow Tim in preschool and are able to help monitor his progress and assist with management of new behavior problems, including aggression.

Appropriate early intensive educational therapies greatly improve long-term outcomes for children with autism spectrum disorder (ASD). Effective primary care management of ASD includes supporting families by referral for appropriate therapies and community resources.

Treatments for Autism Spectrum Disorder

Kofi is a school-aged child with autism, cognitive impairment, aggressive behavior, and trouble sleeping. His mother comes to you with several concerns about his behavior and possible solutions. You answer her many questions about medications and complementary and alternative medicine (CAM) approaches. Ultimately, you refer Kofi to a specialist for prescription of a psychotropic medication to help with his symptoms of autism.

Children with autism spectrum disorder (ASD) often present with challenging or maladaptive behaviors that are commonly seen in addition to the core deficits. Pediatricians are often called upon to help evaluate children for underlying medical concerns and to facilitate obtaining appropriate treatment.

Autism Spectrum Disorder-Specific Anticipatory Guidance

Jack, a 3 1/2-year-old boy with autism spectrum disorder (ASD), is brought in for a well-child visit. His mother reports he is having trouble in several areas common among children with ASD: sleep, toileting, and eating. You examine him and ask his mother some questions about his sleep habits, his diet, and efforts in toilet training. You offer autism-specific anticipatory guidance to help his family address the problems he’s having. Based on his mother’s report of snoring, you refer him for a sleep study. You also give Jack a stool softener for constipation and ask that they stop toilet training for now. You schedule a follow-up appointment so you can devote more time to discussing these issues.

Children with ASD present with similar development issues and challenges to typically developing children, but special consideration may be needed when evaluating these issues and providing anticipatory guidance to families.

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