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Autism

Background

Medical Management Considerations

References

Resources for Families

Advisory Committee

Publication Information

BACKGROUND

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Description and Cause

Autism is a behavioral syndrome characterized by a defined group of behaviors and associated with many genetic and acquired conditions that affect brain development. Its cause is unclear. It is likely to be a heterogenous condition with different causal factors in different cases. The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders-IV defines three necessary diagnostic criteria:

  • Qualitative impairment in social interaction; qualitative impairments in communication; and restricted repetitive and stereotyped patterns of behavior, interests and activities;
  • Delays or abnormal functioning in at least one of the following areas, with onset prior to age 3 years: social interaction, language as used in social communication, or symbolic or imaginative play; and
  • The disturbance is not better accounted for by Rett Syndrome or Childhood Disintegrative Disorder.

Occurrence

  • 1:500-1,000 (autism only; does not include all pervasive developmental disorders) Autism is about 2.5 times more frequent among siblings of autistic patients.
  • Males are 3 to 4 times more likely to be affected than females.

Characteristic Features

  • Impaired development of social skills
  • Impaired development of verbal and nonverbal communication skills
  • Ritualistic and perseverative behavior
  • Resistance to environmental change or change in daily routines
  • Uneven intellectual development
  • Poorly developed symbolic play skills
  • Sleep disturbances
  • Labile mood
  • Unusual responses to sensory experiences
  • Self-restricted diet Ecommittee member stated that this feature comes out of nowhereEwhere would be a better place to mention this?.

Common Associations

  • Mental retardation (60 – 75%)
  • Epilepsy (25%)
  • Fragile X Syndrome
  • 15q duplication
  • Tuberous sclerosis
  • Neurofibromatosis
  • Phenylketonuria
  • Congenital rubella
  • Encephalitis
  • Meningitis
  • Psychiatric disorders (more common: mood disorders, obsessive compulsive disorder, anxiety disorders; less common: ADHD, thought disorders, personality disorders)

MEDICAL MANAGEMENT CONSIDERATIONS

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Note: These considerations are in addition to the normal medical care provided to an individual without autism. All recommendations can be addressed through clinical examination by the primary care provider, unless otherwise noted.

Ongoing

  • Monitor nutritional status and growth in children with restricted diets
  • Monitor speech and language development; social interaction skills
  • Maintain a high level of clinical suspicion of seizures
  • Monitor sleep and behavior, which may signal the onset of a psychiatric disorder
  • Discuss importance of structured home and school environments
  • Discuss importance of self-care skills
  • Encourage interaction with nondisabled peers

Infancy or Early Childhood (Birth to 5 years)

Note: Autism is usually not diagnosed until 18 to 24 months of age. Whether diagnosis is made in infancy or early childhood, the following should be performed:

  • Perform complete physical and neurological assessment
  • Refer for developmental/genetic evaluation for diagnosis and work-up for etiology of the condition
  • Assess cognitive skills using standardized tests where possible
  • Assess hearing (otoacoustic emission (OAE) or brainstem auditory evoked response (BAER))
  • Assess vision (clinical exam by primary care provider, or refer to ophthalmologist)
  • Refer to intensive early intervention programs and autism/disability support groups or other programs that employ applied behavioral analysis.
  • Refer to speech pathologist or language therapist, and/or encourage parents to conduct language therapy under the supervision of speech and language pathologists
  • Monitor behavior, including play skills and social skills
  • Recommend and arrange for dental care
  • Discuss possibility of SSI enrollment

Late Childhood (5 to 13 years)

Emphasize importance of specialized educational techniques like small classes; predictable structure and schedule; visual learning; individualized intervention regarding social skills and behavior management. Implement recommendations of speech and language therapists. Monitor school progress; encourage integration with non-disabled peers whenever possible. Assess self-care skills

Monitor for onset of seizures.

Adolescence and Adulthood (13 years and over)

  • Monitor for mental health problems
  • Refer for behavioral therapy if indicated
  • Discuss long-term financial plans
  • Discuss alternative community living resources
  • Monitor prevocational training and vocational activities
  • Discuss community-supported employment opportunities
  • Monitor for onset of seizures

REFERENCES

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Peer-reviewed Journal Articles/Academies

Campbell, Magda, et al. (1996). Treatment of Autistic Disorder. Journal of the American Academy of Child and Adolescent Psychiatry 35(2), 134-143.Filipek P, et al. (1999). The Screening Diagnosis of Autism Spectrum Disorders. Journal of Autism & Developmental Disorders, 29(6), 434-484.

