Autism Spectrum Disorder

**tip: Find an extended version of this teaching on the DBP Rotation page

Objectives:

1. Define DSM-V criteria for ASD and identify early warning signs and symptoms.
2. Review the proper use and scoring of Autism screening tools (e.g., MCHAT-FU, RITA-T)
3. Review the differential diagnosis of ASD, so that other autism-associated disorders or medical problems are not overlooked.
4. Review therapies for ASD and become familiar with resources for making referrals to appropriate evaluations/services (including Early Intervention)
5. Understand the process of developing individualized education plans in schools and parents’ rights to ensure patients receive proper services.

Articles:

• DSM-V Criteria for ASD
• Identification, Evaluation, and Management of Children with Autism Spectrum Disorder (Pediatrics, 2020)
• Clinician’s Guide to Autism (Peds in Review, 2014)
• Primary Care Autism Screening and Later Autism Diagnosis (Pediatrics, 2020): Study finding although the majority of children are screened for ASD, there are disparities in among those that complete screening. Screening is less likely to occur in Hispanic children. Children who screen positive are more likely to be diagnosed with ASD at a younger age compared to those who screen negative.

Additional Resources:

• AAP Surveillance and Screening Algorithm: Autism Spectrum Disorder
• M-CHAT-R/F: Freely available online level 1 screening tool recommended for ASD-specific screening for at all well-child checks at 18 and 24-30 months. Parents/caregivers fill out this questionnaire which is scored by a provider. Level 1 testing.
• CDC Act Early Autism Case Training (ACT): Free web-based continuing education course to help clinicians better identify ASD, assist families through the diagnostic process, and care for patients with ASD through 3 training modules. The modules incorporate useful videos illustrating typical and autism behaviors as well as examples of how to have difficult conversations with parents and caregivers.
• CHOP Open Access Medical Education: Autism Spectrum Disorder: (2018) Video recording of a lecture presentation by Susan E. Levy MD, MPH covering diagnostic criteria, core clinical features, epidemiology, screening and diagnostic strategies, current treatments, and guidance for parents.
• Peds RAP - New Therapies in Autism: Part One: Podcast recording with autism expert Shafali Jeste, MD discussing legitimate and unproven autism therapies. There is special focus on treating insomnia/sleep disturbance in ASD with melatonin. Other CAM therapies that are considered unsafe are discussed.

Self Assessment:

1. A 24-month-old boy is brought to your office by his mother who tells you she is concerned about his speech and behavior. She reports that her son uses a total of 10 single words to communicate. He grabs her hand to place it on things that he wants. He does not point or make eye contact. The boy has tantrums when there is any change in his routines or when he hears loud noises. He is fascinated with lights, and does not respond to the presence of other children. His hearing evaluation and physical examination findings are normal. The boy’s mother tells you that he has a cousin with “delays.”

Of the following, the BEST next management step for this boy is to

1. administer the Childhood Autism Spectrum Test
2. assist the family in accessing an Individualized Family Service Plan
3. order a functional magnetic resonance imaging study
4. order electroencephalography
5. recommend twice-monthly applied behavioral analysis therapy

2. A 4-year-old girl presents for a health care maintenance visit. Which of the following is the most appropriate screening tool for this girl for autism spectrum disorder (ASD)?

1. Autism Diagnostic Observation Schedule
2. Childhood Autism Screening Test
3. Communication and Symbolic Behavior Scales and Developmental Profile
4. The Infant Toddler Checklist
5. Modified Checklist for Autism in Toddlers

3. A 2-year-old boy presents with severe language delay. Which of the following tests should be administered first?

1. Audiology testing
2. Comparative genomic hybridization array
3. Fragile X syndrome testing
4. Lead level
5. Metabolic testing

4. Parents of a 4-year-old girl diagnosed as having ASD want to know the best, most accepted complementary and alternative therapies for their child’s disorder. Which of the following therapies is best accepted in this category?

1. Chelation for heavy metal poisoning
2. Hyperbaric oxygen therapy
3. Massage therapy
4. Melatonin therapy
5. Vitamin B12 shot therapy

5. Developmental surveillance is performed at every well child visit, with questions like, "Do you have any concerns about your child's growth and development?" At what ages does the AAP recommend that developmental screening be performed? Select all that apply.

1. 2 months
2. 4 months
3. 6 months
4. 9 months
5. 12 months
6. 15 months
7. 18 months
8. 24 months
9. 30 months

Find the answers here.