7 New Autism Assessment and Treatment Recommendations

A recently updated practice parameter from the American Academy of Child and Adolescent Psychiatry (AACAP) offers revised guidelines for assessing and treating children and adolescents with autism spectrum disorder (ASD). ribbon

The revised document was published in the February issue of the Journal of the American Academy of Child & Adolescent Psychiatry and updates the first version of the practice parameter, which was released in 1999. The new recommendations incorporate new ASD research and have been based on an extensive literature search encompassing 20,807 results, which the authors winnowed to 186 articles for full-text examination.

The parameter offers 3 recommendations for assessment of ASD:

• The developmental assessment of young children and the psychiatric assessment of all children should routinely include questions about the core symptoms of ASD, including social relationships and repetitive behaviors.

• If screening reveals significant ASD symptoms, a thorough diagnostic evaluation should be performed to determine the presence of ASD. This evaluation involves a standard psychiatric assessment, interviews with the family, and a patient history that reviews past and current treatment and other interventions.

• Clinicians should coordinate an appropriate multidisciplinary assessment of children with ASD, including a physical exam, a hearing screening, a Wood lamp exam for tuberous sclerosis, and genetic testing. Psychological and communication assessments also are recommended, and the presence of an "unusual ability ('savant skills')" in a child should prompt additional evaluation.

The parameter also offers 4 recommendations for treatment of children with ASD:

• Clinicians should help the family "obtain appropriate, evidence-based, and structured educational and behavioral interventions" for children with ASD.

• Pharmacotherapy may be offered to children with ASD when there is a specific target symptom or comorbid condition. Combining pharmacotherapy with parent training is moderately more efficacious than medication alone, the document notes.

• Clinicians should maintain an active role in long-term treatment planning and family support and support of the child with ASD.

• Clinicians should specifically inquire about the use of alternative/complementary treatments and be prepared to discuss their risk and potential benefits.

The revised guidelines come less than a year after the American Psychiatric Association released the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), in which the diagnostic criteria for autism were changed with the hope that the diagnosis of ASD will be more specific, reliable, and valid.

—Michael Gerchufsky

Reference:

Volkmar F, Siegel M, Woodbury-Smith M, McCracken J, State M; American Academy of Child and Adolescent Psychiatry Committee on Quality Issues. Practice parameter for the assessment and treatment of children and adolescents with autism spectrum disorder. J Am Acad Child Adolesc Psychiatry. 2014 Feb;53(2):237-257.

Related coverage from Consultant for Pediatricians:

• How Will DSM-5’s Revisions Affect Children With Autism? By John W. Harrington, MD

• Information For Parents: Vaccines Do Not Cause Autism, by Golder N. Wilson, MD, PhD, and Miranda O. Ramirez, MD

• Autism Spectrum Disorders: What to Make of the Latest Statistics? By John W. Harrington, MD

• Autism and Genetic Testing: An Update for Clinical Practice, by Golder N. Wilson, MD, PhD, and Vijay S. Tonk, PhD