Autism Spectrum DisordersDisorders

Introduction:

Diagnostic Criteria*

(I) A total of six (or more) items from (A), (B), and (C), with at least two from (A), and one each from (B) and (C)

(A) qualitative impairment in social interaction, as manifested by           at least two of the following:

    1. Marked impairments in the use of multiple, nonverbal behaviors        such as eye-to-eye gaze, facial expression, body posture, and        gestures to regulate social interaction
    2. Failure to develop peer relationships appropriate to        developmental level
    3. A lack of spontaneous seeking to share enjoyment, interests, or        achievements with other people (e.g., by a lack of showing,        bringing, or pointing out objects of interest to other people)
    4. Lack of social or emotional reciprocity (Note: In the description,        it gives the following as examples: not actively participating in        simple social play or games, preferring solitary activities, or        involving others in activities only as tools or "mechanical" aids.)

(B) qualitative impairments in communication as manifested by at least one of the following:

    1. Delay in, or total lack of, the development of spoken language        (not accompanied by an attempt to compensate through        alternative modes of communication such as gesture or mime)
    2. In individuals with adequate speech, marked impairment in the        ability to initiate or sustain a conversation with others
    3. Stereotyped and repetitive use of language or idiosyncratic        language
    4. Lack of varied, spontaneous, make-believe play or social        imitative play appropriate to developmental level

(C) restricted repetitive and stereotyped patterns of behavior, interests, and activities, as manifested by at least two of the following:

    1. Encompassing preoccupation with one or more stereotyped and        restricted patterns of interest that is abnormal either in        intensity or focus
    2. Apparently inflexible adherence to specific, nonfunctional        routines or rituals
    3. Stereotyped and repetitive motor mannerisms (e.g., hand or        finger flapping or twisting, or complex whole-body movements)
    4. Persistent preoccupation with parts of objects

(II) Delays or abnormal functioning in at least one of the following areas, with onset prior to age 3 years:

(A) Social interaction
(B) Language as used in social communication
(C) Symbolic or imaginative play

(III) The disturbance is not better accounted for by Rett's Disorder or Childhood Disintegrative Disorder *Diagnostic and Statistical Manual of Mental Disorders: DSM IV



Clinical Guidelines:

AAP Clinical Guidelines for Autism Spectrum Disorders

Identification and Evaluation of Children with Autism Spectrum Disorder
This report includes information about the epidemiology, etiology, neuropathology and neuroimaging, clinical signs, surveillance and screening, evaluation, and history of autism.

Management of Children with Autism Spectrum Disorders
This report includes information about educational interventions, medical management, and family support. It also addresses areas of controversy such as vaccines, autism, and the use of complementary and alternative treatments.

Caring for Children with Autism Spectrum Disorder: A Resource Toolkit for Clinicians This AAP toolkit is available from the AAP bookstore for $69.95 (AAP members) or $79.95 (AAP non-members). This comprehensive resource helps support clinicians with identification and management of patients with autism spectrum disorders. It is available on CD-ROM.

Pediatrics in Review: Recognition of Autism Before the Age of 2
There are suggestions for clinical probes in the article. The article will also help clinicians distinguish ASD from other types of developmental delay.

Practice Parameter: Screening and Diagnosis of Autism: Report of the Quality Standards Subcommitte of the American Academy of Neurology and Child Neurology Society (August 2000)

Screening for Autism/Aspergers syndrom:

Modified Checklist for Autism in Toddlers (M-CHAT)

For children 16-30 months

The Childhood Asperger Syndrome Test (CAST)/Social and Communication Development Questionnaire-Key

  • For children 4-11 years old
  • 38 items
  • Parents complete the form
  • Free
  • Available in English, Spanish, German, French, Swedish, Russian, and Yugoslavian
  • Screens for Aspergers, but does not provide diagnosis
  • Link to screen and scoring handout

    • (Please note that the AAP does not recommend universal screening for Asperger syndrome for all children.)


Parent information and handouts

Autism Information from AAP

American Academy of Pediatrics, Understanding Autism Spectrum Disorders (ASDs), developed by the Academy's Autism Expert Panel, was written to answer the questions of parents of children who have ASD or used as a resource for healthcare professionals to provide to parents upon their child's diagnosis. For a limited time, you can obtain one complimentary copy. To order your complimentary copy, please send an e-mail to screening@aap.org with "ASD Booklet Request" in the header and your preferred mailing address in the text. There is a limit of one copy per person. Copies are being provided through a cooperative agreement with the National Center of Birth Defects and Developmental Disabilities. Additional copies are available for purchase online at www.aap.org/bookstore


AACAP Facts for Families: The Child with Autism

The Asperger's Association of New England at www.aane.org has resources for families with children or adults with this disorder. They offer excellent educational programs, social/support groups, and referral services for social pragmatics training, sensory integration therapy, individual, and group therapy.

Evidence-based practice

• Educational interventions, including behavioral strategies and   habilitative therapies
• Optimization of medical care including:
    • Routine preventative care
    • Treatment of acute illnesses
    • Treatment of underlying medical conditions
    • Management of sleep dysfunction, challenging behaviors,       psychiatric conditions, and associated medical problems

Optimization of medical care is crucial to both physical health and emotional well-being. Youth with autism spectrum disorders are often unable to describe their physical symptoms or distress and may, instead, express them with self-injurious or aggressive behavior. The differential diagnosis list for any new violent or dangerous behavior must include new onset of an acute medical problem or recent worsening of a chronic disorder (e.g., GERD or constipation).

• Psychopharmalogical approaches should not be considered as a   primary treatment. These do not address the core symptoms of   the disorder, but they may be helpful in treating some target   symptoms.
• Clinical approaches to psychopharmacology
    • Click here for the link to visit the AAP table of selected potential       medication options for common target symptoms in ASD.
    • Click here for the AAP listing of items for clinical management.