The American Academy of Child and Adolescent Psychiatry (AACAP) has published a revised Practice Parameter for the Assessment and Treatment of Children and Adolescents with Autism Spectrum Disorder (ASD). This revision updates the previous guidelines and incorporates new research. The Parameter is applicable to evaluation of children and adolescents (<17 years of age) and includes the following recommendations.
Recommendation 1. The developmental assessment of young children and the psychiatric assessment of all children should routinely include questions about ASD symptomatology. Screening should include inquiries about the core symptoms of ASD, including social relatedness and repetitive or unusual behaviors.
Recommendation 2. If the screening indicates significant ASD symptomatology, a thorough diagnostic evaluation should be performed to determine the presence of ASD.
Recommendation 3. Clinicians should coordinate an appropriate multidisciplinary assessment of children with ASD. This includes a physical exam, hearing screening, genetic testing, communication assessment, and psychological assessment. Psychological assessment, including measurements of cognitive ability and adaptive skills, helps to frame observed social-communication difficulties relative to overall development and clarify areas of strength and weakness useful in designing intervention programs. Likewise, communication assessment, including measurements of receptive and expressive vocabulary and language use (particularly social or pragmatic), is useful for diagnosis and treatment planning. Occupational and physical therapy evaluations may also be needed to evaluate sensory and/or motor difficulties. When members of multiple disciplines are involved in assessment, it is optimal that coordination occurs among the various professionals.
Recommendation 4. The clinician should help the family obtain appropriate, evidence-based,and structured educational and behavioral interventions for children with ASD. Programs shown to be effective typically involve planned, intensive, individualized intervention with an experienced, interdisciplinary team of providers, and family involvement to ensure generalization of skills. The educational plan should reflect an accurate assessment of the child’s strengths and vulnerabilities, with an explicit description of services to be provided, goals and objectives, and procedures for monitoring effectiveness. This includes goals of enhancing verbal and nonverbal communication, academic skills, and social, motor, and behavioral capabilities.
Recommendation 5. Pharmacotherapy may be offered to children with ASD when there is a specific target symptom or comorbid (co-occurring) condition. Pharmacologic interventions may increase the ability of persons with ASD to profit from educational and other interventions and to remain in less restrictive environments through the management of severe and challenging behaviors. Frequent targets for pharmacologic intervention include associated comorbid conditions (e.g., anxiety, depression) and other features, such as aggression, self-injurious behavior, hyperactivity, inattention, compulsive-like behaviors, repetitive or stereotypic behaviors, and sleep disturbances.
Recommendation 6. Raising a child with autism presents major challenges. The clinician should develop a long-term collaboration with the family and maintain an active role in long-term treatment planning and family support and support of the individual. As part of this long-term engagement, parents and siblings of children with ASD will need support.
Recommendation 7. Clinicians should specifically inquire about the use of alternative/complementary treatments and be prepared to discuss their risk and potential benefits.Although most alternative or complementary treatment approaches have very limited empirical support for their use in children with ASD, they are commonly pursued by families. It is important that the clinician be able to discuss these treatments with parents, recognizing the motivation for parents to seek all possible treatments.
This AACAP Practice Parameter recognizes that the multiple developmental and behavioral problems associated with ASD necessitate multidisciplinary care, coordination of services, and advocacy for individuals and their families. The recommendations were developed to assist clinicians in psychiatric decision making and are not intended to define the sole standard of care. Consequently, the Parameters should not be considered inclusive of all appropriate methods of care or exclusive of other methods of care directed at obtaining the desired results. The ultimate judgment regarding the care of a particular person must be made by the clinician in light of all of the circumstances presented by the individual and his or her family, the diagnostic and treatment options available, and available resources.
Practice Parameter for the Assessment and Treatment of Children and Adolescents With Autism Spectrum Disorder. J. Am. Acad. Child Adolesc. Psychiatry, 2014; 53(2): 237–257. Fred Volkmar, MD, Matthew Siegel, MD, Marc Woodbury-Smith, MD, Bryan King, MD, James McCracken, MD, Matthew State, MD, PhD, and the American Academy of Child and Adolescent Psychiatry (AACAP) Committee on Quality Issues (CQI)
Lee A. Wilkinson, PhD is the author of the award-winning book, A Best Practice Guide to Assessment and Intervention for Autism and Asperger Syndrome in Schools, published by Jessica Kingsley Publishers. He is also editor of a new Volume in the APA School Psychology Book Series, Autism Spectrum Disorder in Children and Adolescents: Evidence-Based Assessment and Intervention in Schools.
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