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New Autism Guidelines

On December 16, 2019, the American Academy of Pediatrics updated their Autism guidelines for the first time in 12 years.

The AAP paper, titled “Identification, Evaluation, and Management of Children with Autism Spectrum Disorder,” recommends focusing on early screening and intervention.

Along with pediatricians, the report says parents play a big role in identifying and reporting early signs so children with Autism can get diagnosed quicker and get those necessary early interventions.

What is Autism?

Autism is a developmental disorder characterized by challenges with social skills, repetitive behaviors, speech, and nonverbal communication. The diagnosis of Autism Spectrum Disorder (ASD) is based on identifying observed and reported behaviorally defined clinical symptoms. 

Many children with ASD also have co-occurring conditions, such as sleep disorders, seizures, ADHD, OCD, behavioral problems, mood issues, etc. According to the report, “Co-occurring conditions are common in children with ASD and may have great effects on child and family functioning and clinical management”.

What are the Autism rates?

About 1 in 59 children has been identified with Autism Spectrum Disorder (ASD) according to estimates from CDC’s Autism and Developmental Disabilities Monitoring (ADDM) Network. 

The AAP report notes that the current rate of children diagnosed with Autism has risen dramatically in recent decades to about 1.7 percent of the population.

The CDC indicates that ASD is reported to occur in all racial, ethnic, and socioeconomic groups and that it is about four times more common among boys than among girls. ASD is an international problem and studies in Asia, Europe, and North America have identified individuals with ASD with an average prevalence of between 1% and 2%.

Why the Increase In Autism?

The AAP report denotes that “In the years since 2007, reported prevalence rates of children with ASD have increased, understanding of potential risk factors has expanded, awareness of co-occurring medical and behavioral conditions and genetic contribution to etiology has improved, and the body of research supporting evidence-based interventions has grown substantially,”.

The impact of genetic mutations and genetics in Autism has become increasingly known. “Understanding of gene-environment interaction and research into potential immunologic factors that affect brain development are increasing.” So, it just isn't genetics alone but rather the interaction between genetics and gene mutations with a variety of environmental factors, including environmental toxins. 

There are also prenatal influences including certain medications and having an older mother or father is linked to greater risk of ASD. 

Notably, because fragile X syndrome increases risk for ASD, DNA testing for fragile X syndrome is recommended for all children with ASD. 

The report recommends that families should consider performing genetic testing that may help better understand the type of Autism a child has, which could affect what type of interventions the child is provided.

Prognosis of Autism

The prognosis and development of a child with Autism can't be predicted at this time according to the AAP guidelines. Some interesting findings were reported with regards to outcomes.

  • Young children with ASD with language impairment appear to have more social difficulty than do children with ASD without language impairment
  • Children with ASD and intellectual disability have the most difficulty developing social skills
  • Executive function difficulties are associated with poorer adaptive outcomes, independent of IQ
  • Approximately 9% of children who are diagnosed with ASD in early childhood may not meet diagnostic criteria for ASD by young adulthood
    • Youth who no longer meet criteria for ASD are more likely to have a history of:
      • Higher cognitive skills at 2 years of age
      • Higher verbal IQ scores
      • Participated in earlier intervention services
      • Demonstrated a decrease in their repetitive behaviors over time

Treatments That Help Autism

The AAP recommends that interventions for children either diagnosed with Autism or even before a formal diagnosis, if they are at-risk, should start as soon as possible. The research clearly shows that the earlier intervention begins, the better the outcomes for children with ASD as they get older.

The AAP report states, “Treatments should be individualized, developmentally appropriate, and intensive, with performance data relevant to treatment goals to evaluate and adjust intervention”. It suggests that applied behavior analysis (ABA), developmental approaches, and/or naturalistic approaches should be used. 

Parents are critical in their child's treatment program. “Increasing evidence reveals that focused interventions delivered by trained parents or other caregivers can be an important part of a therapeutic program”. They are especially important in reinforcing social skill interventions. Teaching social skills increases a child’s knowledge of the cues for social behavior and strategies for social problem-solving and these skills result in improved life outcomes.

The report notes that between 28% and 74% of children with ASD are given at least one (and often more) complementary therapy. Complementary therapies can be useful and parents often try to adjust diets to reduce behaviors and symptoms. There are several therapies that can be useful.