Ritvo, E, et al. (1989). The UCLA-University of Utah Epidemiologic Survey of Autism: Recurrence Risk Estimates and Genetic Counseling. American Journal of Psychiatry 146, 1032-1036.

Ritvo, E, et al. (1990). The UCLA-University of Utah Epidemiologic Survey of Autism: The Role of Rare Diseases. American Journal of Psychiatry 147, 1614-1621.

Rogers, SJ, et al. (1998). Empirically Supported Comprehensive Treatment for Young Children with Autism. Journal of Clinical Child Psychology, 27(2), 168-179.

Special Interest Groups/Other Publications

American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders (4th ed., text revision). Washington DC: Author.

California Department of Developmental Services. (2002). Autistic Spectrum Disorders: Best Practice Guidelines for Screening, Diagnosis and Assessment. Sacramento, CA: Author.

Capute, Arnold J. & Accardo, Pasquale J. (1996). Developmental Disabilities in Infancy and Childhood vol. I: Neurodevelopmental Diagnosis and Treatment. Baltimore, MD: Paul H. Brookes Publishing Co.

Capute, Arnold J. and Accardo, Pasquale J. (1996). Developmental Disabilities in Infancy and Childhood vol II: The Spectrum of Developmental Disabilities. Baltimore, MD: Paul H. Brookes Publishing Co.

Connecticut Birth to Three System, Autism Task Force. (1998). Intervention Guidelines for Providers and Families of Young Children with Characteristics of PDD or Autism. Retrieved January 27, 2006 from http://www.birth23.org/Publications/autismguide.PDF (page 7).

National Information Center for Children and Youth with Disabilities. (1998). Autism and Pervasive Developmental Disorder fact sheet. Retrieved January 25, 2006 from http://www.nichcy.org/pubs/factshe/fs1txt.htm

New York State Department of Health Early Intervention Program (1999). Clinical Practice Guideline Quick Reference Guide: Autism/Pervasive Developmental Disorders – Assessment and Intervention for Young Children (Age 0-3 Years). Health Education Services, Albany, NY, 1999 Publication No. 4216

Ozonoff, S., Hendren, R.L., Rogers, S.J. (Eds.) (2003). Autism Spectrum Disorders: A Research Review for Practitioners. Arlington, VA: American Psychiatric Publishing.

RESOURCES FOR FAMILIES

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Association for Autism and Allied Disorders (Canada), 03-5226-1420

Autism Family Support Association (Canada), 03-9885-0533

Autism Research Institute,

http://www.autism.com/ari

Autism Services Center, 304-525-8014

Autism Society of America, 800-328-8476,

http://www.autism-society.org

California Department of Developmental Services, 916-654-1690,

http://www.dds.ca.gov

California Department of Developmental Services

Autistic Spectrum Disorders: Best Practice Guidelines for Screening, Diagnosis and Assessment

California Regional Centers, 916-654-1958,

http://www.dds.cahwnet.gov/rc/RCInfo.cfm

Center for the Study of Autism,

http://www.autism.org

Exceptional Parent Magazine, 800-247-8080,

http://www.eparent.com

Indiana Resource Center for Autism, 812-855-6508

Journal of Autism and Developmental Disorders, 800-221-9369

March of Dimes Birth Defects Foundation, 914-428-7100,

http://www.marchofdimes.com

M.I.N.D. Institute (Medical Investigation of Neurodevelopmental Disorders), 888-883-0961, http://www.ucdmc.ucdavis.edu/mindinstitute

New Jersey Center for Outreach and Services for the Autism Community, 609-883-8100, http://www.njcosac.org/cosacindex

ADVISORY COMMITTEE

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Theodore A. Kastner, M.D., M.S.

Felice Weber Parisi, M.D., M.P.H.

Robin L. Hansen, M.D.

Patrick J. Maher, M.D.

James L. Popplewell, M.D.

PUBLICATION INFORMATION

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Funded by a grant from the California Department of Developmental Services

For more information, contact:

Center for Health Improvement

1330 21st Street, Suite 100

Sacramento, CA 95814

(916) 901-9645

This document does not provide advice regarding medical diagnosis or treatment for any individual case, and any opinions or statements contained in this document are not intended to serve as a standard of medical care. Physicians are encouraged to view the considerations presented in this document in light of evolving scientific information. This document is not intended for use by the layperson. Reproduction of this document may be done with proper credit given to California Department of Developmental Services and the Center for Health Improvement.

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