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AAP Policy

In 2001, the American Academy of Pediatrics published a policy statement on "The Pediatrician's Role in the Diagnosis and Management of Autistic Spectrum Disorder in Children." Recommendations within this policy statement include:

1. Pediatricians should listen carefully to parents when discussing their child's development. They are reliable sources of information, and their concerns should be valued and addressed immediately.

2. In the context of the medical home, pediatricians should monitor all areas of development at each well-child visit. They should be especially vigilant when there are deficits in language and social skill development.

3. Pediatricians should consider using screening and diagnostic tools specific for ASD. Such tools should be ethnoculturally and linguistically appropriate. If a pediatrician feels unable to do so, the child should be promptly referred to a specialist or, preferably, a multidisciplinary team of specialists with expertise in ASD.

4. Any child who has language delays should be referred for an audiologic and a comprehensive speech and language evaluation. If the child is uncooperative, diagnostic otoacoustic emissions or sedated brainstem auditory evoked responses should be obtained.

5. Pediatricians should continue to promote immunizations for all children. Continued high immunization rates are crucial in preventing an increase in life-threatening infectious diseases. Parents should be reassured that at the present time, there is no scientific evidence to support claims that MMR vaccine or any combination of vaccines cause ASD. A decision to not vaccinate places children and communities at risk.

6. Lead screening is indicated in the presence of risk factors, particularly pica, even in an older child. DNA analysis, high-resolution chromosome analysis, and referral to a geneticist should be considered in the presence of dysmorphic features, family history of fragile X syndrome, or mental retardation of undetermined etiology.3,4 Electroencephalography and a neurology referral are indicated in children with suspected seizures or those who have symptoms of regression. Decisions to pursue additional investigation (eg, neuroimaging) or consultation for a coexisting etiologic diagnosis (eg, phenylketonuria, tuberous sclerosis, etc) should be made on the basis of the history and physical examination, including an assessment for focal neurologic signs.3,4

7. Once the diagnosis of ASD is made, the family and caregivers should be provided with current literature and information regarding parent support groups, specific autism intervention programs, and other available community services.

8. Families should receive genetic counseling appropriate to the etiologic diagnosis. Parents of a child with apparently isolated ASD should be counseled regarding the increased recurrence risk (3%-7%) in subsequent children. When following a younger sibling of a child with known ASD, pediatricians should demonstrate a high level of vigilance and monitor the child closely for any developmental or behavioral concern.

9. Any child with a suspected delay or symptoms of ASD should be given the opportunity to enroll in an age-appropriate early intervention program or school program immediately, even before a definitive diagnosis is available. Because these programs are federally mandated69,70 (and fully implemented in most states), children with delayed or deviant development are entitled to them. Although criteria may vary slightly among states, eligibility for these programs is based on the presence of a delay, not on a categoric diagnosis.

10. Because many parents of children with ASD pursue alternative therapies, pediatricians are encouraged to become familiar with the more popular ones and approach the issue objectively and compassionately.38,39

11. Pediatricians should provide comprehensive care of the child with ASD in the context of a medical home. This includes provision of medical interventions and coordination of care with appropriate educational, rehabilitation, social, and subspecialty pediatric services.

12. In the event of an untimely death, physicians should encourage parents of a child with ASD to consent to tissue donation to support ASD research endeavors. To advance this effort, national autism organizations have established a centralized brain bank. For more information, one may call: 1-800-BRAIN-BANK.

PEDIATRICS Vol. 107 No. 5 May 2001, pp. 1221-1226

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Jeff, Age 35