Identification, Evaluation, and Management of Children With Autism Spectrum Disorder: American Academy of Pediatrics 202
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Identification, Evaluation, and Management of Children With Autism Spectrum Disorder: American Academy of Pediatrics 2020 Clinical Guidelines SHARMILA BANERJEE MUKHERJEE From Department of Pediatrics, Kalawati Saran Children’s Hospital, New Delhi, India. Correspondence to:Dr. Sharmila B. Mukherjee, Department of Pediatrics, Kalawati Saran Children’s Hospital, New Delhi. India. [email protected] The American Academy of Pediatrics recently published clinical guidelines for evaluation and management of children and adolescents with Autism Spectrum Disorder (ASD), nearly 12 years after the previous version. This article outlines salient features, highlights significant differences from the 2007 version, and discusses implications for Indian professionals dealing with affected families. Keywords: Dignostic tools, Investigations, Neuroimaging, Screening.
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he American Academy of Pediatrics (AAP) recently released clinical guidelines for the evaluation and management of children and adolescents with autism spectrum disorder (ASD) [1]. The previous 2007 guidelines covered both separately [2,3]. Many changes have occurred over the last 12 years: increasing prevalence; revised nomenclature and diagnostic criteria of Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) [4,5]; greater understanding of clinical profile [6], neurobiology and etiopathogenesis; advances in genetic testing [7]; evidence-based interventions; and a paradigm shift to family-centred therapy and holistic management throughout life. Understandably, there was a strong need for an update.
etiopathogenesis remains uncertain [1]. Earlier diagnosis is more common in higher socio-economic strata who have better access to services, while later identification is associated with milder manifestations. Clinical symptoms include core symptoms and co-existing conditions (medical, genetic, neuro-developmental, psychiatric and/or behavioral), the cumulative effect of which influence extent of social and functional impairment. The guidelines described these in-depth. They also emphasize the need for holistic evaluation and management to achieve best possible outcomes. SCREENING AND DIAGNOSIS The USA health system practices universal developmental surveillance with ASD-specific screening at 18 and 24/30 months. Earlier screening is indicated in high-risk individuals or when red flags for ASD are identified. Suspicion or parental concerns warrant indepth evaluation. Establishment of diagnosis is primarily clinical, based on parental interview, personal observations and DSM-5 criteria. Though diagnostic tools are not mandatory, they help in extracting clinical information. Structured evaluation of behaviour, cognition, language, adaptive function, motor function, hearing, vision and sensory processing is recommended. Diagnoses established by the aforementioned comprehensive assessment in children under 30 months remain stable in ≥80% in adulthood.
The increasing worldwide prevalence of ASD means primary care service providers (PCP) and pediat
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