New Clinical Reports Help Earlier Diagnosis And Management Of Autism

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Main Category: Autism
Also Included In: Pediatrics / Children's Health
Article Date: 29 Oct 2007 - 12:00 PST

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Two new reports intended to help pediatricians identify and help families manage autism spectrum disorders (ASDs) are being unveiled today at the 2007 National Conference and Exhibition (NCE) of the American Academy of Pediatrics (AAP).

The first report, titled "Identification and Evaluation of Children With Autism Spectrum Disorders" gives details on early signs and symptoms of ASDs and guidance on how to assess them.

The second report, titled "Management of Children With Autism Spectrum Disorders" covers treatment and education intended to help doctors and families start intervening and managing ASDs as soon as possible after diagnosis.

Both the clinical reports were produced by the AAP and written by co-authors Chris Johnson, Clinical Professor of Pediatrics at University of Texas Health Science Center at San Antonio and Scott Myers, neurodevelopmental pediatrician at the Janet Weis Children's Hospital/Geisinger Medical Center in Danville, Pennsylvania.

Delays in language development at around 18 months are usually the first signs that cause parents to raise their concerns with doctors. However, the reports suggest it may be possible to start diagnosing ASDs earlier. The subtle signs include baby failing to:

• Turn its head when a parent says its name.
• Look in the indicated direction when a parent points and says "look at ...".
• Point to draw parents' attention to an object of interest.
• Babble, for instance in dialogue with a parent.
• Make eye contact with people.

Another early sign could be smiling later compared to other babies, and becoming attached to hard objects like ballpoint pens, keys, action figures and so on, instead of soft toys or objects like a teddy, cuddly animal or special pillow or blanket.

The report on identification of ASDs advises pediatricians to be aware of the early signs of ASDs and to include questions during the well-child checks to find out if parents and childcarers have any concerns or have noticed anything odd about the baby's behaviour or development. If there are concerns, the doctor is urged to screen the child using a standard test.

The report also recommends screening for all children at 18 and 24 months, whether concerns have been raised or not.

Early intervention can make a big difference to the development of children with ASDs.

"Autism doesn't go away, but therapy can help the child cope in regular environments," said report co-author Johnson.

"It helps children want to learn and communicate," he added.

The second report on management of ASDs strongly recommends intervention starts as soon as a diagnosis is being considered and not after a confirmation is made. The authors suggest the child engages in intensive treatment of 25 hours a week, with a high teacher to student ratio, parental involvement, and plenty of one-to-one time as well.

The report also suggests pediatricians make themselves aware of any complementary and alternative medicine (CAM) approaches the parents may be using to treat their child. They should ask them for details and also give advice about options and risks of any particular approaches. The report advises doctors adopt a sensitive approach that expresses a desire to give parents good quality information so they can make informed choices rather steer parents toward or away from certain practices because of their own views.

Co-author Myers said:

"Many parents are interested in CAM treatments such as various vitamin and mineral supplements, chelation therapy, and diet restrictions. It's important for pediatricians to maintain open communication and continue to work with these families even if there is disagreement about treatment choices."

"At the same time, it's also important to critically evaluate the scientific evidence of effectiveness and risk of harm and convey this information to the families, just as one should for treatment with medication and for non-medical interventions," added Myers.

The report says that behaviour management is often the most effective treatment for challenging behaviours, and in some cases this is effectively combined with medication. The report includes guidance on managing medication and side effects.

The two reports will form part of a toolkit being put together by the AAP for pediatricians. The toolkit will contain summary charts, guides, screening and monitoring tools, checklists, growth charts, handouts to give to families, referral forms and tools for early intervention, as well as sample letters for insurance companies.

The toolkit will be called "AUTISM: Caring for Children with Autism Spectrum Disorders: A Resource Toolkit for Clinicians".

Click here for the first AAP report: "Identification and Evaluation of Children With Autism Spectrum Disorders" (PDF).

Click here for second AAP report: "Management of Children With Autism Spectrum Disorders" (PDF).

Written by: Catharine Paddock
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