W11 Pediatric Clinical Reference Tool

Child

Adolescent

Notable differences from adults

Description of the Disorder in Pediatric Populations

Autism spectrum disorder is a group of neurodevelopmental disorders (NIH, n.d.).

These disorders are characterized by persistent deficits in behavioral, communication and social interactions (CDC, n.d).

It is most diagnosed in males with a 3:1 male to female ratio (Hodges et al., 2020).

Diagnosis by a trained specialist or pediatric practitioner can be made as early as 2 years of age. Developmental screening by the American Academy of Pediatrics is recommended at ages 9 months, 18 months, and 36 months, with specific screenings for ASD at 18 months, and 24 months. (CDC, n.d.).

Diagnosis is based on the DSM-5 criteria which includes:

· Persistent deficits in social communication and interactions in multiple settings including social emotional reciprocity for example inability to understand others’ feelings and thoughts, difficulty coordinating non-verbal communication, and difficulty developing and maintaining relationships.

· Persistent restricted and repetitive movements, for example rocking, spinning and echolalia.

· Functional impairment in social, academic, and daily routines

· Presence of symptoms during the early developmental period

· Symptoms are not caused by intellectual disability

Assessment of the level of severity is important to determine support needed. There are three levels for both social communication and interaction as well as repetitive and restricted behaviors (ASD, 2021).

Same as child

There is limited information on adult ASD, but diagnostic criteria recommended at 18 years and above includes presence of

· Disruptive and self-injurious behaviors

· Learning disabilities, dysmorphic features, and epilepsy (Scattoni et al., 2021)

Poor job prospects, limited social integration and high rate of mental health problems (Howlin & Magiati, 2017)

Treatment Recommendations

While there is no actual medication to treat autism as a condition, the FDA has approved two medications to treat symptoms often accompanied with this disorder (Murphy, 2018).

· *Risperidone – initial dose of 0.5mg QD or BID, may increase slowly 0.5-1mg per day up to 6mg per day. Avoid taking with anxiety medications such as Lorazepam or Diazepam due to increased sedation (Murphy, 2018).

· *Aripiprazole – initial 2mg/day, may increase by 5mg/day each week, max dose of 15mg/day.

These two medications have shown to help with the irritability associated with ASD.

The most effective treatment for ASD has proven to be:

Behavioral therapy

this is to help with several things:

· Anxiety in social situations

· Inability to understand other's feelings and thoughts

· Inability to make friends

· Hard time expressing their feelings

· Rude or blunt disposition

Educational interventions

· Relationship development

· Sensory integration

· Social skill training

· Occupational therapy (Sharma, Gonda, & Tarazi, 2018).

Same as child

Treatment options do not vary significantly. One thing to note however, is that some of the symptoms associated with ASD may be more prominent when socially involved. Due to this they may seek out medication as well as behavioral therapy to help with their interactions among other adults.

Safety Issues

One of the most significant safety concerns associated with ASD is safety. Most parents/caretakers view safety as one of the most critical concerns affecting their children in the home environment. Children with autism are likely to engage in unsafe activities such as breaking plates and cups, dumping drawers/bins, and breaking windowpanes, which may eventually harm them. Some of the things that parents do to ensure their children's safety include:

· Modifying doors and stairways.

· Covering electrical outlets.

· Putting cabinets to ensure that they are out of reach.

Another paramount safety concern is that parents with ASD children should not let them wander around because they might end up being assaulted by perpetrators (Rice et al., 2016). Children with ASD have problems with communication; thus, they cannot report an incident such as sexual assault, even when it occurs. Parents with ASD children, therefore, are to be trained on elopement, childproofing home, and other vital aspects to keep their children safe.

Same as child

All depends on functioning level of autism diagnosed. If the person is high functioning, they may not need any special safety considerations. Otherwise, safety would be like that of a child.