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Review
. 2020 Jan;145(1):e20193447.
doi: 10.1542/peds.2019-3447. Epub 2019 Dec 16.

Identification, Evaluation, and Management of Children With Autism Spectrum Disorder

Susan L Hyman  1 , Susan E Levy  2 , Scott M Myers  3 ; COUNCIL ON CHILDREN WITH DISABILITIES, SECTION ON DEVELOPMENTAL AND BEHAVIORAL PEDIATRICS
Collaborators, Affiliations
Review

Identification, Evaluation, and Management of Children With Autism Spectrum Disorder

Susan L Hyman et al. Pediatrics. 2020 Jan.

Abstract

Autism spectrum disorder (ASD) is a common neurodevelopmental disorder with reported prevalence in the United States of 1 in 59 children (approximately 1.7%). Core deficits are identified in 2 domains: social communication/interaction and restrictive, repetitive patterns of behavior. Children and youth with ASD have service needs in behavioral, educational, health, leisure, family support, and other areas. Standardized screening for ASD at 18 and 24 months of age with ongoing developmental surveillance continues to be recommended in primary care (although it may be performed in other settings), because ASD is common, can be diagnosed as young as 18 months of age, and has evidenced-based interventions that may improve function. More accurate and culturally sensitive screening approaches are needed. Primary care providers should be familiar with the diagnostic criteria for ASD, appropriate etiologic evaluation, and co-occurring medical and behavioral conditions (such as disorders of sleep and feeding, gastrointestinal tract symptoms, obesity, seizures, attention-deficit/hyperactivity disorder, anxiety, and wandering) that affect the child's function and quality of life. There is an increasing evidence base to support behavioral and other interventions to address specific skills and symptoms. Shared decision making calls for collaboration with families in evaluation and choice of interventions. This single clinical report updates the 2007 American Academy of Pediatrics clinical reports on the evaluation and treatment of ASD in one publication with an online table of contents and section view available through the American Academy of Pediatrics Gateway to help the reader identify topic areas within the report.

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Conflict of interest statement

POTENTIAL CONFLICT OF INTEREST: MeMix LLC is a company that makes an application (for phones). Dr Levy is on the advisory board for the application’s development. This application is being developed to assist in nutritional and dietary management of children with autism. Dr Levy has not received any money yet from this company. This application is the focus of a National Institutes of Health R21 grant, for which Dr Levy is funded for ∼2% of her salary. Once it is studied and marketed (if appropriate), Dr Levy will (possibly in the future) earn some money. Her years of relationship with the company are 2015 to the present. Dr Hyman has a relationship with Roche. Dr Hyman is the site principal investigator of a clinical trial of a novel agent being tested to promote social function in patients with autism. The University of Rochester (Dr Hyman’s institution) was 1 of >40 sites and had 2 study participants in 2018. University of Rochester will be leaving the trial in 2019 (withdrawal submitted) because of staffing, and that reimbursement for staff time does not cover the cost of participation. Funding was for the staff to complete the assessments required for the clinical trial. Dr Hyman got no personal reimbursement from the company; the funding was for staff time for recruitment and assessment and clinical research center support for the trial.

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