Since sleep is such an issue for children with ASD, it is important to note that melatonin has been demonstrated to be a safe and effective intervention.

There are many treatments and the AAP suggests using evidence-based therapies. The AAP suggests that the goals of all Autism treatments should:

  • Minimize core deficits 
  • Improve social communication and interaction
  • Reduce restricted or repetitive behaviors and interests
  • Reduce co-occurring associated impairments
  • Maximize functional independence by facilitating learning and acquisition of adaptive skills
  • Eliminate, minimize, or prevent problem behaviors that may interfere with functional skills

Key Findings from the AAP Autism Guidelines

There were many important findings from the AAP Autism guidelines, but here are some additional key ones.

  • The pediatric health care provider is a resource for information and should collaborate with families
  • That children should be formally and regularly screened for Autism as early as possible.
  • Conduct developmental and behavioral observations during all well visits with children, developmental screening at the 9-, 18-, and 30-month visits, and standardized screening of patients for Autism spectrum disorder (ASD) at 18 and 24 months old.
  • Girls may have lesser intensity of symptoms and fewer externalizing behaviors and therefore may be under diagnosed.
  • When developmental concerns are identified, pediatricians should refer children to early intervention (0-3 years of age) or school services to initiate services.
  • Constipation is common in Autism
  • Pediatricians often see young children with severe food selectivity and sleep problems who are later diagnosed with ASD
  • Individuals with ASD are at increased risk for seizures.
  • Almost 16% of young children with ASD have a head circumference greater than the 97th percentile
  • Intervention for children either diagnosed with Autism or even before a formal diagnosis, if they are at-risk, should start as soon as possible.
  • The research shows that the earlier intervention begins, the better their outcomes as they get older.
    There needs to be better identification of co-occurring health conditions now associated with ASD including, ADHD, OCD, anxiety and  sleep and intestinal disorders, seizures, etc.
    That families should consider performing genetic testing that may help better understand the type of Autism a child has, which could affect what type of interventions the child is provided.
  • Children with ASD need evidence-based services to address social, academic and behavioral needs at home and school, with access to appropriate pediatric and mental health care, respite services and leisure activities.
    There is a need for a combination of developmental and behavioral approaches, as well as parent-mediated therapies.
  • At school age, social skills should be addressed through pragmatic language therapy, teaching play and interaction with peers.
  • Wandering is a major behavioral and health risk issue and should be addressed through anticipatory guidance throughout the lifespan.
  • Addressing GI and feeding issues is important
  • Families should be supported to work on transitions to post-secondary education, work and adult health providers
  • Pediatricians need to inform patients and families about the evidence for interventions and give referrals to organizations and providers that can see these children quickly

Evidence-Based Therapies for Children with Autism

Call our center today to discuss how we can help you or your child with our clinically effective and natural therapies, such as neurofeedback or biofeedback, addressing Autism, ADHD, anxiety, OCD, depression, and numerous other conditions.  We also offer counseling, executive functioning coaching, social skills support, and behavioral support for children and families, and parent coaching sessions with our staff psychotherapists. To set up an appointment for a consultation with Dr. Roseann, or to meet with one of our psychotherapists, call 203.544.2781 or email: [email protected]

Live out of state? We work with children, individuals, and families through our intensive therapies program “The 360° Reboot® Program”. Or take our Symptom Reversal home study course for parents.

Dr. Roseann is a Pediatric Mental Health Expert and Therapist and our center provides expert-level care for children, adults, and families from all over the US, supporting them with research-based and holistic therapies that are bridged with neuroscience. She is frequently featured as an expert on local and national media outlets. She is a Dr. Roseann is a Board Certified Neurofeedback (BCN) Practitioner, a Board Member of the Northeast Region Biofeedback Society (NRBS) and Epidemic Answers, Certified Integrative Medicine Mental Health Provider (CMHIMP) and an Amen Clinic Certified Brain Health Coach. She is also a member of The International Lyme Disease and Associated Disease Society (ILADS), The American Psychological Association (APA), National Association of School Psychologists (NASP), Connecticut Counseling Association (CCA), International OCD Foundation (IOCDF) International Society for Neurofeedback and Research (ISNR) and The Association of Applied Psychophysiology and Biofeedback (AAPB).

©Roseann-Capanna-Hodge, LLC 2019

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