Two new clinical reports from the American Academy of Pediatrics (AAP) will help pediatricians recognize autism spectrum disorders (ASDs) earlier and guide families to effective interventions, which will ultimately improve the lives of children with ASDs and their families...
The first clinical report, "Identification and Evaluation of Children With Autism Spectrum Disorders," provides detailed information on signs and symptoms so pediatricians can recognize and assess ASDs in their patients. Language delays usually prompt parents to raise concerns to their child's pediatrician usually around 18 months of age. However, there are earlier subtle signs that if detected could lead to earlier diagnosis. These include:
-- not turning when the parent says the baby's name;
-- not turning to look when the parent points says, "Look at…" and not pointing themselves to show parents an interesting object or event;
-- lack of back and forth babbling;
-- smiling late; and
-- failure to make eye contact with people.
Most children, at some time during early development, form attachments with a stuffed animal, special pillow or blanket. Children with ASDs may prefer hard items (ballpoint pens, flashlight, keys, action figures, etc.). They may insist on holding the object at all times.
The report advises pediatricians to be cognizant of signs of ASD, as well as other developmental concerns, at every well-child visit by simply asking the parents if they or their child's other caregivers have any concerns about their child's development or behavior. If concerns are present that may relate to ASD, the clinician is advised to use a standardized screening tool. The report also introduces universal screening, which means pediatricians conduct formal ASD screening on all children at 18 and 24 months regardless of whether there are any concerns.
"Red Flags" that are absolute indications for immediate evaluation include:
-- no babbling or pointing or other gesture by 12 months;
-- no single words by 16 months;
-- no two-word spontaneous phrases by 24 months; and
-- loss of language or social skills at any age.
Early intervention can make a huge difference in the child's prognosis. "Autism doesn't go away, but therapy can help the child cope in regular environments," said Chris Plauche Johnson, MD, MEd, FAAP, and co-author of the reports. "It helps children want to learn and communicate."
Educational strategies and associated therapies, which are the cornerstones of treatment for ASDs, are reviewed in the second AAP clinical report, "Management of Children With Autism Spectrum Disorders." Early intervention is crucial for effective treatment. The report strongly advises intervention as soon as an ASD diagnosis is seriously considered rather than deferring until a definitive diagnosis is made. The child should be actively engaged in intensive intervention at least 25 hours per week, 12 months per year with a low student-to-teacher ratio allowing for sufficient one-on-one time. Parents should also be included.
Pediatricians who treat children with ASDs should recognize that many of their patients will use nonstandard therapies. The report says it's important for pediatricians to become knowledgeable about complementary and alternative medicine (CAM) therapies, ask families about current and past CAM use, and provide balanced information and advice about treatment options, including identifying risks or potential harmful effects. They should avoid becoming defensive or dismissing CAM in ways that convey a lack of sensitivity or concern, but they should also help families to understand how to evaluate scientific evidence and recognize unsubstantiated treatments.
"Many parents are interested in CAM treatments such as various vitamin and mineral supplements, chelation therapy, and diet restrictions. It's important for pediatricians to maintain open communication and continue to work with these families even if there is disagreement about treatment choices," said co-author of the reports Scott M. Myers, MD, FAAP. "At the same time, it's also important to critically evaluate the scientific evidence of effectiveness and risk of harm and convey this information to the families, just as one should for treatment with medication and for non-medical interventions."
Although use of the gluten-free/casein-free diet for children with ASDs is popular, there is little evidence to support or refute this intervention. More studies are in progress, and it is anticipated that these studies will provide substantially more useful information regarding the efficacy of the gluten-free/casein-free diet.
Tantrums, aggressive behaviors, and self-injury are common among children with ASDs, and medical factors may cause or exacerbate these behaviors. Behavior management strategies are often the most effective treatment for challenging behaviors. In some children, medications are effective in addition to the behavioral strategies. The report addresses the medical issues that some children with ASDs encounter such as seizures, gastrointestinal problems, and sleep disturbance, and provides guidance for medication management.
Both reports will be available on http://www.aap.org and will also be part of the new AAP practical resource for pediatricians "AUTISM: Caring for Children with Autism Spectrum Disorders: A Resource Toolkit for Clinicians," which includes screening and surveillance tools, guideline summary charts, management checklists, developmental checklists, developmental growth charts, early intervention referral forms and tools, sample letters to insurance companies and family handouts.
American Academy of Pediatrics (AAP)
141 Northwest Point Blvd.
Elk Grove Village, IL 60007-1098
United States
http://www.aap.org
Who is Wilder?
Wilder is a precious and beautiful 3 year old little boy, full of love and a joy for life. He is trapped by a devastating disorder that robs him of communication with others and the ability to live life to its fullest. This disorder is AUTISM.Wilder is now considered to be high functioning on the autism spectrum due to the dedicated work of his family. Treatment is expensive and the window of time for positive results is very limited. Children on the spectrum are most helped through consistent intervention during their preschool and early childhood years. Wilder’s parents, Josh and Gina, took him to a DAN! (defeat autism now!) doctor on November 8th and 9th to begin his recovery process. The road that lies ahead for their family is very involved and very expensive. Wilder's new treatment plan consists of Speech Therapy, Occupational Therapy, a daily HeadStart school program for development of social skills, cranioSacral Therapy, B-12 injections, antifungal medications, Low Dose Allergy shots, enzyme enrichment and nutritional supplements. Additionally, he will receive chelation treatments to extract heavy metal buildup from his body and his parents will continue to maintain his strict diet that excludes many substances (including gluten and casein) that he has adhered to since January 2007.
In the last 11 months Wilder has gone from having no words at all to being able to communicate with his family. His social skills and eye contact have also improved; these changes in his development have resulted from only two methods of therapy: changing his diet and receiving speech therapy. Because of this his parents know that adding all of the new treatments proposed by the DAN! Doctor will be the key to his ultimate healing.
YOU can make a DIFFERENCE in Wilder's life. Josh and Gina are doing all they can for
him, but they need some help...YOUR HELP! If you have ever thought to yourself, "Oh, I wish I could do something to help", here is your opportunity! Please click on the Donate link above to show Josh and Gina your support. Please give whatever you can; every dollar is so needed and appreciated. Thank you for your support!! To contact Josh and Gina email them at...
wilderswindow@gmail.com
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Sunday, November 4, 2007
Posted by wilderswindow at 6:49 PM
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