Management of Children With Autism Spectrum Disorders

Abstract

Pediatricians have an important role not only in early recognition and evaluation of autism spectrum disorders but also in chronic management of these disorders. The primary goals of treatment are to maximize the child's ultimate functional independence and quality of life by minimizing the core autism spectrum disorder features, facilitating development and learning, promoting socialization, reducing maladaptive behaviors, and educating and supporting families. To assist pediatricians in educating families and guiding them toward empirically supported interventions for their children, this report reviews the educational strategies and associated therapies that are the primary treatments for children with autism spectrum disorders. Optimization of health care is likely to have a positive effect on habilitative progress, functional outcome, and quality of life; therefore, important issues, such as management of associated medical problems, pharmacologic and nonpharmacologic intervention for challenging behaviors or coexisting mental health conditions, and use of complementary and alternative medical treatments, are also addressed.

Complementary and Alternative Medicine in Autism: An Evidence-Based Approach to Negotiating Safe and Efficacious Interventions with Families

“…5 These core symptoms are frequent targets of medical, behavioral, and educational interventions. 6 Associated symptoms such as hyperactivity, anxiety, aggression, insomnia, and gastrointestinal symptoms are also common in ASD and are frequent targets of both conventional treatments and CAM therapies. 6 -9 Autism spectrum disorders are highly heritable, but phenotypic heterogeneity and environmental influences on gene expression complicate identification of causal factors.…”

“…Multisite research networks have been established, 13,14 and clinical practice guidelines for the identification and treatment of children with ASD have recently clarified the role of the primary care provider. 6,15 Additionally, a stronger evidence base is emerging for educational and behavioral treatments. 16,17 Recently, several very well-designed medication trials have begun to clarify the evidence base for medications that physicians use for some of the most problematic associated symptoms of ASD.…”

“…13,14,18,19 For many families, however, geographic and economic barriers continue to limit access to high-quality behavioral and educational interventions, 20,21 and many concerns endorsed by families of children with ASD remain difficult to treat. 6,9,13 Additionally, despite increasing use of conventional psychiatric medications in children with ASD, 14,19 the evidence base supporting such use remains limited, and well-designed studies have found increased adverse effects and no clinical benefit from some medications that have been widely prescribed to children with ASD. 14 These inconsistencies can be challenging for families and contribute to the increased levels of treatment uncertainty reported by parents of children with ASD.…”

“…Hierarchy of evidence and the need for controlled studies to truly establish safety and efficacy can be discussed with families. 6 This is critical, given that several studies have demonstrated that patients continue to desire and value the advice of their healthcare providers to inform their decision-making in regard to choosing specific types of CAM. 1,9,22 Maintaining the quality of the relationship between the health care professional, the patient, and family significantly affects patient outcomes and family function, 35 but this can be difficult when providers are asked to endorse or provide a therapy that they themselves consider risky or potentially harmful.…”

“…Vitamin B 6 is important in neurotransmitter production and is a cofactor for many enzymes related to protein metabolism. It also has effects on the immune system (NCCAM, http://ods.od.…”