Autism Spectrum Disorder.

Abstract

1. Melissa Long, MD* 2. Kelly Register-Brown, MD, MSc† 1. *Division of General and Community Pediatrics 2. †Division of Psychiatry and Behavioral Health Sciences, Children’s National Hospital, Washington, DC * Abbreviations: AAP: : American Academy of Pediatrics ABA: : applied behavior analysis ADHD: : attention-deficit/hyperactivity disorder ASD: : autism spectrum disorder CBD: : cannabidiol CDC: : Centers for Disease Control and Prevention COVID-19: : coronavirus disease 2019 DSM-5 : : Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition EEG: : electroencephalogram FDA: : Food and Drug Administration ID: : intellectual disability MCHAT-R/F: : Modified Checklist for Autism in Toddlers, Revised, with Follow-up With autism spectrum disorder (ASD) prevalence rising and a shortage of specialists available for diagnosis and management, pediatricians will need to be increasingly comfortable 1) giving a provisional diagnosis of ASD to create access to critical early behavioral interventions, 2) managing the comorbidities that significantly affect quality of life, and 3) supporting families to navigate the increasingly complex web of ASD-related services. After completing this article, readers should be able to: 1. Appreciate the evolution in prevalence data over time and recognize the disparities that exist in diagnosis based on race and sex. 2. Recognize the heterogeneity of autism spectrum disorder (ASD) clinical presentation depending on the child’s age, sex, and developmental abilities. 3. Understand the diagnostic criteria for ASD. 4. Distinguish findings associated with ASD from those of isolated speech and language delay, intellectual disability, and profound hearing loss. 5. Determine age-appropriate screening for ASD and be prepared to discuss results and next steps with families. 6. Plan for appropriate management of core symptoms of ASD and identify the common medical and psychiatric comorbidities with ASD. 7. Recognize the complexity of care coordination required to support families of children with ASD and the importance of advocating for a pediatric medical home. Autism spectrum disorder (ASD) is a neurodevelopmental disability characterized by differences in social and communication functioning and by restricted and repetitive behaviors and interests. The increasing prevalence of ASD has been the subject of intense attention in the medical literature and lay press. In the United States, the Centers for Disease Control and Prevention (CDC) Autism and Developmental Disabilities Monitoring Network, which measures confirmed diagnoses of ASD, has found an increased prevalence of ASD among 8-year-old US children from 1 in 150 in 2000 to 2002 to 1 in 54 during 2016. (1) Reasons for the observed increase in ASD prevalence likely include increased screening …