Autism Spectrum Disorder: Primary Care Principles

Abstract

Autism spectrum disorder is characterized by difficulty with social communication and restricted, repetitive patterns of
behavior, interest, or activities. The Diagnostic and Statistical Manual of Mental Disorders, 5th ed., created an umbrella diagnosis
that includes several previously separate conditions: autistic disorder, Asperger syndrome, childhood disintegrative disorder,
and pervasive developmental disorder not otherwise specified. There is insufficient evidence to recommend screening for
autism spectrum disorder in children 18 to 30 months of age in whom the disorder is not suspected; however, there is a
growing body of evidence that early intensive behavioral intervention based on applied behavior analysis improves cognitive
ability, language, and adaptive skills. Therefore, early identification of autism spectrum disorder is important, and experts
recommend the use of a validated screening tool at 18- and 24-month well-child visits. Medications can be used as adjunctive
treatment for maladaptive behaviors and comorbid psychiatric conditions, but there is no single medical therapy that is
effective for all symptoms of autism spectrum disorder. Prognosis is heavily affected by the severity of diagnosis and the
presence of intellectual disability. Children with optimal outcomes receive earlier, more intensive behavioral interventions
and less pharmacologic treatment.