Pediatricians' Group Issues New Autism Guidelines

MONDAY Oct. 29, 2007 -- In an effort to make it easier for pediatricians to spot and begin early treatment for children with autism spectrum disorders, the American Academy of Pediatrics has released two new reports with recommendations for identifying and managing these conditions.

"Pediatricians are the front line" in identifying autism spectrum disorders, said Dr. Melissa Nishawala, clinical director of the Autism Spectrum Disorders Service at the New York University Child Study Center. "And, the earlier we find out, the swifter we can intervene when the brain is more immature, and we can help to model it in different directions.

"The tendency has been to understand that child development varies widely and to reassure the parents that some children speak late or even if they seem to be off track developmentally, that most children catch up," Nishawala added. "So, if there's a parental concern, they may get a referral, or it may take several months" of waiting to see if the child gets back on track developmentally.

The result can be that it may take a year or more before a child is officially diagnosed with autism, and a critical window in treatment time has been lost.

The reports are published in the November issue of Pediatrics; they were released Monday during the American Academy of Pediatrics annual meeting in San Francisco.

The first report, which details ways to detect autism spectrum disorders, highlights some of the earlier signs that might suggest an autism spectrum disorder. They may include:

  • A lack of warm, joyful expressions while gazing at a parent or other caregiver.
  • No back-and-forth babbling between the infant and parent beginning around 5 months of age.
  • A lack of recognition of a parent's voice or not turning when the parent says the baby's name.
  • Failure to make eye contact.
  • Delayed onset of babbling past 9 months of age.
  • No or few pre-speech gestures, such as waving or pointing.
  • Repetitive movements with objects.

Later, as speech develops and these disorders become more apparent, some important red flags are:

  • No single words by 16 months of age.
  • No babbling, pointing or other communicative gestures by 1 year of age.
  • A lack of two-word phrases by 2 years of age.
  • A loss of language skills at any age.

The report recommends universal screening of all children for autism between 18 months and 24 months of age, even if parents haven't expressed any particular concerns.

The second report focuses on what to do after autism has been diagnosed and stresses that early intervention is critical. The report recommends that intervention should begin as soon as autism is suspected, rather than waiting until the diagnosis is confirmed. Children with autism spectrum disorders should be involved in intervention therapies for at least 25 hours a week, all year long, according to the report.

The report also suggests that pediatricians familiarize themselves with some of the complementary and alternative therapies that parents may use for their children. For example, some parents feel that when their child is on a casein/glutein-free diet that their symptoms improve. However, such a diet needs to be carefully planned, because nutritional deficiencies can develop. If a pediatrician is aware that the child is on such a diet, he or she can give the parent a referral to a nutritionist to ensure that the child is getting the right nutrients, the report said.

"Pediatricians need to be aware of the alternatives and listen to parents who may want to go down those avenues, and they need to know where to send those families for additional help," said Dr. Cynthia Johnson, director of the Autism Center at Children's Hospital of Pittsburgh at the University of Pittsburgh Medical Center. "If families feel dismissed by their doctor, they may not disclose all the treatments they're trying."

The management report also noted that some medical issues are common in children with autism spectrum disorders, such as sleep disturbances and gastrointestinal trouble, and that pediatricians need to be aware that these may be a problem.

Johnson said both reports were very well done and comprehensive. Nishawala also felt the new recommendations were comprehensive but said it might have been helpful to include additional information about which therapies have been debunked in autism treatment.

More information

To learn more about autism, visit the U.S. National Institute of Neurological Disorders and Stroke.

Posted: October 2007


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