The last time the American Academy of Pediatrics issued clinical recommendations on autism spectrum disorder, the prevalence of autism was calculated at one in every 155 children. Today, 12 years later, one in every 59 kids in the U.S. has autism and the academy has updated its recommendations.
Much has happened in the field during the past 12 years. Research about possible causes of ASD has progressed quickly, and we now understand more about contributing factors such as genetics and environment. We also know more about the medical and behavioral conditions that can co-occur with autism and, perhaps most importantly, have much more research supporting evidence-based interventions.
The new recommendations, published in the January 2020 “Pediatrics,” continue the previous focus on early identification. In a separate report in the same edition of the journal, the academy urges universal screening for developmental delays.
At every well child visit, pediatricians should be looking for behavioral and developmental issues. Doctors should also conduct developmental screening at 9-, 18-, and 30-month visits, and screen specifically for autism when children are 18 and 24 months old, the recommendations state. This is true even though autism isn’t routinely diagnosed in children younger than 18 months old.
“There is no reason to wait for a diagnosis of autism before starting some services, such as speech or behavioral therapies,” said the report’s lead author, Susan L. Human, MD, in a statement. “Interventions work best when they are early, when they are intense and when they involve the family.”
At the same time, the organization is urging parents and caregivers to help ensure problems are not missed. “We encourage families to tell their doctor what they have noticed about their children’s milestones and behavior, as well as any concerns that other care providers have shared with them about their child,” said Michelle M. Macias, MD, coauthor of the report on screening for developmental delays. The ultimate goal is to identify problem areas and missed milestones before a child turns 3. “There are helpful therapies and sometimes medical treatments that can ease those symptoms considerably,” Macias said.
Conditions that co-occur with autism – including intellectual disability, language disorders, attention deficit hyperactivity disorder, anxiety, sleep disorders, feeding and gastrointestinal issues and seizures – should also be treated, according to the reports.
During treatment, families play a key role in advocating for each child, and should be involved in care at every level, including planning a transition to the adult system of medical and behavioral care when the child is old enough, according to the report. Families can also become involved in clinical research and support organizations to help advance knowledge about autism and developmental disorders going forward.