Questions to Ask Your Pediatrician About Autism P. Gail Williams, M.D. Associate Professor of Pediatrics University of Louisville . Questions to ask your pediatrician when you suspect the diagnosis . Questions to ask your pediatrician once the diagnosis is made Overview . What are the signs of autism? . Communication impairments . Social skills deficits . Limited range of interests and activities When You Suspect the Diagnosis . Frequently ignore language . Deficits in nonverbal communication (eye gaze, pointing and gesturing, facial expression, etc.) . Echolalia . Impairments in receptive and expressive language . Language regression in 1/3 of cases Communication in Young Children with Autism . “Off in his own world” . Lack of joint attention, shared enjoyment . Difficult to engage in interactive play . Social deficits often most evident with same age peers Social Interaction in Young Children with Autism . Minimal or atypical toy play . Strong preoccupations . Perseverative activities or speech . Insistence on routine, rituals . Abnormal response to sensory input Range of Activities in Young Children with Autism First Signs . Can we screen for autism? . The American Academy of Pediatrics has recommended specific autism screening at 18 and 24 month well child checks. . Many screening tools are available . Perhaps the most widely used is M-CHAT . Readily available and sensitive When You Suspect the Diagnosis of Autism . What services are available? . First Steps provides services for any child with developmental disabilities below the age of 3 . Includes speech therapy, occupational therapy, developmental intervention, behavior interventions . The public school system provides preschool and therapy services after age 3 . Don’t wait to start services When You Suspect the Diagnosis . How can I get definitive diagnosis? . Facilities throughout the state can provide evaluations; most are in academic centers . Evaluation should include thorough history, behavioral observations, developmental measures, autism diagnostic tool . Medical evaluation also helpful When You Suspect the Diagnosis . What causes autism? . Etiology still unknown . Neurobiologic disorder due to differences in brain development . Strong genetic component . Possible environmental factors Once the Diagnosis is Made . How common is autism? . Current research indicates prevalence rate of 1 in 88 . Dramatic increase in prevalence over last 20 to 30 years . In part, due to increased awareness, better diagnostic tools, increased services, etc. Once the Diagnosis is Made . What are the risks for having a second child with autism? . Previously quoted as 3 to 8% . Recent study of siblings of children with autism indicated recurrence risk of nearly 19% Once the Diagnosis is Made . Should any medical tests be done? . Autism is associated with other medical and genetic conditions in 10 to 15% of cases . Genetic testing recommended to include Fragile X DNA testing, microarray chromosome analysis . Sleep deprived EEG if history of language regression . Consider MRI of brain Once the Diagnosis is Made Medical Tests . Are there any medical conditions more common in autism? . Intellectual disability is identified in approximately 50% of children with autism . Seizures are present in approximately one-third of children with autism Once the Diagnosis is Made . What about vaccinations and autism? . First concerns were raised about measles vaccine and autism . Initial work discredited; numerous studies showed no relationship between autism and measles vaccine . Later concern about thimerosol and autism . Studies showed no relationship; no longer used as preservative in vaccines Once the diagnosis is made . What about sleep? . Many children with ASD have sleep problems . Disruption in Circadian rhythms . Difficulty falling and staying asleep, waking early . Behavioral interventions first line . Melatonin may be helpful Once the Diagnosis is Made . What about eating habits? . Often very limited food repertoires . Can be based on sensory issues . Behavioral approach often very effective . Systematic approach to introducing new foods . Provide rewards and exposure, not trying to force Once diagnosis is made . What is the treatment for autism? . Primarily educational and behavioral . 24 evidence based practices . Speech therapy . Occupational therapy . Social skills training Once the Diagnosis is Made . What about behavioral problems associated with autism? . Behavioral problems common . Attention problems and hyperactivity . Anxiety and depression . Marked irritability with mood lability, aggression, self injurious behavior Once the diagnosis is made . What role does medication have in the treatment of autism? . Medication does not address core symptoms of autism . Adjunctive to help with associated behavior problems that interfere with home, school and community function Once the diagnosis is made . What medications are used to treat these behavioral problems? . Medications for ADHD: stimulants, nonstimulants . Medications for depression/anxiety: SSRI’s . Medications for severe irritability: atypical antipsychotics Once the diagnosis is made . What should I ask before starting medication? . What behaviors are being targeted by the medication? . What side effects are possible? . What monitoring should be done? . How will we measure progress on medication? Once the diagnosis is made . What about alternative biomedical interventions? . Wide variety available, including dietary changes, vitamins, and supplements . Others: hyperbaric oxygen, chelation therapy . Little research available Once the diagnosis is made . What should I consider if I want to try biomedical interventions? . Potential benefits . Potential side effects . Expense . Role in overall program . Evidence supporting intervention Once the diagnosis is made . What can I expect in the future? . Progress, but variable in rate . Factors in prognosis: intelligence, temperament, language, early intervention . Access services and supports to optimize child’s potential, but realize that each child’ potential is different Once the diagnosis is made . Where do I go from here? . Educate yourself about autism . Access appropriate educational and behavioral services . Become an advocate for your child . Resources: KATC Family Guide, AAP, Autism Speaks, CDC, local family support groups Once the Diagnosis is Made