Autism Spectrum Disorder: Updated Guidelines from the American Academy of Pediatrics
Am Fam Physician. 2020 Nov 15;102(9):629-631.
Author disclosure: No relevant financial affiliations.
Key Points for Practice
• AAP, in contrast to the USPSTF, recommends screening for ASD at 18 and 24 months of age.
• Chromosomal microarray and fragile X testing can provide prognostic and genetic counseling information to parents of children with ASD.
• Applied behavior analysis is an intensive behavior therapy for ASD that can improve outcomes, especially at younger ages.
• Wandering and suicide are major safety threats in children and adolescents with ASD.
From the AFP Editors
Autism spectrum disorder (ASD) is a neurodevelopmental disorder affecting one in 59 children in the United States and other industrialized nations. In addition to behavior issues, ASD is associated with seizures, gastrointestinal concerns, sleep difficulties, and mental health issues that can profoundly impact the quality of life of children and their families. The American Academy of Pediatrics (AAP) has published updated guidelines for diagnosis and treatment of ASD.
Screening and Diagnosis
Although the U.S. Preventive Ser vices Task Force (USPSTF) found insufficient evidence for screening, the AAP recommends a combination of developmental surveillance and standardized autism screening tests at 18 and 24 months of age based on better outcomes with earlier intervention. Early symptoms that may be identified via surveillance include not responding to name by 12 months of age, not pointing to items of interest by 14 months of age, avoiding eye contact, repetitive movements, unusual reactions to sensations, and echolalia. The AAP recommends the Modified Checklist for Autism in Toddlers (M-CHAT) for initial screening in children up to 30 months of age. Children with persistent deficits on M-CHAT Revised with Follow-Up have a 47% risk of ASD and a 95% risk of any developmental disorder. No screening tools are valid for children older than 30 months.
According to criteria from the Diagnostic and Statistical Manual of Mental Disorders, 5th ed., ASD is diagnosed by the presence of three social communication issues and two of four restrictive or repetitive behaviors (https://www.aafp.org/afp/2016/1215/p972.html#afp20161215p972-t1). Nearly one-third of children with ASD have intellectual disability or minimal verbal ability.
After ASD is diagnosed, severity of deficits should be characterized by a multidisciplinary team; all evaluations require formal cognitive and language assessments. Occupational therapy, physical therapy, audiology, and visual assessments also should be included. Children with developmental delays benefit from referral to early intervention school services.
One in 10
Coverage of guidelines from other organizations does not imply endorsement by AFP or the AAFP.
This series is coordinated by Michael J. Arnold, MD, contributing editor.
A collection of Practice Guidelines published in AFP is available at https://www.aafp.org/afp/practguide.
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