Autism spectrum disorder in children and adolescents: Overview of management
- Laura Weissman, MD
Laura Weissman, MD
- Instructor in Pediatrics
- Harvard Medical School
- Carolyn Bridgemohan, MD
Carolyn Bridgemohan, MD
- Section Editor — Developmental and Behavioral Pediatrics
- Assistant Professor of Pediatrics
- Harvard Medical School
- Section Editors
- Marilyn Augustyn, MD
Marilyn Augustyn, MD
- Section Editor — Developmental and Behavioral Pediatrics
- Associate Professor
- Boston University School of Medicine
- Marc C Patterson, MD, FRACP
Marc C Patterson, MD, FRACP
- Section Editor — Pediatric Neurology
- Professor of Neurology, Pediatrics, and Medical Genetics
- Chair, Division of Child and Adolescent Neurology
- Mayo Clinic College of Medicine
Autism spectrum disorder (ASD) is a biologically based neurodevelopmental disorder characterized by impairments in two major domains: 1) deficits in social communication and social interaction and 2) restricted repetitive patterns of behavior, interests, and activities . ASD encompasses disorders previously known as autistic disorder (classic autism, sometimes called early infantile autism, childhood autism, or Kanner's autism), childhood disintegrative disorder, pervasive developmental disorder-not otherwise specified, and Asperger disorder (also known as Asperger syndrome). (See "Autism spectrum disorder: Diagnosis", section on 'Diagnostic criteria' and "Asperger syndrome (a specific autism spectrum disorder): Clinical features and diagnosis in children and adolescents" and "Asperger syndrome (a specific autism spectrum disorder): Management and prognosis in children and adolescents".)
This topic will provide an overview of the treatment of ASD. Related topics are presented separately:
- American Psychiatric Association. Autism spectrum disorder. In: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, American Psychiatric Association, Arlington, VA 2013. p.50.
- Maglione MA, Gans D, Das L, et al. Nonmedical interventions for children with ASD: recommended guidelines and further research needs. Pediatrics 2012; 130 Suppl 2:S169.
- Myers SM. Management of autism spectrum disorders in primary care. Pediatr Ann 2009; 38:42.
- Lai MC, Lombardo MV, Baron-Cohen S. Autism. Lancet 2014; 383:896.
- Johnson CP, Myers SM, American Academy of Pediatrics Council on Children With Disabilities. Identification and evaluation of children with autism spectrum disorders. Pediatrics 2007; 120:1183.
- Baird G, Charman T, Cox A, et al. Current topic: Screening and surveillance for autism and pervasive developmental disorders. Arch Dis Child 2001; 84:468.
- Rutter M. Autism: its recognition, early diagnosis, and service implications. J Dev Behav Pediatr 2006; 27:S54.
- Orinstein AJ, Helt M, Troyb E, et al. Intervention for optimal outcome in children and adolescents with a history of autism. J Dev Behav Pediatr 2014; 35:247.
- Fein D, Barton M, Eigsti IM, et al. Optimal outcome in individuals with a history of autism. J Child Psychol Psychiatry 2013; 54:195.
- Fountain C, Winter AS, Bearman PS. Six developmental trajectories characterize children with autism. Pediatrics 2012; 129:e1112.
- Myers SM, Johnson CP, American Academy of Pediatrics Council on Children With Disabilities. Management of children with autism spectrum disorders. Pediatrics 2007; 120:1162.
- National Research Council Committee on Educational Interventions for Children with Autism. Educating Children with Autism, Lord C, McGee JP (Eds), National Academy Press, Washington, DC 2001.
- New York State Department of Health Early Intervention Program. Clinical practice guideline: The guideline technical report: Autism/Pervasive developmental disorders assessment and intervention for young children (age 0-3 years). Publication No. 4217, Albany, NY 1999.
- Dawson G, Osterling J. Early intervention in autism: effectiveness and common elements of current approaches. In: Effectiveness of Early Intervention: Second Generation Research, Guralnick MJ (Ed), Paul Brookes, Baltimore, MD 1997. p.307.
- Volkmar F, Siegel M, Woodbury-Smith M, et al. Practice parameter for the assessment and treatment of children and adolescents with autism spectrum disorder. J Am Acad Child Adolesc Psychiatry 2014; 53:237.
- Howlin P. Practitioner review: psychological and educational treatments for autism. J Child Psychol Psychiatry 1998; 39:307.
- Durand VM, Carr EG. Functional communication training to reduce challenging behavior: maintenance and application in new settings. J Appl Behav Anal 1991; 24:251.
- Carbone PS, Farley M, Davis T. Primary care for children with autism. Am Fam Physician 2010; 81:453.
- Public Law 108-446. Individuals with Disabilities Education Improvement Act of 2004. Available at: www.copyright.gov/legislation/pl108-446.pdf (Accessed on May 20, 2010).
- Hanson E, Kalish LA, Bunce E, et al. Use of complementary and alternative medicine among children diagnosed with autism spectrum disorder. J Autism Dev Disord 2007; 37:628.
- Wong HH, Smith RG. Patterns of complementary and alternative medical therapy use in children diagnosed with autism spectrum disorders. J Autism Dev Disord 2006; 36:901.
