Autism Spectrum Disorder

Use developmental surveillance to identify persistent social-communication concerns, restricted or repetitive behaviors, developmental regression, language delay, adaptive impairment, or caregiver concern that warrants formal assessment. For toddlers, M-CHAT-R/F is the most commonly recommended screening instrument, but a negative screen should not override concerning surveillance findings. JAMA+1JAMASensitivity and Specificity of the Modified Checklist for ...ScienceDirectScreening and diagnostic tools for autism spectrum disorder: Systematic review and meta-analysis

Refer children with a positive screen or clinically significant developmental concern for comprehensive ASD evaluation and concurrently connect them with developmental and therapeutic services appropriate to identified functional deficits. M-CHAT-R/F has pooled sensitivity of 78% and specificity of 98%, with substantial between-study variability; its predictive value therefore depends on the tested population and follow-up process. JAMA+1JAMASensitivity and Specificity of the Modified Checklist for ...ScienceDirectScreening and diagnostic tools for autism spectrum disorder: Systematic review and meta-analysis

Do not use an ASD screening tool as a stand-alone diagnostic instrument. Diagnostic instruments also have imperfect operating characteristics: pooled estimates for ADOS were sensitivity 87% and specificity 75%, for ADI-R sensitivity 77% and specificity 68%, and for CARS sensitivity 89% and specificity 79%. ScienceDirectScienceDirectScreening and diagnostic tools for autism spectrum disorder: Systematic review and meta-analysis

Conduct a comprehensive evaluation that integrates developmental history, direct observation, and standardized instruments such as ADOS-2 and ADI-R. The assessment should characterize social communication, reciprocal interaction, restricted or repetitive behavior, play or imagination, language, adaptive functioning, and the degree to which findings impair daily functioning. ScienceDirect+2ScienceDirectAutism Diagnostic Observation Schedule - an overviewScienceDirectAutism Diagnostic Interview Revised - an overviewPubMedNutritional management and autism spectrum disorder - PMC

Use ADOS-2 as a standardized observational component when trained personnel are available. It is a semi-structured assessment with five modules selected according to age and expressive language ability; administration generally takes 45-60 minutes and includes activities intended to elicit diagnostic social-communication and restricted or repetitive behaviors. ScienceDirectScienceDirectAutism Diagnostic Observation Schedule - an overview

Use ADI-R when a structured informant history is needed to clarify early developmental symptoms, language and communication, mutual social interaction, stereotyped behaviors, and restricted interests. It requires trained administration and usually takes 1-2 hours; it was designed to complement direct observation rather than function as a solitary diagnostic procedure. ScienceDirectScienceDirectAutism Diagnostic Interview Revised - an overview

Elicit seizure-like events, episodes of unresponsiveness, convulsive events, and developmental plateau or regression. Epilepsy and ASD co-occur frequently; reported epilepsy prevalence in ASD ranges from approximately 5% to 46%. A concerning event history should prompt neurologic assessment directed at seizure classification and treatment rather than attribution of new behavioral change to ASD alone. PubMedPubMedOverlap Between Epilepsy and Neurodevelopmental Disorders: Insights from Clinical and Genetic Studies - Epilepsy - NCBI Bookshelf

Consider a syndromic or genetic branch when ASD coexists with intellectual disability, epilepsy, characteristic physical findings, or a family history suggestive of inherited neurodevelopmental disease. Fragile X syndrome is one established condition in which children should be evaluated for ASD and, if diagnostic criteria are met, may benefit from ASD interventions; medication sensitivity may require low starting doses and gradual titration when psychotropics are used. PubMedPubMedFMR1 Disorders - GeneReviews® - NCBI Bookshelf - NIH

For severe aggression, destructive behavior, or persistent challenging behavior, first define antecedents, consequences, communication demands, sleep disruption, pain or medical contributors, and environmental mismatch through a functional behavioral assessment. The result should specify an intervention target and replacement skill rather than simply label behavior as an ASD symptom. PubMed+1PubMedFMR1 Disorders - GeneReviews® - NCBI Bookshelf - NIHPubMedBehavioral Interventions for Autism Spectrum Disorder - PMC

Create a written plan that specifies the impairment, intervention, setting, responsible discipline, measurable outcome, and reassessment interval. Core components commonly include behavioral intervention, speech-language therapy, occupational therapy when indicated, individualized educational support, and family training. PubMed+2PubMedNutritional management and autism spectrum disorder - PMCPubMedBehavioral Interventions for Autism Spectrum Disorder - PMCPubMedFMR1 Disorders - GeneReviews® - NCBI Bookshelf - NIH

Use applied behavior analysis or another structured behavioral intervention when the treatment target is a defined behavior, communication skill, social skill, adaptive skill, or participation barrier. ABA is individualized to behavioral, social, and adaptive strengths and weaknesses, typically delivered one-to-one by a board-certified behavior analyst, and uses measured progress to guide modification. PubMed+1PubMedFMR1 Disorders - GeneReviews® - NCBI Bookshelf - NIHPubMedCHILDHOOD AND ADOLESCENCE DISORDERS - Nursing: Mental Health and Community Concepts - NCBI Bookshelf

For young children, early intensive behavioral intervention, Early Start Denver Model, intensive individualized intervention, cognitive behavioral therapy for relevant emotional difficulties, and parent-mediated intervention are among interventions supported in the reviewed literature. Select the modality by developmental level, target symptom, access, family capacity, and treatment response rather than assigning a uniform program. PubMedPubMedBehavioral Interventions for Autism Spectrum Disorder - PMC

At each follow-up, review the prespecified functional outcomes across home, school, and community settings: communication, adaptive skills, educational participation, behavior frequency and severity, sleep, feeding, emotional symptoms, and caregiver implementation burden. Maintain therapies that produce measurable benefit and revise goals when progress plateaus or developmental demands change. PubMed+1PubMedNutritional management and autism spectrum disorder - PMCPubMedCHILDHOOD AND ADOLESCENCE DISORDERS - Nursing: Mental Health and Community Concepts - NCBI Bookshelf

Reassess for newly apparent co-occurring conditions when there is a stepwise decline in function, emerging paroxysmal events, severe escalation of aggression, or a mismatch between intervention intensity and impairment. Epilepsy, ADHD, intellectual disability, and other neurodevelopmental conditions may co-occur and materially alter care planning. PubMedPubMedOverlap Between Epilepsy and Neurodevelopmental Disorders: Insights from Clinical and Genetic Studies - Epilepsy - NCBI Bookshelf

Coordinate prescribing clinicians, behavioral clinicians, speech-language pathologists, occupational therapists, school personnel, and family caregivers around a shared behavioral and functional plan. Multidisciplinary management is particularly important when medication is used for a co-occurring symptom target or when safety-related behavior persists. PubMed+1PubMedFMR1 Disorders - GeneReviews® - NCBI Bookshelf - NIHPubMedSerine Deficiency Disorders - GeneReviews® - NCBI Bookshelf