Management of Autism Spectrum Disorder

Diagnostic Confirmation and Initial Evaluation

The American Academy of Pediatrics recommends documenting normal hearing with formal audiogram to rule out hearing loss that mimics autism symptoms, and obtaining high-resolution chromosome studies and Fragile X testing at diagnosis confirmation, with a diagnostic yield of 30-40% using current technology 1, 4
The American College of Medical Genetics and Genomics suggests referring for clinical genetics evaluation, with a diagnostic yield of 10% beyond standard karyotype using chromosomal microarray, 5% using Fragile X testing, 5% using MECP2 testing in females, and 3% using PTEN testing if head circumference exceeds 2.5 standard deviations 1, 4

The American Academy of Pediatrics recommends implementing Applied Behavioral Analysis (ABA) techniques as the foundation of treatment, with a focus on functional analysis of target behaviors, differential reinforcement, and forward or backward chaining with reinforcement for multistep task completion 2
The American Academy of Child and Adolescent Psychiatry suggests using visual schedules, planners, timers, and assistive technology to address organizational weaknesses, and providing explicit teaching of social reciprocity and pragmatic language skills through structured programs 2

The American Speech-Language-Hearing Association recommends implementing Picture Exchange Communication System, sign language, activity schedules, or voice output communication aids for nonverbal or minimally verbal individuals, and explicitly teaching social reciprocity and pragmatic language skills through structured programs for individuals with fluent speech but pragmatic deficits 2, 3

The American Academy of Pediatrics recommends screening systematically for psychiatric comorbidities, including depression, anxiety disorders, sleep disturbances, and ADHD symptoms, with a prevalence of 20% for depression, 11% for anxiety disorders, and 13% for sleep disturbances 3, 5, 6, 7
The American Academy of Child and Adolescent Psychiatry suggests using standardized rating scales to monitor treatment response, and combining medication with behavioral interventions for behavioral disturbances 3

The American Academy of Child and Adolescent Psychiatry recommends using risperidone and aripiprazole for irritability and aggression, with a standardized mean difference of 1.1 and a large effect size, and methylphenidate for ADHD symptoms, with a standardized mean difference of 0.6 and a moderate effect size 3

The American College of Medical Genetics and Genomics recommends providing genetic counseling to all families, with a recurrence risk of 3-10% for full siblings, and ≥30% if ≥2 children are affected 1

The American Psychological Association suggests using cognitive behavioral therapy for adolescents and adults with higher cognitive functioning, demonstrating efficacy for anxiety and anger management 3