- Levy SE, Hyman SL. Complementary and alternative medicine treatments for children with autism spectrum disorders. Child Adolesc Psychiatr Clin N Am 2008; 17:803.
- Committee on Children With Disabilities. American Academy of Pediatrics: The pediatrician's role in the diagnosis and management of autistic spectrum disorder in children. Pediatrics 2001; 107:1221.
- Hyman SL, Stewart PA, Schmidt B, et al. Nutrient intake from food in children with autism. Pediatarics 2012; 130:S145.
- Soden SE, Garrison CB, Egan AM, Beckwith AM. Nutrition, physical activity, and bone mineral density in youth with autistic spectrum disorders. J Dev Behav Pediatr 2012; 33:618.
- McElhanon BO, McCracken C, Karpen S, Sharp WG. Gastrointestinal symptoms in autism spectrum disorder: a meta-analysis. Pediatrics 2014; 133:872.
- Anderson C, Law JK, Daniels A, et al. Occurrence and family impact of elopement in children with autism spectrum disorders. Pediatrics 2012; 130:870.
- Kiely B, Migdal TR, Vettam S, Adesman A. Prevalence and Correlates of Elopement in a Nationally Representative Sample of Children with Developmental Disabilities in the United States. PLoS One 2016; 11:e0148337.
- Rice CE, Zablotsky B, Avila RM, et al. Reported Wandering Behavior among Children with Autism Spectrum Disorder and/or Intellectual Disability. J Pediatr 2016; 174:232.
- Brimacombe M, Chaaban J, Zimmerman-Bier B, et al. Autism spectrum disorders: concurrent clinical disorders. J Child Neurol 2008; 23:6.
- Liptak GS, Stuart T, Auinger P. Health care utilization and expenditures for children with autism: data from U.S. national samples. J Autism Dev Disord 2006; 36:871.
- Kogan MD, Strickland BB, Blumberg SJ, et al. A national profile of the health care experiences and family impact of autism spectrum disorder among children in the United States, 2005-2006. Pediatrics 2008; 122:e1149.
- Krauss MW, Gulley S, Sciegaj M, Wells N. Access to specialty medical care for children with mental retardation, autism, and other special health care needs. Ment Retard 2003; 41:329.
- Ruble LA, Heflinger CA, Renfrew JW, Saunders RC. Access and service use by children with autism spectrum disorders in Medicaid Managed Care. J Autism Dev Disord 2005; 35:3.
- Farmer JE, Clark MJ, Mayfield WA, et al. The relationship between the medical home and unmet needs for children with autism spectrum disorders. Matern Child Health J 2014; 18:672.
- Thomas KC, Ellis AR, McLaurin C, et al. Access to care for autism-related services. J Autism Dev Disord 2007; 37:1902.
- Anderson DK, Liang JW, Lord C. Predicting young adult outcome among more and less cognitively able individuals with autism spectrum disorders. J Child Psychol Psychiatry 2014; 55:485.
- Szatmari P, Georgiades S, Duku E, et al. Developmental trajectories of symptom severity and adaptive functioning in an inception cohort of preschool children with autism spectrum disorder. JAMA Psychiatry 2015; 72:276.
- Gillberg C, Steffenburg S. Outcome and prognostic factors in infantile autism and similar conditions: a population-based study of 46 cases followed through puberty. J Autism Dev Disord 1987; 17:273.
- Sigman M, McGovern CW. Improvement in cognitive and language skills from preschool to adolescence in autism. J Autism Dev Disord 2005; 35:15.
- Stevens MC, Fein DA, Dunn M, et al. Subgroups of children with autism by cluster analysis: a longitudinal examination. J Am Acad Child Adolesc Psychiatry 2000; 39:346.
- Howlin P, Moss P, Savage S, Rutter M. Social outcomes in mid- to later adulthood among individuals diagnosed with autism and average nonverbal IQ as children. J Am Acad Child Adolesc Psychiatry 2013; 52:572.
- Liptak GS, Kennedy JA, Dosa NP. Social participation in a nationally representative sample of older youth and young adults with autism. J Dev Behav Pediatr 2011; 32:277.
- Shattuck PT, Narendorf SC, Cooper B, et al. Postsecondary education and employment among youth with an autism spectrum disorder. Pediatrics 2012; 129:1042.
- Howlin P, Goode S, Hutton J, Rutter M. Adult outcome for children with autism. J Child Psychol Psychiatry 2004; 45:212.
- Farley MA, McMahon WM, Fombonne E, et al. Twenty-year outcome for individuals with autism and average or near-average cognitive abilities. Autism Res 2009; 2:109.
- GENERAL PRINCIPLES
- Early intervention
- Specialist involvement
- Treatment setting
- TREATMENT MODALITIES
- Behavioral and educational interventions
- Psychopharmacologic interventions
- Complementary and alternative therapies
- ROLE OF THE PRIMARY CARE PROVIDER
- Early identification
- Medical home
- - Office visits
- - Routine care
- - Surveillance for comorbidities
- - Access to care
- Family support
- INFORMATION FOR PATIENTS