The diagnostic criteria exist on a continuum of severity and functional impairment ( Table 1 and Table 2). Key diagnostic features of children with ASD include deficits in social communication and restricted, repetitive patterns of behavior, interest, or activities. A summary of this evidence is available to review with concerned parents on the CDC's website at. 13 Previous concerns for causality related to thimerosal-based vaccines have been conclusively disproven. 13 Perinatal events such as low birth weight and preterm delivery increase the risk of ASD as a part of the greater overall risk of neurodevelopmental injury. 13 In utero risks include valproate (Depacon) exposure, maternal infections, traffic-related air pollution, and pesticide exposure. Prenatal risks include advanced paternal or maternal age and maternal metabolic conditions, such as diabetes mellitus, hypertension, and obesity. 9 – 12 Additional risk is associated with environmental factors. The genetic contribution to ASD occurs via a diverse group of mutational mechanisms along many biologic pathways. Studies of the genetic heritability of ASD range from 40% to 90%, with most recent estimates at nearly 50% genetic liability. 5 – 7 In 2013, DSM-5 created the umbrella diagnosis of ASD, consolidating four previously separate disorders: autistic disorder, Asperger syndrome, childhood disintegrative disorder, and pervasive developmental disorder not otherwise specified. Additionally, school-aged children with higher functioning are being diagnosed with previously unrecognized ASD. (DSM-5), an increase in social awareness, and mandatory availability of treatments. 3, 4 The increase in ASD prevalence may be partially attributed to the evolving diagnostic criteria prior to the publication of Diagnostic and Statistical Manual of Mental Disorders, 5th ed. 2 These data correlate with other studies across multiple nations and widely separated locations. The Centers for Disease Control and Prevention's (CDC's) monitored network of 11 locations has described an autism prevalence of one in 68 children, with a male-to-female ratio of 4.5-to-1. 1 Although it appeared to be a rare disorder at that time, the prevalence of autism spectrum disorder (ASD) steadily increased. Children with optimal outcomes receive earlier, more intensive behavioral interventions and less pharmacologic treatment.Īutism was first described by psychiatrist Leo Kanner in 1943 as a disorder in children who had problems relating to others and a high sensitivity to changes in their environment. Prognosis is heavily affected by the severity of diagnosis and the presence of intellectual disability. 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. 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. 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. 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. Autism spectrum disorder is characterized by difficulty with social communication and restricted, repetitive patterns of behavior, interest, or activities.
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