A review paper published in the Canadian Medical Association Journal provides a summary of the current understanding of ASD and suggests a comprehensive set of guidelines on best practices for detection, diagnosis and treatment for children with autism based on the currently available evidence randomized controlled trials (RCTs) or systematic reviews. - See more at:
"We have come to understand ASD as a remarkably heterogeneous constellation of conditions that covary with other disabilities and disorders (e.g., intellectual disability, epilepsy, ADHD, anxiety disorders) and various medical problems," writes Dr. Stephen Scherer, senior scientist and director of The Centre for Applied Genomics at The Hospital for Sick Children (SickKids) and director of the McLaughlin Centre at the University of Toronto, with coauthors. "Recent discoveries of underlying genomic factors have shown great complexity and implicate various networks of causal factors."
ASD, which includes a variety of traits that range from mild to severe, is estimated to affect about 1% of the population, although it is under-recognized in the developing world.
The review, by specialists in pediatrics, psychiatry, epidemiology, neurology and genetics from across Canada, outlines the current understanding of ASD and best practices for pediatricians, family doctors and specialist clinics, and identifies resources for clinicians.
Topics include:
What causes autism? The causes are thought to be multi-factorial: genetic, epigenetic, and non- genetic factors.
How is ASD diagnosed?The diagnostic assessment of ASD allows a physician to determine if a child meets the accepted ASD criteria (usually per Diagnostic and Statistical Manual of Mental Disorders
[DSM] criteria), identify comorbid medical orgenetic syndromes or psychopathology, and identify the patient’s treatment needs. Red flags come from parents and or caregivers such a teachers.
How can ASD be detected early?Although more than 80% of children with ASD show clear behavioural signs by two years of age and a diagnosis can be made reliably this early, the average age at diagnosis is about four years. According to the article the most effective strategy is to have children tested by age of 18 to 24 months using standardized tools. The ways a parent can detect ASD is by monitoringtheir child’s developmentThey can take action if they are concerned. They should also trust their instincts. Parents know their child best.
What other illnesses or conditions are associated with ASD? According to the National Center on Birth Defects and Developmental Disabilities, at the Centers for Disease Control and Prevention, Children with autism are “1.8 times more likely than children without developmental disabilities to have ever had an asthma diagnosis, 1.6 times more likely to have had eczema or a skin allergy during the past year, 1.8 times more likely to have had a food allergy during the past year, 2.1 times more likely to have had three or more ear infections during the past year, 2.2 times more likely to have had frequent severe headaches or migraines during the past year, and 3.5 times more likely to have had frequent diarrhea or colitis during the past year.”
What treatments and interventions are available and effective? According to The American Academyof Pediatrics the following treatments are used in ASD: 1. Behavioral interventions: Behavioral training and management uses positive reinforcement, self-help, and social skills training to improve behavior and communication. 2. Biomedical interventions which includes giving the child medication. Medicines are most commonly used to treat related conditions and problem behaviors, including depression, anxiety, hyperactivity, and obsessive-compulsive behaviors. 3. Specialized therapies. These include speech, occupational, and physical therapy. These therapies are important components of managing autism and should all be included in various aspects of the child's treatment program.”
"Community physicians play an essential role in identifying early signs of ASD and ensuring timely diagnosis," write the authors. "The greatest impact on outcome will come from careful attention to parents' concerns, observing early social and communication skills (e.g., interaction with parents and response to simple social games), immediate referral to available intervention services (e.g., infant development and/or speech-language services, and timely referrals for specialized assessments and interventions."
The authors describe "red flags" for autism as well as best practices for treatments, which include behavioral interventions such as applied behavior analysis. This technique uses a variety of approaches to teach children skills to reduce problem behavior.
They also touch upon future directions for understanding the disease.
"New experimental therapeutics holds promise for the treatment of core symptoms and has the potential to alter developmental trajectories. Treatments in animal models carrying single gene mutations for disorders associated with ASD are particularly promising. Future research should focus on how we can better match interventions to child and family characteristics through personalized medicine over the lifetime of the patient," the authors conclude.
I have a nephew who is diagnosed with ASD. He was just diagnosed recently at age 6. I feel that if his grandparents who had custody of him had him tested at a younger age for this disorder he would today be progressing in school rather than digressing. My sister who now has custody saw the signs and symptoms because we have other family members on the autism spectrum. She had him tested and now he is on medication and has be involved in specialized therapies as well as behavioral interventions. This is a slow process changing him but none the less worth it. http://www.webmd.com/brain/autism/autism-treatment-overview http://blog.autismspeaks.org/2012/01/24/autism-and-associated-medical-conditions/
http://www.cmaj.ca/content/early/2014/01/13/cmaj.121756.full.pdf