AAP 2011: Autism Diagnostic Guidelines to Be Updated

During Sunday morning’s session on diagnosing autism, presenters Kathryn Ellerbeck, MD, FAAP, and Catherine Smith, PhD, covered the difficulties in determining whether or not a child has autism.

After going through a number of case studies, the presenters closed the session by providing a number of resources that pediatricians will want to familiarize themselves with as autism diagnostic guidelines continue to evolve. Right now, pediatricians rely on DSM-IV criteria to help them evaluate children for autism spectrum disorders. If patients fall within the spectrum, pediatricians are then encouraged to take the appropriate steps to get the patient proper care. That can include referring them to:

1) An educational system for educational identification

2) Autism experts for clinical diagnosis

3) Medical sub-specialists for etiologic diagnosis

4) Mental health system for co-occurring diseases

However, as more information about ASDs come to light, diagnostic guidelines will change. In fact, an “autism tool kit” is set to be released next year and DSM-V criteria is set to be released in 2013. However, these new resources will incorporate information from other resources that pediatricians should familiarize themselves with now. Those resources, according to Ellerbeck and Smith, are:

- The Social Communication Questionnaire

- Autism Spectrum Screening Questionnaire

- The Childhood Asperger Syndrome Test

In doing so, pediatricians will be ahead of the curve and will be armed with the proper protocol for interviewing children for a potential autism diagnosis.

Questions & Answers

Following the presentation, audience members had an opportunity to ask questions. The first attendee was a pediatrician from New Jersey who wondered how much a pediatrician should get involved when suspecting that a child has autism. He explained that he was beginning to think that one of his patients had autism but that the child was doing well in school and that his parents were defensive about the possibility. Seeing as neither the child’s teachers nor parents wanted to explore this issue, the pediatrician was limited in what he could do, even though he was concerned about how ignoring the exploration of the issue could lead to behavioral problems later in life. Ellerbeck and Smith understood his plight, and mentioned that there are many cases in which an autistic patients' symptoms often worsen over time, but the only advice they could offer was to to tell him to see if he could “probe” a little more with the parents by asking questions like how many friends the child had and if he was interacting well with others. Aside from that, unfortunately, there wasn’t much he could do.

The next question also came from a pediatrician from New Jersey, causing the presenters and people in the audience to raise an eyebrow and informally name NJ the capital of autism. (The pediatrician did not disagree with it and did say that there was a high rate of autistic children in the state.) She wanted to know what the involvement of schools should be in helping children who are diagnosed with autism, stating that she had two patients who weren’t getting the necessary linguistic help they should have been receiving. “It really all depends on the school districts,” Ellerbeck said. She added that it’s really a case-by-case basis where one school district can be very understanding and helpful, whereas another one just blocks away may approach the situation much differently and require parents to get private help if possible. It was evident that the pediatrician was dealing with the latter type of school district and she seemed very concerned and frustrated that the school was not intervening to assist in helping these children.

The final question came from a pediatrician who wanted to know if autism was a “lifelong diagnosis” or one that could be removed from a patient over time if enough progress was made. Ellerbeck and Smith noted that a small percentage of autistic individuals really do make enough progress to have this diagnosis removed, though a majority of cases often improve but certain autism criteria remain. The pediatrician was asking this question because the parents of a patient of hers were explaining to her that their autistic son had improved and wanted her to write them documentation saying that the child was no longer autistic. The presenters told her to be cautious about doing that because, in order to even consider removing the diagnosis, lots of information would have to be retrieved from parents, teachers, and other before re-evaluating the diagnosis.

Autism spectrum disorders are extremely complicated and present in many different ways. However, the good news is that data in continually being collected and efforts to understand, diagnose, and treat these disorders are ongoing. Evolving criteria is a good sign, and hopefully will lead to earlier intervention and better outcomes moving forward.